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Chen B, Zhao H, Li M, Zhao T, Liao R, Lu J, Zou Y, Tu J, Teng X, Huang Y, Liu J, Huang P, Wu J. Effect of multicomponent intervention on malnutrition in older adults: A multicenter randomized clinical trial. Clin Nutr ESPEN 2024; 60:31-40. [PMID: 38479928 DOI: 10.1016/j.clnesp.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND & AIMS Malnutrition is a significant geriatric syndrome (GS) prevalent in older adults and seriously affects patient prognosis and quality of life. We assessed the impact of the multicomponent intervention of health education, dietary advice, and exercise with oral nutritional supplementation (ONS) on nutritional status, body composition, physical functions, and quality of life. METHODS This multicenter randomized clinical trial (RCT) was performed from April 2021 to April 2022. The intervention lasted for 12 weeks, and 99 older adults with malnutrition or at risk of malnutrition were enrolled in six nursing homes. All participants were randomly assigned to the control (health education plus standard diet plus exercise) or research (health education plus standard diet plus exercise plus ONS) group. The research group consumed ONS (244 kcal, 9.8g protein, and 9.6g fat per time) twice a day between meals. The primary outcomes were changes in the nutritional status and body composition from baseline to 12 weeks. The secondary outcomes were changes in physical function, quality of life and nutritional associated other blood markers. RESULTS For primary outcomes, after 12 weeks, body weight increased similarly in both treatment arms (time × treatment effect, P > 0.05). There were no between-group differences in body mass index (BMI) or mini nutritional assessment tool-short form (MNA-SF) scores (time × treatment effects, P > 0.05). The MNA-SF score from 11.0 (10.5, 12.0) to 13.0 (11.0, 13.0) in the research group and from 11.0 (10.0, 12.0) to 12.0 (11.0, 13.0) in the control group (both P < 0.05). There were no between-group differences in the skeletal muscle mass index (SMI), fat-free mass index (FFMI), appendicular skeletal muscle mass (ASMM), fat mass (FAT), or leg muscle mass (LMM) (time × treatment effects, P > 0.05). Both groups showed similar and highly significant increases in SMI, FFMI, and LMM after (P < 0.05). The research group showed an increase in fat-free mass (FFM) and ASMM and a decrease in the percent of body fat (PBF) and waist circumference (WC) (P < 0.05). For secondary outcomes, There were no between-group differences in grip strength, short physical performance battery (SPPB), 6-min walking distance (6MWD), activities of daily living (ADL), instrumental activities of daily living (IADL), frailty status (FRAIL), mini-mental state examination (MMSE), Tinetti, geriatric depression scale-15 (GDS-15), or 12-item short form survey (SF-12) (time × treatment effects, P > 0.05). Although there was no significant difference, the 6MWD changed differentially between the two treatment arms during the study period in favor of the research group. Although not significant, SF-12 scores improved after 12 weeks in both groups. No between-group differences were observed in prealbumin (PRE), c-reactive protein (CRP), vitamin D (VIT-D), insulin-like growth factor 1 (IGF-1), alanine transaminase (ALT), aspartate aminotransferase (AST), serum creatinine (Scr), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), insulin, and adiponectin levels (time × treatment effects, P > 0.05). Insulin and adiponectin levels were significantly higher in the control group (P < 0.05). CONCLUSION The twelve-week multicomponent intervention improved the nutritional status of older people in China at risk of malnutrition. ONS may enhance the effects of exercise on muscle mass. This clinical trial was registered (https://www. CLINICALTRIALS gov). The trial number is ChiCTR2000040343.
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Affiliation(s)
- Bo Chen
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Jiangsu Provincial Key Laboratory of Gerontology & Geriatrics, Nanjing 210029, China; Jiangsu Provincial Innovation Center of Gerontology & Geriatrics, Nanjing 210029, China
| | - Hongye Zhao
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Department of General Practice, The First People's Hospital of Lianyungang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang 222000, China
| | - Min Li
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ting Zhao
- Department of Nutrition, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ruoqi Liao
- Rehabilitation Medical Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Lu
- Rehabilitation Medical Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanzheng Zou
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Junlan Tu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xinran Teng
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yaxuan Huang
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jin Liu
- Clinical Medicine Research Institution, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Peng Huang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jianqing Wu
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Jiangsu Provincial Key Laboratory of Gerontology & Geriatrics, Nanjing 210029, China; Jiangsu Provincial Innovation Center of Gerontology & Geriatrics, Nanjing 210029, China.
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Marcos-Pardo PJ, Espeso-García A, Vaquero-Cristóbal R, Abelleira-Lamela T, Esparza-Ros F, González-Gálvez N. Physical and psychological effects of outdoor fitness equipment training on middle-aged and older adults: study protocol of a randomised controlled trial. BMJ Open Sport Exerc Med 2023; 9:e001829. [PMID: 38169819 PMCID: PMC10759096 DOI: 10.1136/bmjsem-2023-001829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
This project will investigate the effectiveness of an 8-week outdoor fitness equipment (OFE) programme on health parameters in healthy community-dwelling middle and older adults, corresponding to the present paper to the study protocol, which follows a single-blind randomised controlled trial design. The training intervention will involve participation in an OFE programme implemented over 8 weeks, two sessions/week. Rating of perceived exertion, heart rate, training volume and adherence to the exercise programme will be registered each session. The control group will not receive any structured exercise programme. Blinded examiners will evaluate before and after the training programme muscle strength with both maximum knee extension and elbow flexion isometric tests, handgrip strength test and five time sit-to-stand test; cardiovascular fitness with 400-metre walking test; postural stability with the balance tests of the short physical performance battery (SPPB) battery; dynamic balance with Timed Up and Go (TUG) test; body composition with dual-energy X-ray absorptiometry; functional performance by gait speed, TUG and SPPB battery; blood pressure; and sagittal spine disposition and pelvic tilt. Information will also be collected about demographic characteristics, health-related quality of life, satisfaction with life and adherence to the Mediterranean diet questionnaires. After that, sarcopenia, osteoporosis and fracture risk will be calculated. The results derived from this research will increase the knowledge of the effectiveness of OFE training for improving the health of healthy community-dwelling middle and older adults.
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Affiliation(s)
- Pablo Jorge Marcos-Pardo
- CIBIS Research Center, SPORT Research Group (CTS-1024), University of Almeria, Almeria, Andalucía, Spain
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes, Madrid, Spain
| | | | - Raquel Vaquero-Cristóbal
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes, Madrid, Spain
- Department of Physical Activity and Sport Sciences, Faculty of Sport Sciences, University of Murcia, Murcia, Murcia, Spain
| | | | - Francisco Esparza-Ros
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes, Madrid, Spain
- International Chair of Kineanthropometry, UCAM Universidad Católica de Murcia, Murcia, Murcia, Spain
| | - Noelia González-Gálvez
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes, Madrid, Spain
- Facultad de Deporte, UCAM Universidad Católica de Murcia, Murcia, Murcia, Spain
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Hainline G, Hainline RD, Handlery R, Fritz S. A Scoping Review of the Predictive Qualities of Walking Speed in Older Adults. J Geriatr Phys Ther 2023:00139143-990000000-00040. [PMID: 37820357 PMCID: PMC11006824 DOI: 10.1519/jpt.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE Walking speed (WS) is an easily assessable and interpretable functional outcome measure with great utility for the physical therapist providing care to older adults. Since WS was proposed as the sixth vital sign, research into its interpretation and use has flourished. The purpose of this scoping review is to identify the current prognostic value of WS for the older adult. METHODS A scoping review was conducted using PubMed, CINAHL, and SPORTDiscus to find relevant articles highlighting the predictive capabilities of WS for older adults. Titles and abstracts were reviewed to identify relevant articles. Articles were excluded based on the following criteria: sample included both younger and older adults without separate analyses, sample was focused on a particular disease, if the study was published before 2017, or if the study did not report relevant cut points for interpretation of WS. The search returned 1064 results. Following removal of articles not meeting inclusion criteria and critical appraisal, relevant cut points were extracted from 47 original research publications. RESULTS AND DISCUSSION A preliminary review of the included articles showed that WS is a valuable prognostic tool across many health domains, including mental health, mortality, disability, pain, bone and joint health, falls, cognition, physical activity, metabolic health, risk for cardiovascular disease, socialization, and metabolic health. The fastest WS of 1.32 meters per second (m/s) served as a cutoff for decreased risk for incident development of type 2 diabetes, while the slowest WS of less than 0.2 m/s was associated with increased duration of hospitalization. Multiple studies reported on the prognostic value of WS slower than 1.0 m/s. CONCLUSION Although the reported range of predictive WS values was broad, multiple studies found WS of approximately 1.0 m/s to be a useful marker for delineating risk or decline across a variety of health domains. Clinicians may find it useful to use a WS slower than 1.0 m/s as a "yellow flag" to guide evaluation and intervention for their older adult clients.
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Lee SW, Lee EH, Choi IC. An ensemble machine learning approach to predict postoperative mortality in older patients undergoing emergency surgery. BMC Geriatr 2023; 23:262. [PMID: 37131138 PMCID: PMC10155414 DOI: 10.1186/s12877-023-03969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/13/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Prediction of preoperative frailty risk in the emergency setting is a challenging issue because preoperative evaluation cannot be done sufficiently. In a previous study, the preoperative frailty risk prediction model used only diagnostic and operation codes for emergency surgery and found poor predictive performance. This study developed a preoperative frailty prediction model using machine learning techniques that can be used in various clinical settings with improved predictive performance. METHODS This is a national cohort study including 22,448 patients who were older than 75 years and visited the hospital for emergency surgery from the cohort of older patients among the retrieved sample from the Korean National Health Insurance Service. The diagnostic and operation codes were one-hot encoded and entered into the predictive model using the extreme gradient boosting (XGBoost) as a machine learning technique. The predictive performance of the model for postoperative 90-day mortality was compared with those of previous frailty evaluation tools such as Operation Frailty Risk Score (OFRS) and Hospital Frailty Risk Score (HFRS) using the receiver operating characteristic curve analysis. RESULTS The predictive performance of the XGBoost, OFRS, and HFRS for postoperative 90-day mortality was 0.840, 0.607, and 0.588 on a c-statistics basis, respectively. CONCLUSIONS Using machine learning techniques, XGBoost to predict postoperative 90-day mortality, using diagnostic and operation codes, the prediction performance was improved significantly over the previous risk assessment models such as OFRS and HFRS.
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Affiliation(s)
- Sang-Wook Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Seoul, 05505, Songpa-gu, Republic of Korea
| | - Eun-Ho Lee
- University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Seoul, 05505, Songpa-gu, Republic of Korea
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Seoul, 05505, Songpa-gu, Republic of Korea.
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Chan HCN, Fei X, Leung ELY, Langston K, Marshall S, van der Meij BS. Post-discharge consequences of protein-energy malnutrition, sarcopenia, and frailty in older adults admitted to rehabilitation: A systematic review. Clin Nutr ESPEN 2023; 54:382-397. [PMID: 36963884 DOI: 10.1016/j.clnesp.2023.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND & AIMS Malnutrition, sarcopenia, and frailty are three prevalent wasting conditions among older rehabilitation patients that lead to multiple health-related negative outcomes. This systematic review and meta-analysis aimed to determine the post-discharge consequences of malnutrition, sarcopenia, and frailty in older adults admitted to inpatient rehabilitation. METHODS MEDLINE, Embase, Web of Science, and CINAHL databases were searched on 20 April, 2021 for longitudinal studies in older adults (≥65 years) admitted for inpatient rehabilitation. This systematic review included and synthesised studies that 1) measured malnutrition, sarcopenia, and/or frailty using a validated assessment tool or guideline; and 2) reported the association with post-discharge mortality, physical function, quality of life, or discharge location. The Academy of Nutrition & Dietetics Quality Criteria Checklist and GRADE criteria were used to assess risk of bias and evidence certainty. Where possible, data were pooled using Revman. RESULTS Twenty-six observational studies (n = 9709 participants in total) with similarly aged populations were included. Eight, seven, and eleven studies assessed malnutrition, sarcopenia, and frailty, respectively. Follow-up periods ranged from immediate to 7 years post-rehabilitation. Malnutrition was associated with discharge to a higher level of care (GRADE: very low), and worse quality of life (GRADE: very low) and physical function (GRADE: very low). Sarcopenia was associated with worse physical function (GRADE: very low) and lower rate of home discharge (OR: 0.14; 95%CI: 0.09-0.20; I2:30%; GRADE: low). Frailty was associated with increased mortality (GRADE: very low), hospital readmission (GRADE: very low), and decreased home discharge (GRADE: very low). CONCLUSION Wasting conditions in older adults during rehabilitation admission may be associated with poorer quality of life, lower rates of home discharge, and higher rates of health service use, physical dysfunction, and mortality following discharge. Further research is needed to investigate the comparative and combined impacts, as well as the overlap of malnutrition, sarcopenia, and frailty during and after rehabilitation to guide priority screening and intervention.
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Affiliation(s)
- Hei Chun Nicholas Chan
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Xinzhu Fei
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Eden Long Yin Leung
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Keanne Langston
- Department of Nutrition and Dietetics, Robina Hospital, Gold Coast, Queensland, Australia
| | - Skye Marshall
- Research Institute for Future Health, Gold Coast, Queensland, Australia
| | - Barbara Suzanne van der Meij
- Dietetics and Foodservices, Mater Health, Brisbane, Queensland, Australia; Mater Research Institute - University of Queensland, Brisbane, Queensland, Australia; Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands; Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands.
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Clinical frailty scale score during geriatric rehabilitation predicts short-term mortality: RESORT cohort study. Ann Phys Rehabil Med 2023; 66:101645. [PMID: 35151896 DOI: 10.1016/j.rehab.2022.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/25/2021] [Accepted: 01/03/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Frailty is associated with poor health outcomes, such as functional decline and institutionalization. The Clinical Frailty Scale (CFS) is a judgement-based frailty assessment tool developed to identify frail adults and assess level of frailty. OBJECTIVES We aimed to determine the association between CFS at admission and discharge, admission-discharge change, and mortality in individuals admitted to geriatric rehabilitation. METHODS REStORing health of acutely unwell adulTs (RESORT) is a longitudinal, observational inception cohort of consecutive individuals admitted to geriatric rehabilitation at the Royal Melbourne Hospital, Melbourne, Australia. The CFS was assessed at admission and discharge from geriatric rehabilitation. Logistic regression was used to examine the association between CFS score at admission and in-hospital mortality. Cox proportional hazards regression analysis was used to analyse associations between CFS at admission and discharge, admission-to-discharge change, and 3-month and 1-year mortality. RESULTS A total of 1766 participants were included: median age was 83.4 years (Interquartile range [IQR] 77.6-88.4), 57% were female, median length of stay in geriatric rehabilitation was 20 days (13.8-31.7) and median CFS score was 6 (5-7) at both admission and discharge. Increased CFS score was associated with in-hospital mortality (odds ratio [OR] 1.8, 95% CI 1.4-2.4), 3-month mortality and 1-year mortality (admission CFS: hazard ratio [HR] 1.4, 95% CI 1.2-1.6; discharge CFS: HR 1.4, 95% CI 1.2-1.7). Risk of 3-month mortality was increased when CFS score increased from admission to discharge (HR 2.1, 95% CI 1.2-3.8) as compared with when it decreased. CONCLUSION CFS score at admission and discharge was associated with post-discharge mortality in individuals admitted to geriatric rehabilitation. These findings support the use of the CFS in clinical settings to assist clinical characterisation and decision making.
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Homes R, Clark D, Moridzadeh S, Tosovic D, Van den Hoorn W, Tucker K, Midwinter M. Comparison of a Wearable Accelerometer/Gyroscopic, Portable Gait Analysis System (LEGSYS+ TM) to the Laboratory Standard of Static Motion Capture Camera Analysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:537. [PMID: 36617135 PMCID: PMC9824443 DOI: 10.3390/s23010537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Examination of gait patterns has been used to determine severity, intervention triage and prognostic measures for many health conditions. Methods that generate detailed gait data for clinical use are typically logistically constrained to a formal gait laboratory setting. This has led to an interest in portable analysis systems for near clinical or community-based assessments. The following study assessed with the wearable accelerometer/gyroscopic, gait analysis system (LEGSYS+TM) and the standard of static motion capture camera (MOCAP) analysis during a treadmill walk at three different walking speeds in healthy participants (n = 15). To compare each speed, 20 strides were selected from the MOCAP data and compared with the LEGSYS+ strides at the same time point. Both scatter and bland-Altman plots with accompanying linear regression analysis for each of the parameters. Each stride parameter showed minimal or a consistent difference between the LEGSYS+ and MOCAP, with the phase parameters showing inconsistencies between the systems. Overall, LEGSYS+ stride parameters can be used in the clinical setting, with the utility of phase parameters needing to be taken with caution.
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Affiliation(s)
- Ryan Homes
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Devon Clark
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Sina Moridzadeh
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Danijel Tosovic
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Wolbert Van den Hoorn
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
- ARC ITTC Joint Biomechanics, Queensland Unit for Advanced Shoulder Research, Movement Neuroscience Group, Injury Prevention Group, Exercise & Movement Science, School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4067, Australia
| | - Kylie Tucker
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Mark Midwinter
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4067, Australia
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Abstract
PURPOSE OF REVIEW Ageing, the accrual of molecular and cellular damage over a lifetime confers progressive physiologic dysfunction of bodily systems, leaving the body in a heightened state of vulnerability to biophysical and psychosocial stressors. The inflection point is frailty which easily leads to disability and death. Interstitial lung disease (ILD) creates biophysical and psychosocial stresses difficult for even optimally fit patients to cope with. With evolving ILD treatment pathways, people with ILD are living longer. RECENT FINDINGS ILD and ageing are bi-directionally influential: ILD, its treatments, complications, and collateral systemic extra-pulmonary damage (hypoxic and oxidative stress) wear on the ageing person and ageing impacts a person's tolerance of ILD. ILD extent may proportionally accelerate age-related vulnerabilities. ILD related to inflammatory systemic diseases, e.g. connective tissue diseases or sarcoidosis, exert an even more complex biophysical impact on the body. SUMMARY The present review stresses goals of preventing frailty in ILD and preserving general health and well being of people living with ILD of any age, from time of diagnosis and as they age. The development of a prediction score is proposed to classify those at risk of frailty and guide interventions that preserve successful ageing for all levels of ILD severity. VIDEO ABSTRACT http://links.lww.com/COPM/A32.
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Lee SW, Kim KS, Park SW, Kim J, Choi JH, Lee S, Joung KW, Choi IC. Application of the New Preoperative Frailty Risk Score in Elderly Patients Undergoing Emergency Surgery. Gerontology 2022; 68:1276-1284. [PMID: 35576904 DOI: 10.1159/000524760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Predicting preoperative frailty risk in emergency surgery is difficult with limited information because preoperative evaluation is not commonly performed properly. A recent study attempted to predict preoperative frailty risk using only diagnostic and surgical codes that can be extracted from the electronic medical records system. OBJECTIVE This study aimed to validate whether the prediction model of preoperative frailty risk presented in the previous study is well applied to other medical hospitals' data. METHODS This is a retrospective cohort study including 1,557 patients (≥75 years old) who were admitted to a single institution for emergency operations between January 1, 2010, and December 31, 2019, for study analysis. The Charlson comorbidity index, Hospital Frailty Risk Score, and the recently developed Operation Frailty Risk Score (OFRS) were calculated using the patient's diagnostic and operation codes. The predictive performances of these calculated risk scores and the American Society of Anesthesiologists-Physical Status classification for postoperative 90-day mortality were compared by using the receiver operating characteristic curve analysis. FINDINGS The predictive performance of the OFRS, Charlson comorbidity index, American Society of Anesthesiologists-Physical Status, and Hospital Frailty Risk Score for postoperative 90-day mortality was 0.81, 0.630, 0.699, and 0.549 on a c-statistics basis, respectively. CONCLUSIONS The OFRS using diagnostic and operation codes may show the best predictive performance for 90-day mortality compared to other risk scores, and it can be the clinically applicable model to evaluate the preoperative frailty risk in elderly patients undergoing emergency surgery.
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Affiliation(s)
- Sang-Wook Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,
| | - Keon-Sik Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sung-Wook Park
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Jaewon Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hyun Choi
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sangho Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Woon Joung
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Teipel SJ, Amaefule CO, Lüdtke S, Görß D, Faraza S, Bruhn S, Kirste T. Prediction of Disorientation by Accelerometric and Gait Features in Young and Older Adults Navigating in a Virtually Enriched Environment. Front Psychol 2022; 13:882446. [PMID: 35548510 PMCID: PMC9083357 DOI: 10.3389/fpsyg.2022.882446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To determine whether gait and accelerometric features can predict disorientation events in young and older adults. Methods Cognitively healthy younger (18–40 years, n = 25) and older (60–85 years, n = 28) participants navigated on a treadmill through a virtual representation of the city of Rostock featured within the Gait Real-Time Analysis Interactive Lab (GRAIL) system. We conducted Bayesian Poisson regression to determine the association of navigation performance with domain-specific cognitive functions. We determined associations of gait and accelerometric features with disorientation events in real-time data using Bayesian generalized mixed effect models. The accuracy of gait and accelerometric features to predict disorientation events was determined using cross-validated support vector machines (SVM) and Hidden Markov models (HMM). Results Bayesian analysis revealed strong evidence for the effect of gait and accelerometric features on disorientation. The evidence supported a relationship between executive functions but not visuospatial abilities and perspective taking with navigation performance. Despite these effects, the cross-validated percentage of correctly assigned instances of disorientation was only 72% in the SVM and 63% in the HMM analysis using gait and accelerometric features as predictors. Conclusion Disorientation is reflected in spatiotemporal gait features and the accelerometric signal as a potentially more easily accessible surrogate for gait features. At the same time, such measurements probably need to be enriched with other parameters to be sufficiently accurate for individual prediction of disorientation events.
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Affiliation(s)
- Stefan J Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Chimezie O Amaefule
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Stefan Lüdtke
- Mobile Multimedia Information Systems, Institute for Visual and Analytic Computing, University of Rostock, Rostock, Germany.,Institute for Enterprise Systems, University of Mannheim, Mannheim, Germany
| | - Doreen Görß
- Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Sofia Faraza
- Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Sven Bruhn
- Institute for Sports Science, University of Rostock, Rostock, Germany
| | - Thomas Kirste
- Mobile Multimedia Information Systems, Institute for Visual and Analytic Computing, University of Rostock, Rostock, Germany
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de Groot AJ, Wattel EM, van Dam CS, van Balen R, van der Wouden JC, Hertogh CMPM. Referral to geriatric rehabilitation: a scoping review of triage factors in acutely hospitalised older patients. Age Ageing 2022; 51:6527383. [PMID: 35150588 PMCID: PMC8840799 DOI: 10.1093/ageing/afac015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Old or frail acutely hospitalised patients can benefit from geriatric rehabilitation but criteria concerning referral decisions are unclear. This review presents an overview of clinical factors associated with referral to geriatric rehabilitation that may further consensus between hospital and rehabilitation professionals on triage. DESIGN Scoping review. METHODS A review was conducted following Arksey and O'Malley's framework. The search included literature concerning a broad spectrum of acutely hospitalised patients and factors associated with their referral to geriatric rehabilitation. RESULTS Selected abstracts were categorised into distinct geriatric rehabilitation care pathways such as stroke, hip fracture, amputation of lower limb, cardiac and oncologic rehabilitation. Abstracts on internal medical patients were further reviewed and 29 studies were included. A total of 13 studies focused on factors identifying rehabilitation needs and 16 on factors associated with outcome of geriatric rehabilitation. Triage factors were diverse and included frailty status, functional decline, cognitive symptoms and multimorbidity. Mood symptoms and living situation further specified post-acute care needs. In overview, triage factors could be characterised as demographic (n = 4), diagnosis-related (n = 8), mental (n = 6), functional (n = 10) or multi-domain (n = 12) and mapped in a transitional care pathway. CONCLUSIONS AND IMPLICATIONS Frailty and functional decline are characteristics frequently associated with referral to geriatric rehabilitation of acutely hospitalised internal medical patients. A comprehensive geriatric assessment or a simpler multi-domain set of tests reveals rehabilitation needs and approximates a functional prognosis. Professional consensus on factors and timing of triage in hospital is within reach.
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Affiliation(s)
- Aafke J de Groot
- Department of Medicine for Older People and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Elizabeth M Wattel
- Department of Medicine for Older People and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Carmen S van Dam
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes C van der Wouden
- Department of Medicine for Older People and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Gordon EH, Reid N, Khetani IS, Hubbard RE. How frail is frail? A systematic scoping review and synthesis of high impact studies. BMC Geriatr 2021; 21:719. [PMID: 34922490 PMCID: PMC8684089 DOI: 10.1186/s12877-021-02671-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS While the frailty index (FI) is a continuous variable, an FI score of 0.25 has construct and predictive validity to categorise community-dwelling older adults as frail or non-frail. Our study aimed to explore which FI categories (FI scores and labels) were being used in high impact studies of adults across different care settings and why these categories were being chosen by study authors. METHODS For this systematic scoping review, Medline, Cochrane and EMBASE databases were searched for studies that measured and categorised an FI. Of 1314 articles screened, 303 met the eligibility criteria (community: N = 205; residential aged care: N = 24; acute care: N = 74). For each setting, the 10 studies with the highest field-weighted citation impact (FWCI) were identified and data, including FI scores and labels and justification provided, were extracted and analysed. RESULTS FI scores used to distinguish frail and non-frail participants varied from 0.12 to 0.45 with 0.21 and 0.25 used most frequently. Additional categories such as mildly, moderately and severely frail were defined inconsistently. The rationale for selecting particular FI scores and labels were reported in most studies, but were not always relevant. CONCLUSIONS High impact studies vary in the way they categorise the FI and while there is some evidence in the community-dweller literature, FI categories have not been well validated in acute and residential aged care. For the time being, in those settings, the FI should be reported as a continuous variable wherever possible. It is important to continue working towards defining frailty categories as variability in FI categorisation impacts the ability to synthesise results and to translate findings into clinical practice.
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Affiliation(s)
- E H Gordon
- Centre for Health Services Research, The University of Queensland, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia. .,Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia.
| | - N Reid
- Centre for Health Services Research, The University of Queensland, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - I S Khetani
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - R E Hubbard
- Centre for Health Services Research, The University of Queensland, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.,Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
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Stuck AK, Mangold JM, Wittwer R, Limacher A, Bischoff-Ferrari HA. Ability of 3 Frailty Measures to Predict Short-Term Outcomes in Older Patients Admitted for Post-Acute Inpatient Rehabilitation. J Am Med Dir Assoc 2021; 23:880-884. [PMID: 34687605 DOI: 10.1016/j.jamda.2021.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the ability of 3 commonly used frailty measures to predict short-term clinical outcomes in older patients admitted for post-acute inpatient rehabilitation. DESIGN Observational cohort study. SETTING AND PARTICIPANTS Consecutive patients (n = 207) admitted to a geriatric inpatient rehabilitation facility. METHODS Frailty on admission was assessed using a frailty index, the physical frailty phenotype, and the Clinical Frailty Scale (CFS). Predictive capacity of the frailty instruments was analyzed for (1) nonhome discharge, (2) readmission to acute care, (3) functional decline, and (4) prolonged length of stay, using multivariate logistic regression models and receiver operating characteristic (ROC) curves. RESULTS The number of patients classified as frail was 91 (44.0%) with the frailty index, 134 (64.7%) using the frailty phenotype, and 151 (73.0%) with the CFS. The 3 frailty measures revealed acceptable discriminatory accuracy for nonhome discharge (area under the curve ≥ 0.7) but differed in their predictive ability: the adjusted odds ratio (OR) for nonhome discharge was highest for the CFS [6.2, 95% confidence interval (CI) 1.8-21.1], compared to the frailty index (4.1, 95% CI 2.0-8.4) and the frailty phenotype (OR 2.9, 95% CI 1.2-6.6). For the other outcomes, discriminatory accuracy based on ROC tended to be lower and predictive ability varied according to frailty measure. Readmission to acute care from inpatient rehabilitation was predicted by all instruments, most pronounced by the frailty phenotype (OR 5.4, 95% CI 1.6-18.8) and the frailty index (OR 2.5, 95% CI 1.1-5.6), and less so by the CFS (OR 1.4, 95% CI 0.5-3.8). CONCLUSIONS AND IMPLICATIONS Frailty measures may contribute to improved prediction of outcomes in geriatric inpatient rehabilitation. The choice of the instrument may depend on the individual outcome of interest and the corresponding discriminatory ability of the frailty measure.
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Affiliation(s)
- Anna K Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Joel M Mangold
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rachel Wittwer
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Heike A Bischoff-Ferrari
- Department of Aging Medicine, University Hospital Zurich, Zurich, Switzerland; Centre on Aging and Mobility, University Hospital Zurich, University of Zurich, Zurich, Switzerland; University Clinic for Aging Medicine, City Hospital Zurich, Waid, Zurich, Switzerland
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[Predictive ability of baseline frailty and handgrip strength at admission on outcomes at discharge in a geriatric functional recovery unit]. Rev Esp Geriatr Gerontol 2021; 56:91-95. [PMID: 33478771 DOI: 10.1016/j.regg.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the predictive capacity of different frailty scales, as well as the strength of the handgrip, and to determine their relationship with clinical favourable outcomes. PATIENTS AND METHOD Prospective study of patients admitted to the Geriatric Functional Recovery Unit (GFRU) of the Hospital Central Cruz Roja. The «FRAIL» scale, «Clinical Frailty Scale» (CFS) and «Fragil-VIG» index, and handgrip strength by hydraulic dynamometer were completed on admission. A functional gain was assumed as 20 or more points in the Barthel Index and return to home, as good outcomes at discharge. The discriminative capacity of favourable outcomes for each frailty scale and handgrip strength was analysed by means of ROC curves, calculating the C statistic (area under the curve = AUC). RESULTS The analysis included 74 patients (median age 82 years; 48.5% women), admitted for stroke recovery (65%), orthopaedic pathology (16%), and other causes (19%). The prevalence of frailty varied between 31% (FRAIL scale), 40% (CFS), and 57.5% («Fragil-VIG»). Median handgrip strength was 15 Kg in males (interquartile range 11-21), and 9 Kg in females (interquartile range 7-12). At discharge, 51.5% of patients had a functional gain of 20 or more points in Barthel index, and 63% returned to their previous home. The discriminating ability to achieve acceptable functional gain at discharge was good for CFS (AUC = 0.72; 95% CI; 0.60-0.84) and «Fragil-VIG» (AUC = 0.72; 95% CI;0.58-0.82), and handgrip strength was the only tool related to return home (AUC = 0.68; 95% CI;0.56-0.81). CONCLUSION To evaluate frailty on admission to a GFRU contributes to predicting favourable clinical outcomes, but the discriminating capacity of each scale is variable.
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Legrand T, Younesian H, Gélinas-Trudel C, Barthod CV, Campeau-Lecours A, Turcot K. Influence of the overground walking speed control modality: Modification to the walk ratio and spatio-temporal parameters of gait. Gait Posture 2021; 83:256-261. [PMID: 33197862 DOI: 10.1016/j.gaitpost.2020.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 02/02/2023]
Affiliation(s)
- T Legrand
- Department of Kinesiology, Medicine Faculty, Université Laval, Québec City, QC, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada.
| | - H Younesian
- Department of Kinesiology, Medicine Faculty, Université Laval, Québec City, QC, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
| | - C Gélinas-Trudel
- Department of Mechanical Engineering, Science and Engineering Faculty, Université Laval, Québec City, QC, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
| | - C V Barthod
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
| | - A Campeau-Lecours
- Department of Mechanical Engineering, Science and Engineering Faculty, Université Laval, Québec City, QC, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
| | - K Turcot
- Department of Kinesiology, Medicine Faculty, Université Laval, Québec City, QC, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
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Santos NCD, Soares NS, Anjos JLMD, Matos BSD, Carvalho DB. Testes funcionais validados em indivíduos hospitalizados e não hospitalizados: revisão sistemática. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i4.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objetivo: Realizar uma revisão sistemática sobre os testes funcionais validados em diferentes perfis de indivíduos hospitalizados e não hospitalizados e avaliar as evidências psicométricas para confiabilidade e validade. Métodos: Trata-se de uma revisão sistemática. Foram utilizadas as bases de dados EMBASE, MEDLINE, Lilacs e SciELO com as palavras-chave Functional Tests (Walk Test, Gait Speed Test, Chair Stand Test, Timed Up And Go, Step Test),Validation Studies as Topic e sinônimos. Foram incluídos estudos de validação de testes funcionais em indivíduos hospitalizados ou não hospitalizados que utilizaram os critérios de validade e/ou confiabilidade e relacionaram os testes a diferentes variáveis. Esses artigos poderiam ser observacionais longitudinais ou de corte transversal ou estudos de validação que utilizaram dados de ensaios clínicos. Foram excluídos os artigos que não apresentaram características importantes da amostra e a descrição do teste. Resultados: A pesquisa resultou em 36.150 artigos, e 89 foram incluídos. Os estudos foram organizados em tabelas com informações como autor, ano; critérios de validação; amostra; teste; variáveis associadas; resultados. A qualidade dos artigos foi avaliada por meio da Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Conclusão: Os testes funcionais são válidos e confiáveis para a avaliação de indivíduos hospitalizados e não hospitalizados, estando associados à força muscular, capacidade de caminhar, controle postural, atividades de vida diária, risco de quedas, hospitalização e mortalidade.
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Frailty and the Risk of Polypharmacy in the Older Person: Enabling and Preventative Approaches. J Aging Res 2020; 2020:6759521. [PMID: 32676209 PMCID: PMC7341397 DOI: 10.1155/2020/6759521] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Frail older people have an inherent risk of polypharmacy due to the need to treat multiple comorbidities, thus leading to various negative effects on their health due to the adverse actions from the drugs. This issue was discussed from a person-centered perspective, highlighting the category of frail older adults who are at a higher risk. Appropriate medication reconciliation in this population with useful prescribing tools (Beers and START/STOPP criteria) to minimize polypharmacy and to provide alternative prescriptive intervention could go alongside primary care to reduce the extent of frailty and polypharmacy. Reducing delayed referrals and extended hospitalization with electronic health record systems and using the signs of frailty from the Electronic Frailty Index (EFI) to predict polypharmacy for frail older persons are preventative approaches that proactively respond to frailty associated with the risk of polypharmacy.
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18
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Eichler S, Völler H, Reibis R, Wegscheider K, Butter C, Harnath A, Salzwedel A. Geriatric or cardiac rehabilitation? Predictors of treatment pathways in advanced age patients after transcatheter aortic valve implantation. BMC Cardiovasc Disord 2020; 20:158. [PMID: 32252646 PMCID: PMC7137198 DOI: 10.1186/s12872-020-01452-x] [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: 08/01/2019] [Accepted: 03/29/2020] [Indexed: 01/06/2023] Open
Abstract
Background Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization. Methods From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model. Results After TAVI, 249 patients (80.7 ± 5.1 years, 59.0% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p < 0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive. Conclusion Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings.
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Affiliation(s)
- Sarah Eichler
- Department of Rehabilitation Medicine, University of Potsdam, Faculty of Health Sciences Brandenburg, Am Neuen Palais 10, D-14469, Potsdam, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Faculty of Health Sciences Brandenburg, Am Neuen Palais 10, D-14469, Potsdam, Germany. .,Klinik am See, Rehabilitation Center for Internal Medicine, Rüdersdorf, Germany.
| | - Rona Reibis
- Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Germany
| | - Christian Butter
- Heart Center Brandenburg, Medical School Brandenburg, Bernau, Germany
| | | | - Annett Salzwedel
- Department of Rehabilitation Medicine, University of Potsdam, Faculty of Health Sciences Brandenburg, Am Neuen Palais 10, D-14469, Potsdam, Germany
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The Effect of Age on Gait Speed When Texting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020599. [PMID: 31963409 PMCID: PMC7014418 DOI: 10.3390/ijerph17020599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 11/22/2022]
Abstract
Texting while walking exerts a high cognitive load, and may be a sensitive test of the integrity of the cognitive–motor interface. We aimed to investigate the association between chronological age and gait speed while texting. A convenience sample of 308 community-dwellers was recruited: n ≥ 50 in each age group (20–29, 30–39, 40–49, 50–59) and n = 100 aged ≥60 years. Gait speed was measured over 10 metres under two experimental conditions: 1) walking at usual pace; 2) walking at usual pace while texting the message “Good morning Harry” on their smartphone. Both median gait speed with and without texting decreased with increasing age (p < 0.001). The differences between single- and dual-task gait speed were substantial for each age group and increased after the age of 50 years (p < 0.001). Median gait speeds while texting in people aged 50–59 (1.07 m/s) and ≥60 years (1.00 m/s) were below the recommended minimum for safely crossing roads (1.20 m/s). Texting while walking currently exposes people aged 50 and over to considerable environmental hazards. The significant slowing of gait speed while texting from middle age may be a marker of neurodegeneration, a cohort effect, or an appropriate compensatory response to reduce the risk of injury.
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Setiati S, Laksmi PW, Aryana IGPS, Sunarti S, Widajanti N, Dwipa L, Seto E, Istanti R, Ardian LJ, Chotimah SC. Frailty state among Indonesian elderly: prevalence, associated factors, and frailty state transition. BMC Geriatr 2019; 19:182. [PMID: 31269921 PMCID: PMC6609407 DOI: 10.1186/s12877-019-1198-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/24/2019] [Indexed: 12/16/2022] Open
Abstract
Background Information about frailty status and its transition is important to inform clinical decisions. Predicting frailty transition is beneficial for its prevention. While Indonesia is the 4th largest geriatric population in Asia, data about frailty transition is limited. This study aimed to obtain data on prevalence of frailty, its risk factors, frailty state transition and its prognostic factors, as well as to develop prognostic score for frailty state transition. Methods Multicenter study on subjects aged ≥60 years old was done to obtain the prevalence of frailty status and to identify risk factors of frailty. Prospective cohort over 12 months was done to obtain data on frailty state transition. Multiple logistic regression analysis was performed to identify its prognostic factors from several clinical data, which then were utilized to develop prognostic score for frailty state worsening. Results Cross-sectional data from 448 subjects showed that 25.2% of the subjects were frail based on Frailty index-40 items. Risk factors of frailty were age (OR 2.72; 95% CI 1.58–4.76), functional status (OR 2.89; 95% CI 1.79–4.67), and nutritional status (OR 3.75; 95% CI 2.29–6.13). Data from the 162 subjects who completed the cohort showed 27.2% of the cohort had frailty state worsening. Prognostic factors for frailty state worsening were being 70 years or older (OR 3.9; 95% CI 1.2–12.3, p < 0.05), negative QoL, i.e., fair and poor QoL (OR 2.5; 95% CI 1.1–5.9, p < 0.05), and slow gait speed (OR 2.8; 95% CI 1.3–6.4, p < 0.05). The internal validation of the prognostic score consisted of those three variables showed good performance. Conclusion The prevalence of frailty in this study among Indonesian elderly in outpatient setting was 25.2%. The risk factors of frailty were age, functional status and nutritional status. The prognostic factors for frailty state worsening were being 70 years old or older, negative QoL (fair or poor quality of life), and slow gait speed. A prognostic score to predict frailty state worsening in 12 months had been developed.
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Affiliation(s)
- Siti Setiati
- Division of Geriatric, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. .,Clinical Epidemiology and Evidence Based Medicine Unit, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Pangeran Diponegoro No. 71, Jakarta, 10430, Indonesia.
| | - Purwita Wijaya Laksmi
- Division of Geriatric, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - I G P Suka Aryana
- Division of Geriatric, Departement of Internal Medicine, Faculty of Medicine, Universitas Udayana, Sanglah Teaching Hospital, Bali, Bali, Indonesia
| | - Sri Sunarti
- Division of Geriatric, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, dr. Syaiful Anwar Hospital, Malang, East Java, Indonesia
| | - Novira Widajanti
- Division of Geriatric, Departement of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Lazuardhi Dwipa
- Division of Geriatric,Department of Internal Medicine, Faculty of Medicine, Universitas Padjajaran, Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Euphemia Seto
- Division of Geriatric, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rahmi Istanti
- Division of Geriatric, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Laurentius Johan Ardian
- Division of Geriatric, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sabrina Chusnul Chotimah
- Division of Geriatric, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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