1
|
Whitehall L, Górska S, Rush R, Singh Roy A, Irvine Fitzpatrick L, Forsyth K. Psychometric Evaluation of the Making it CLEAR Questionnaire: A Resilience Measure for Older Adults. Innov Aging 2021; 5:igab030. [PMID: 34676306 PMCID: PMC8528023 DOI: 10.1093/geroni/igab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives Previous efforts to develop a resilience measure for older adults have
largely failed to consider the environmental influences on their resilience,
and have primarily concentrated on the resilience of community-dwelling
older adults. Our objective was to validate a new multidimensional measure
of resilience, the Making it CLEAR (MiC) questionnaire, for use with older
adults at the point of discharge from hospital. Research Design and Methods This study tested the structure, validity, and reliability of the MiC
questionnaire. The questionnaire consists of 34 items, which assess the
“individual determinants of resilience” (IDoR) and the
“environmental determinants of resilience” (EDoR) across 2
subscales. 416 adults aged 66–102 years participated. Exploratory
factor analysis, item analysis, and linear regression were undertaken. Results The IDoR subscale contained six factors which were labeled
“Self-efficacy,” “Values,” “Interpersonal
skills,” “Life orientation,” “Self-care
ability,” and “Process skills.” The EDoR subscale
contained five factors related to “Person–environment
fit,” “Friends,” “Material assets,”
“Habits,” and “Family.” Both subscales demonstrated
acceptable convergent validity and internal consistency, while individual
items showed acceptable levels of discrimination and difficulty. Discussion and Implications The study provides evidence supporting the validity and quality of the MiC
questionnaire. The results suggest that the MiC questionnaire could be used
to identify the resilience needs of older adults at the point of hospital
discharge. However, future research should identify which items of the MiC
questionnaire are associated with hospital readmission, in order to develop
an easily applicable screening tool for clinical practice.
Collapse
Affiliation(s)
- Lucy Whitehall
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Sylwia Górska
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Robert Rush
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Anusua Singh Roy
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | | | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| |
Collapse
|
2
|
Martocchia A, Scarienzi M, Prunas P, Bentivegna E, Cacciafesta M, Martelletti P, Sesti G. The effects of the glycaemic control on the severity of the delirium in the advanced phase of Alzheimer's disease. F1000Res 2020; 9:1470. [PMID: 34316365 PMCID: PMC8278245 DOI: 10.12688/f1000research.26022.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Behavioural and psychological symptoms of dementia (BPSD) and delirium are common in advanced phases of Alzheimer's disease (AD). METHODS Thirty-eight moderate-severe AD patients were enrolled (n=16 affected by type 2 diabetes). Each patient received a comprehensive geriatric assessment (CGA) (including evaluation of BPSD and frailty), and a complete metabolic evaluation (including the measurement of the glycated haemoglobin, HbA1c). RESULTS Both the hyper- and hypo-glycaemic extremes of the glycaemic spectrum worsened BPSD, but delirium was more susceptible to hypoglycaemic events. The severity of delirium was significantly related to cognitive function (r = -0.585, p<0.001) and frailty (r = +0.440, p<0.05). CONCLUSIONS The measurement of HbA1c was useful for evaluating the risk of delirium in relationship to glycaemic control and nutritional status.
Collapse
Affiliation(s)
| | - Marta Scarienzi
- Sapienza University of Rome, ROMA CAPITALE, RM, 00100, Italy
| | - Pietro Prunas
- Sapienza University of Rome, ROMA CAPITALE, RM, 00100, Italy
| | | | - Mauro Cacciafesta
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Giorgio Sesti
- Sapienza University of Rome, ROMA CAPITALE, RM, 00100, Italy
| |
Collapse
|
3
|
Martocchia A, Scarienzi M, Prunas P, Bentivegna E, Cacciafesta M, Martelletti P, Sesti G. The effects of the glycaemic control on the severity of the delirium in the advanced phase of Alzheimer's disease. F1000Res 2020; 9:1470. [PMID: 34316365 PMCID: PMC8278245 DOI: 10.12688/f1000research.26022.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) and delirium are common in advanced phases of Alzheimer's disease (AD). METHODS Thirty-eight moderate-severe AD patients were enrolled (n=16 affected by type 2 diabetes). Each patient received a comprehensive geriatric assessment (CGA) (including evaluation of BPSD and frailty), and a complete metabolic evaluation (including the measurement of the glycated hemoglobin, HbA1c). RESULTS Both the hyper- and hypo-glycemic extremes of the glycemic spectrum worsened BPSD, but delirium was more susceptible to hypoglycemic events. The severity of delirium was significantly related to cognitive function (r = -0.585, p<0.001) and frailty (r = +0.440, p<0.05). CONCLUSIONS The measurement of HbA1c was useful for evaluating the risk of delirium in relationship to glycemic control and nutritional status.
Collapse
Affiliation(s)
| | - Marta Scarienzi
- Sapienza University of Rome, ROMA CAPITALE, RM, 00100, Italy
| | - Pietro Prunas
- Sapienza University of Rome, ROMA CAPITALE, RM, 00100, Italy
| | | | - Mauro Cacciafesta
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Giorgio Sesti
- Sapienza University of Rome, ROMA CAPITALE, RM, 00100, Italy
| |
Collapse
|
4
|
Assessing the strengths and weaknesses of the Clinical Frailty Scale through correlation with a frailty index. Aging Clin Exp Res 2020; 32:2225-2232. [PMID: 31898172 DOI: 10.1007/s40520-019-01450-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Care for the elderly patient is a challenge that geriatricians now share with other medical specialties. Frailty has emerged as a key concept. Due to its simplicity and applicability, the Clinical Frailty Scale (CFS) is gaining increasing acceptance. AIM Compare the CFS with the Frail-VIG index (IF-VIG), an index based on the accumulation of deficits and developed on the basis of comprehensive geriatric assessment. METHODS Cross-sectional and single-center study carried out at the Acute Geriatric Unit of a University Hospital. Patients consecutively recruited on admission over a 6-month period (n = 184). The concurrent validity of the CFS was measured by assessing the concordance between the two measurement methods. The degree of association was determined by applying a linear regression model, calculating the Pearson correlation coefficient (r). RESULTS The prevalence of frailty was 91.8%. A mean IF-VIG score of 0.41 (SD ± 0.14) was found. The two most frequently recorded CFS categories were 6 and 7. An effective correlation was established (r = 0.706, p < 0.001). In the cohort with severe dementia, the association fell (r = 0.442). In the whole population, it rose adding Charlson index score (r = 0.747). CONCLUSIONS The strong correlation of the CFS with a frailty index supports its use. Incorporating comorbidity into the physical function domains of the CFS improved the correlation. However, the CFS was unsuitable in patients with dementia. To infer prognosis, in categories 6 and 7, the situational diagnosis should be extended with more discriminative tools.
Collapse
|
5
|
Manckoundia P, Rosay C, Menu D, Nuss V, Mihai AM, Vovelle J, Nuémi G, d’Athis P, Putot A, Barben J. The Prescription of Vitamin K Antagonists in a Very Old Population: A Cross-Sectional Study of 8696 Ambulatory Subjects Aged Over 85 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186685. [PMID: 32937847 PMCID: PMC7558265 DOI: 10.3390/ijerph17186685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 01/12/2023]
Abstract
We compared very elderly people taking vitamin K antagonists (VKA) and those not taking VKA (noVKA). Individuals were included in the noVKA group if there was no VKA on their reimbursed prescriptions during the study period. We also compared three subgroups, constituted by VKA type (fluindione, warfarin, or acenocoumarol). We included individuals aged over 85 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for prescribed VKA in September 2017. The VKA and noVKA groups were compared in terms of demographic conditions, registered chronic diseases (RCD), number of drugs per prescription and cardiovascular medications. The three VKA subgroups were compared for the same items plus laboratory monitoring, novel and refill VKA prescriptions, and prescriber specialty. Of the 8696 included individuals, 1157 (13.30%) were prescribed VKA. Mean age was 90 years. The noVKA group had fewer women (53.67 vs 66.08%), more RCD (93.43 vs. 71.96%) and more drugs per prescription (6.65 vs. 5.18) than the VKA group (all p < 0.01). Except for direct oral anticoagulants and platelet aggregation inhibitors, the VKA group took significantly more cardiovascular medications. The most commonly prescribed VKA was fluindione (59.46%). Mean age was higher in the warfarin (90.42) than in the acenocoumarol (89.83) or fluindione (89.71) subgroups (p < 0.01). No differences were observed for sex (women were predominant) or RCD. 13% of subjects in this population had a VKA prescription. Fluindione was the most commonly prescribed VKA.
Collapse
Affiliation(s)
- Patrick Manckoundia
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
- UMR Inserm/U1093 Cognition, Action, Sensorimotor Plasticity, University of Burgundy and Franche Comté, 21000 Dijon, France
- Correspondence: ; Tel.: +33-3-80-29-39-70
| | - Clémentine Rosay
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Didier Menu
- Mutualité Sociale Agricole of Burgundy Franche Comté, 21000 Dijon, France;
| | - Valentine Nuss
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Anca-Maria Mihai
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Jérémie Vovelle
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Gilles Nuémi
- Department of Medical Information, University Hospital, University of Burgundy, 21000 Dijon, France; (G.N.); (P.d.)
| | - Philippe d’Athis
- Department of Medical Information, University Hospital, University of Burgundy, 21000 Dijon, France; (G.N.); (P.d.)
| | - Alain Putot
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Jérémy Barben
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| |
Collapse
|
6
|
McGovern D, Williams SP, Parsons K, Farrah TE, Gallacher PJ, Miller-Hodges E, Kluth DC, Hunter RW, Dhaun N. Long-term outcomes in elderly patients with ANCA-associated vasculitis. Rheumatology (Oxford) 2020; 59:1076-1083. [PMID: 31794032 PMCID: PMC7671635 DOI: 10.1093/rheumatology/kez388] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/01/2019] [Indexed: 01/18/2023] Open
Abstract
Objective ANCA-associated vasculitis (AAV) is a small vessel vasculitis that commonly presents in the elderly. However, there are few long-term outcome data for these patients. Here, we assessed long-term outcomes in a single-centre cohort of elderly patients with AAV. Additionally, we tested whether a pre-morbid frailty score could aid prognosis. Methods Using a prospectively-compiled dataset, we investigated patients over the age of 65 who presented with AAV between 2005 and 2017 to a regional vasculitis centre. We used a Cox model to determine the factors associated with mortality. We also compared outcomes in pre-specified subgroups stratified by baseline frailty score, ANCA serotype and induction immunosuppression (with cyclophosphamide, rituximab or mycophenolate mofetil used as the main glucocorticoid-sparing agent). Results 83 patients were included in the study and were followed for a median of 1203 days. Median age was 74 years (range 65–92). Two- and five-year survival in the overall cohort were 83% (95% CI 75, 92%) and 75% (95% CI 65, 86%), respectively. The median cumulative dose of oral prednisolone was 2030 mg during the first three months. Only one patient received intravenous glucocorticoids. Age, frailty score and CRP at presentation were independently associated with mortality; all deaths occurred in patients aged over 75 at presentation. Patients treated with a cyclophosphamide-based induction regimen tended to be younger than those treated with rituximab or mycophenolate mofetil. Survival was better in the cyclophosphamide-treated group. Conclusion In the contemporary era, the overall prognosis of AAV in elderly patients is good. Baseline frailty associates with disease outcomes including mortality. A low-dose glucocorticoid regimen (avoiding intravenous methylprednisolone) can be used to treat AAV effectively in elderly patients.
Collapse
Affiliation(s)
- Dominic McGovern
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh
| | - Sam P Williams
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh
| | - Katrina Parsons
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow
| | - Tariq E Farrah
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh.,University/British Heart Foundation Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Peter J Gallacher
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh.,University/British Heart Foundation Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Eve Miller-Hodges
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh.,University/British Heart Foundation Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - David C Kluth
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh
| | - Robert W Hunter
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh.,University/British Heart Foundation Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Neeraj Dhaun
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh.,University/British Heart Foundation Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| |
Collapse
|
7
|
Barben J, Menu D, Rosay C, Vovelle J, Mihai AM, Nuss V, d'Athis P, Putot A, Manckoundia P. The prescription of direct oral anticoagulants in the elderly: An observational study of 19 798 Ambulatory subjects. Int J Clin Pract 2020; 74:e13420. [PMID: 31532052 DOI: 10.1111/ijcp.13420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/01/2019] [Accepted: 09/13/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Direct oral anticoagulants (DOACs) are increasingly prescribed to elderly people, but the epidemiologic data for this population remains scarce. We compared the elderly population taking DOACs and those not taking DOACs (noDOAC). METHOD We included individuals over 75 years old, affiliated to Mutualité Sociale Agricole of Burgundy (a French regional health insurance agency), who had been refunded for a prescribed DOAC between 1st and 30th September 2017. The DAOC group (DAOCG) and noDOAC group (noDOACG) were compared in terms of demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs. In the DOACG, we compared the type of prescribing physician and laboratory monitoring for novel prescriptions (initial) and prescription refills (≥ 3 months). RESULTS Of the 19 798 included patients, 1518 (7.7%) were prescribed DAOCs and 18 280 (92.3%) were not. Mean and median age was 85 years in the 2 groups (DOACG and noDOACG). In the DOACG, there were more men (50% vs 40.2%), more RCD (88.9% vs 68.7%) and more drugs per prescription (6 ± 2.8 vs 5 ± 2.9) (All P < .01). The DOACG also took more antihypertensive drugs. The most commonly prescribed DOACs were apixaban (42.9%) followed by rivaroxaban (38.4%) and dabigatran (18.6%). Complete blood count, serum creatinine and coagulation function tests were requested for 69.4%, 75% and 22.2%, respectively, of patients prescribed DAOCs. CONCLUSIONS The DOACG had more RCD and drugs per prescription than the noDOACG; routine laboratory monitoring was insufficient. What's known Platelet aggregation inhibitors (low-dose) are recommended for secondary prevention of cardiovascular events in patients suffering from symptomatic atherosclerosis. The main risk of this treatment is bleeding. What's new A prescription for platelet aggregation inhibitors was found in 34% of geriatric inpatients in this prospective study. Compliance to guidelines was better for symptomatic peripheral artery disease than for primary prevention in accordance with recent publications. Geriatric comorbidities had no impact on the prescription of platelet aggregation inhibitors. Underuse of platelet aggregation inhibitors was observed in 11.3% of cases and overuse in 13.7% of cases.
Collapse
Affiliation(s)
- Jérémy Barben
- "Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital, Dijon, France
| | - Didier Menu
- "Mutualité Sociale Agricole" of Burgundy, Dijon, France
| | - Clémentine Rosay
- "Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital, Dijon, France
| | - Jérémie Vovelle
- "Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital, Dijon, France
| | - Anca-Maria Mihai
- "Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital, Dijon, France
| | - Valentine Nuss
- "Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital, Dijon, France
| | - Philippe d'Athis
- Department of Medical Information, University Hospital, Dijon, France
| | - Alain Putot
- "Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital, Dijon, France
| | - Patrick Manckoundia
- "Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital, Dijon, France
- UMR Inserm/U1093 Cognition, Action, Sensorimotor Plasticity, University of Burgundy and Franche Comté, Dijon, France
| |
Collapse
|
8
|
Strombom P, Widmar M, Keskin M, Gennarelli RL, Lynn P, Smith JJ, Guillem JG, Paty PB, Nash GM, Weiser MR, Garcia-Aguilar J. Assessment of the Value of Comorbidity Indices for Risk Adjustment in Colorectal Surgery Patients. Ann Surg Oncol 2019; 26:2797-2804. [PMID: 31209671 DOI: 10.1245/s10434-019-07502-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Comorbidity indices (CIs) are widely used in retrospective studies. We investigated the value of commonly used CIs in risk adjustment for postoperative complications after colorectal surgery. METHODS Patients undergoing colectomy without stoma for colonic neoplasia at a single institution from 2009 to 2014 were included. Four CIs were calculated or obtained for each patient, using administrative data: Charlson-Deyo (CCI-D), Charlson-Romano (CCI-R), Elixhauser Comorbidity Score, and American Society of Anesthesiologists classification. Outcomes of interest in the 90-day postoperative period were any surgical complication, surgical site infection (SSI), Clavien-Dindo (CD) grade 3 or higher complication, anastomotic leak or abscess, and nonroutine discharge. Base models were created for each outcome based on significant bivariate associations. Logistic regression models were constructed for each outcome using base models alone, and each index as an additional covariate. Models were also compared using the DeLong and Clarke-Pearson method for receiver operating characteristic (ROC) curves, with the CCI-D as the reference. RESULTS Overall, 1813 patients were included. Postoperative complications were reported in 756 (42%) patients. Only 9% of patients had a CD grade 3 or higher complication, and 22.8% of patients developed an SSI. Multivariable modeling showed equivalent performance of the base model and the base model augmented by the CIs for all outcomes. The ROC curves for the four indices were also similar. CONCLUSIONS The inclusion of CIs added little to the base models, and all CIs performed similarly well. Our study suggests that CIs do not adequately risk-adjust for complications after colorectal surgery.
Collapse
Affiliation(s)
- Paul Strombom
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Widmar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Metin Keskin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Renee L Gennarelli
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricio Lynn
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jose G Guillem
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
9
|
Golpanian S, DiFede DL, Pujol MV, Lowery MH, Levis-Dusseau S, Goldstein BJ, Schulman IH, Longsomboon B, Wolf A, Khan A, Heldman AW, Goldschmidt-Clermont PJ, Hare JM. Rationale and design of the allogeneiC human mesenchymal stem cells (hMSC) in patients with aging fRAilTy via intravenoUS delivery (CRATUS) study: A phase I/II, randomized, blinded and placebo controlled trial to evaluate the safety and potential efficacy of allogeneic human mesenchymal stem cell infusion in patients with aging frailty. Oncotarget 2017; 7:11899-912. [PMID: 26933813 PMCID: PMC4914257 DOI: 10.18632/oncotarget.7727] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/30/2016] [Indexed: 02/07/2023] Open
Abstract
Frailty is a syndrome associated with reduced physiological reserves that increases an individual's vulnerability for developing increased morbidity and/or mortality. While most clinical trials have focused on exercise, nutrition, pharmacologic agents, or a multifactorial approach for the prevention and attenuation of frailty, none have studied the use of cell-based therapies. We hypothesize that the application of allogeneic human mesenchymal stem cells (allo-hMSCs) as a therapeutic agent for individuals with frailty is safe and efficacious. The CRATUS trial comprises an initial non-blinded phase I study, followed by a blinded, randomized phase I/II study (with an optional follow-up phase) that will address the safety and pre-specified beneficial effects in patients with the aging frailty syndrome. In the initial phase I protocol, allo-hMSCs will be administered in escalating doses via peripheral intravenous infusion (n=15) to patients allocated to three treatment groups: Group 1 (n=5, 20 million allo-hMSCs), Group 2 (n=5, 100 million allo-hMSCs), and Group 3 (n=5, 200 million allo-hMSCs). Subsequently, in the randomized phase, allo-hMSCs or matched placebo will be administered to patients (n=30) randomly allocated in a 1:1:1 ratio to one of two doses of MSCs versus placebo: Group A (n=10, 100 million allo-hMSCs), Group B (n=10, 200 million allo-hMSCs), and Group C (n=10, placebo). Primary and secondary objectives are, respectively, to demonstrate the safety and efficacy of allo-hMSCs administered in frail older individuals. This study will determine the safety of intravenous infusion of stem cells and compare phenotypic outcomes in patients with aging frailty.
Collapse
Affiliation(s)
- Samuel Golpanian
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Darcy L DiFede
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marietsy V Pujol
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maureen H Lowery
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Silvina Levis-Dusseau
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Division of Endocrinology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bradley J Goldstein
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Otolaringology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ivonne H Schulman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Division of Nephrology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bangon Longsomboon
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ariel Wolf
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan W Heldman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Division of Cardiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pascal J Goldschmidt-Clermont
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Division of Cardiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Division of Cardiology, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
10
|
Fabrício-Wehbe SCC, Rodrigues RAP, Haas VJ, Fhon JRS, Diniz MA. Association of frailty in hospitalized and institutionalized elderly in the community-dwelling. Rev Bras Enferm 2016; 69:691-6. [DOI: 10.1590/0034-7167.2016690411i] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 03/23/2016] [Indexed: 02/27/2023] Open
Abstract
ABSTRACT Objective: to investigate the association between frailty with hospitalization and institutionalization in a follow-up study of elderly residents. Method: the follow-up study was performed in 2008 and 2013 with elderly of both genders, aged 65 years and older who were living in the community-dwelling. The sampling procedure performed was probabilistic, with dual-stage clustering. In 2008, 515 elderly people were interviewed and, in 2013, 262. We used the socioeconomic and demographic data, self-reported morbidity, specific data of hospitalization and institutionalization. Frailty was measured by the Edmonton Frail Scale (EFS), and functional capacity through the Functional Independence Measure. Results: we found the mean gross EFS score was higher among resident elderly who were hospitalized and institutionalized and was statistically significant in both investigated years. Conclusion: the confirmation of association between frailty and hospitalization and institutionalization reinforces the importance of the subject, and highlights frailty as an important tool for risk estimates for these adverse events.
Collapse
|
11
|
The Canadian Cardiovascular Society Heart Failure Companion: Bridging Guidelines to Your Practice. Can J Cardiol 2016; 32:296-310. [DOI: 10.1016/j.cjca.2015.06.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 01/09/2023] Open
|
12
|
Abstract
Objective: To evaluate the impact of frailty, measured using the Canadian Study of Health and Aging Clinical Frailty Scale, on outcomes of older people hospitalized with acute illness. Method: Consecutive patients were randomly allocated to a model development sample or a model validation sample. Multivariate analyses were used to model in-hospital mortality, new nursing home placement, and length of stay. Variables selected in the development samples were tested in the validation samples. Results: The mean age of all 2,125 patients was 82.9 years. Most (93.6%) were admitted through the emergency department. Frailty predicted in-hospital mortality (odds ratio [OR] = 2.97 [2.11, 4.17]), new nursing home placement (OR = 1.60 [1.14, 2.24]), and length of hospital stay (hazard ratio = 0.87 [0.81, 0.93]). Discussion: Frailty is a strong predictor of adverse outcomes in older people hospitalized with acute illness. An increased awareness of its impact may alert clinicians to screen for frailty.
Collapse
|
13
|
Swidler M. Considerations in starting a patient with advanced frailty on dialysis: complex biology meets challenging ethics. Clin J Am Soc Nephrol 2013; 8:1421-8. [PMID: 23788617 DOI: 10.2215/cjn.12121112] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Nephrologists have focused on the uremic syndrome as an indication for dialysis. The elderly frail renal patient approaching ESRD represents a complex biologic system that is already failing. This patient phenotype exhibits progressive geriatric disabilities and dependence interspersed with shrinking periods of stability regardless of whether dialysis is started. Consequently, the frail renal patient faces challenging treatment choices underpinned by ethical tensions. Identifying the advanced frail renal patient and optimizing the shared decision-making process will enable him or her to make well informed choices based on an understanding of his or her overall condition and personal values and preferences. This approach will also permit nephrologists to fulfill their ethical obligations to respect patient autonomy, promote patient benefit, and minimize patient harm.
Collapse
Affiliation(s)
- Mark Swidler
- Department of Medicine and Geriatrics/Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| |
Collapse
|