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Jones R, Enogela EM, Zumbro EL, Soukhamneut P, Richardson CR, Buford TW, Jackson EA. Assessment of Frailty Among Older Adults in the Physical Activity Daily Trial. J Appl Gerontol 2024:7334648241244690. [PMID: 38655762 DOI: 10.1177/07334648241244690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Frailty is common among cardiac patients; however, frailty assessment data from patients with peripheral arterial disease (PAD) are limited. The purpose of this observational study was to identify the prevalence and factors related to frailty in addition to unique frailty marker groupings in a cohort of sedentary adults with PAD. We grouped three PAD-relevant frailty characteristics using Fried's frailty phenotype -1) exhaustion, (2) weakness, and (3) slowness-and observed the prevalence of pre-frailty (1-2 characteristics) and frailty (3 characteristics) in the PAD cohort. Of the 106 participants, 34.9% were robust/non-frail, 53.8% were pre-frail, and 2.8% were frail. Exhaustion (33.3%) was the most occurring characteristic followed by weakness (20.0%) and slowness (5.0%). The grouping of weakness + slowness (10.0%) was the most prevalent followed by exhaustion + weakness (8.3%) and exhaustion + slowness (5.0%). Among pre-frail participants, ankle brachial index was correlated with a reduction in gait speed.
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Affiliation(s)
- Raymond Jones
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ene M Enogela
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily L Zumbro
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Thomas W Buford
- University of Alabama at Birmingham, Birmingham, AL, USA
- Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
| | - Elizabeth A Jackson
- University of Alabama at Birmingham, Birmingham, AL, USA
- Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
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2
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Swales B, Ryde GC, Whittaker AC. A Mixed Methods Feasibility Study of Machine-Based Resistance Training With Prefrail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial II. J Aging Phys Act 2024; 32:244-263. [PMID: 38262397 DOI: 10.1123/japa.2022-0170] [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: 05/11/2022] [Revised: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 01/25/2024]
Abstract
Physical activity is an effective, proactive intervention to reduce or reverse frailty and functional decline. However, uncertainty exists about the feasibility and impact of resistance training on multidimensional health in prefrail older adults in residential care. This mixed methods feasibility study assessed practicability with limited efficacy testing on health and functional outcomes. Eleven prefrail older adults participated in a 6-week progressive resistance training protocol three times per week. The intervention and measures were found to be appropriate and acceptable by those who completed the trial, with participants self-reporting improved well-being, mood, and function. Analysis identified several barriers to recruitment, including prior commitments, seasonal impact, and session timing, and offered potential solutions with further recommendations for program refinement prior to a definitive randomized controlled trial. These findings add to our understanding of prefrail older adults' preferences regarding participation in physical activity research and the perceived benefits of resistance training. This trial was registered with ClinicalTrials.gov: NCT03141879.
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Affiliation(s)
- Bridgitte Swales
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Gemma C Ryde
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Anna C Whittaker
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
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3
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Tan LF, Chan YH, Denishkrshna A, Merchant RA. Association between different skeletal muscle mass indices, physical function, and inflammation in obese pre-frail older adults. Arch Gerontol Geriatr 2024; 118:105289. [PMID: 38043454 DOI: 10.1016/j.archger.2023.105289] [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: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES There is lack of consensus on measurement of muscle mass and quality in obese older adults. We aim to evaluate the association of four muscle mass indices (appendicular skeletal muscle mass (ASM) over height2(ASMIht), ASM/weight (ASMwt), ASM/body fat percentage (ASMbfp)and ASM/body mass index (BMI) ASMIbmi) with physical function and inflammation in pre-frail obese older adults. METHODS Cross-sectional study of 407 community dwelling pre-frail older adults. Data on demographics, cognition, and physical function(gait speed, handgrip strength (HGS) and Short Physical Performance Battery (SPPB) test), body composition and inflammation biomarkers were collected. Participants were analysed based on BMI tertiles(T1 lowest,T3 highest). RESULTS The mean age was 72.67 years, mean BMI 25.42 kg/m2 and 59.5 % were females. Participants in T3 had a mean BMI of 30.75 kg/m2, younger with lower education levels, multimorbidity, polypharmacy and lower prevalence of sarcopenia. In BMI T3, ASMIbmi was significantly associated with EQ-5D index (β 0.53, 95 % CI 0.04 to 1.03, p = 0.033),HGS (β 5.28, 95 % CI 0.27 to 10.29, p = 0.039), SPPB (β 2.19, 95 % CI 0.47 to 3.91, p = 0.013) and IL-6 (β -4.13, 95 % CI -7.46 to -0.81, p = 0.017). ASMIwt was associated with EQ-5D index (β 0.17, 95 % CI 0.02 - 0.33, p = 0.047). ASMbfp was associated with HGS (β 6.97, 95 % CI 0.051 to 13.92, p = 0.049). There was significant association of HGS with all muscle mass indices in BMI T2, and ASMbfpin BMI T1. CONCLUSION ASMIbmi was significantly associated with SPPB, HGS, EQ-5D index and IL-6 in BMI T3. ASMbfp was associated with HGS in all the tertiles. Our results need further validation at population level.
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Affiliation(s)
- Li Feng Tan
- Healthy Ageing Programme, Alexandra Hospital, National University Health System, Singapore
| | - Yiong Huak Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A Denishkrshna
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Reshma Aziz Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore.
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Ramos JTGDS, Pereira AG, Ferrari FS, Andrade MF, de Melo CS, Boas PJFV, Felix TF, de Carvalho M, Dorna MS, Azevedo PS, Phillips BE, Polegato BF, Okoshi K, Bazan SGZ, Paiva SAR, Zornoff LAM, Reis PP, Minicucci MF. Circulating miRNAs are associated with frailty and ST-elevation myocardial infarction pathways. Arch Gerontol Geriatr 2023; 106:104870. [PMID: 36442406 DOI: 10.1016/j.archger.2022.104870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Frailty and ST-Elevation Myocardial Infarction (STEMI) share similar molecular pathways. Specific biomarkers, such as microRNAs (miRNAs), may provide insights into the molecular mechanisms that cause the relationship between frailty and STEMI. OBJECTIVE Our aim was to identify and compare circulating miRNA levels between frail and non-frail older adults following STEMI and comprehend the regulatory miRNA-gene networks and pathways involved in this condition. METHODS This exploratory study is a subanalysis of a larger observational study. In this study, we selected patients ≥ 65 years old, following STEMI, with pre-frail/frail (n=5) and non-frail (n=4) phenotype evaluated using the Clinical Frailty Scale and serum circulating miRNA levels were analyzed. RESULTS Pre-frail/frail patients had greater serum levels of 53 miRNAs, compared with non-frail patients. Notably, miR-103a-3p, miR-598-3p, and miR-130a-3p were the top three significantly deregulated miRNAs predicted to modulate gene expression associated with aging. Additional computational analyses showed 7,420 predicted miRNA gene targets, which were regulated by at least two of the 53 identified miRNAs. Pathway enrichment analysis showed that axon guidance and MAPK signaling were among pathways regulated by miRNA target genes. CONCLUSIONS These novel findings suggest a correlation between the identified miRNAs, target genes, and pathways in pre-frail and frail patients with myocardial infarction.
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Affiliation(s)
| | - Amanda Gomes Pereira
- São Paulo State University (Unesp), Medical School, Internal Medicine Department, Botucatu, Brazil.
| | - Felipe Sanches Ferrari
- São Paulo State University (Unesp), Medical School, Internal Medicine Department, Botucatu, Brazil
| | - Morganna Freitas Andrade
- São Paulo State University (Unesp), Medical School, Internal Medicine Department, Botucatu, Brazil
| | - Caroline Souto de Melo
- Department of Anesthesiology, Complexo Hospitalar Santa Genoveva de Uberlândia, Minas Gerais, Brazil
| | | | - Tainara F Felix
- São Paulo State University (Unesp), Medical School, Experimental Research Unit (UNIPEX), Botucatu, Brazil
| | - Marcio de Carvalho
- São Paulo State University (Unesp), Medical School, Experimental Research Unit (UNIPEX), Botucatu, Brazil
| | - Mariana Souza Dorna
- São Paulo State University (Unesp), Medical School, Internal Medicine Department, Botucatu, Brazil
| | - Paula Schmidt Azevedo
- São Paulo State University (Unesp), Medical School, Internal Medicine Department, Botucatu, Brazil
| | - Bethan E Phillips
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Derby, UK
| | - Bertha Furlan Polegato
- São Paulo State University (Unesp), Medical School, Internal Medicine Department, Botucatu, Brazil
| | - Katashi Okoshi
- São Paulo State University (Unesp), Medical School, Internal Medicine Department, Botucatu, Brazil
| | | | | | | | - Patricia P Reis
- São Paulo State University (Unesp), Medical School, Experimental Research Unit (UNIPEX), Botucatu, Brazil; São Paulo State University (Unesp), Medical School, Department of Surgery and Orthopedics, Botucatu, Brazil
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García-Sánchez J, Mafla-España MA, Torregrosa MD, Cauli O. Androstenedione and Follicle-Stimulating Hormone Concentration Predict the Progression of Frailty Syndrome at One Year Follow-Up in Patients with Localized Breast Cancer Treated with Aromatase Inhibitors. Biomedicines 2022; 10:biomedicines10071634. [PMID: 35884939 PMCID: PMC9312841 DOI: 10.3390/biomedicines10071634] [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: 05/17/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The standard treatment in postmenopausal women with estrogen- and progesterone-positive localized breast cancer consists of aromatase inhibitors (AROi). The ability of AROi to promote or worsen frailty syndrome over time and the relationship with changes in gonadal hormones concentration in blood have not been investigated. Methods: A prospective study to evaluate the relationship between frailty syndrome and gonadal hormones concentrations in blood at baseline (prior to AROi treatment) and after 6 and 12 months under AROi treatment in post-menopausal women with breast cancer. Frailty syndrome was evaluated by the Fried’ criteria. We evaluated whether hormone concentration at baseline could predict frailty syndrome at follow-up. Results: Multinomial regression analysis showed that of the different hormones, those significantly (p < 0.05) associated to the worsening of frailty syndrome were high androstenedione levels and low follicle-stimulating hormone (FSH) levels in blood. Receiver operating characteristic curve analysis showed both androstenedione and FSH significantly (p < 0.05) discriminate patients who developed or presented worsening of frailty syndrome over time, with acceptable sensitivity (approximately 80% in both cases) but low specificity (40%). Conclusion: Hormonal concentrations before AROi treatment constitute possible biomarkers to predict the progression of frailty syndrome.
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Affiliation(s)
- Javier García-Sánchez
- Medical Oncology Department, Doctor Peset University Hospital, 46017 Valencia, Spain; (J.G.-S.); (M.D.T.)
- Medical Oncology Department, Hospital Center of Wallonie Picardy, 7500 Tournai, Belgium
| | - Mayra Alejandra Mafla-España
- Frailty Research Organized Group, University of Valencia, 46010 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
| | - María Dolores Torregrosa
- Medical Oncology Department, Doctor Peset University Hospital, 46017 Valencia, Spain; (J.G.-S.); (M.D.T.)
| | - Omar Cauli
- Frailty Research Organized Group, University of Valencia, 46010 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
- Correspondence:
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6
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Yamada Y, Kobayashi T, Condo A, Sangarlangkarn A, Ko F, Taniguchi Y, Kojima G. Prevalence of Frailty and Prefrailty in People With Human Immunodeficiency Virus Aged 50 or Older: A Systematic Review and Meta-Analysis. Open Forum Infect Dis 2022; 9:ofac129. [PMID: 35415198 PMCID: PMC8995074 DOI: 10.1093/ofid/ofac129] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/10/2022] [Indexed: 12/16/2022] Open
Abstract
Background With effective antiretroviral therapy, there is an emerging population of adults aged 50 years or older with human immunodeficiency virus (HIV). Frailty is an increasingly recognized clinical state of vulnerability associated with disability, hospitalization, and mortality. However, there is a paucity of large studies assessing its prevalence in people with HIV (PWH) aged 50 or older. Methods PubMed was systematically searched for studies published between January 2000 and August 2020 reporting the prevalence of frailty in PWH aged 50 or older. The pooled prevalence of frailty and prefrailty was synthesized using a random-effects meta-analysis. Results Of the 425 studies identified, 26 studies were included in the analysis, with a total of 6584 PWH aged 50 or older. The included studies were published between 2012 and 2020, and all studies used the Fried frailty phenotype to define frailty. The overall pooled prevalence of frailty and prefrailty was 10.9% (95% confidence interval [CI], 8.1%–14.2%) and 47.2% (95% CI, 40.1%–54.4%), respectively. A high degree of heterogeneity was observed (I2 = 93.2%). In the subgroup analysis, HIV-related variables and other demographic variables were examined, and heterogeneity disappeared only in the group of a longer duration since HIV diagnosis (I2 = 0%). Conclusions The pooled prevalence of frailty and prefrailty defined by the Fried frailty phenotype was assessed in PWH aged 50 or older. Findings from this study quantified the proportion of this specific population with this common geriatric syndrome. Future studies identifying effective strategies for frailty screening and intervention are required for this vulnerable population.
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Affiliation(s)
- Yuji Yamada
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Takaaki Kobayashi
- Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Angela Condo
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Fred Ko
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Yu Taniguchi
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Gotaro Kojima
- Department of Research, Dr. AGA Clinic, Minato-ku, Tokyo, Japan
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7
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García-Sánchez J, Mafla-España MA, Tejedor-Cabrera C, Avellán-Castillo O, Torregrosa MD, Cauli O. Plasma Aromatase Activity Index, Gonadotropins and Estrone Are Associated with Frailty Syndrome in Post-Menopausal Women with Breast Cancer. Curr Oncol 2022; 29:1744-1760. [PMID: 35323344 PMCID: PMC8947022 DOI: 10.3390/curroncol29030144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 01/04/2023] Open
Abstract
Frailty syndrome is associated with poor outcomes, morbidity and premature mortality. We performed a cross-sectional study to evaluate the presence of frailty syndrome based on Fried’s frailty phenotype in post-menopausal women with breast cancer. We further analyzed the association between frailty syndrome with geriatric assessments and the association with the concentration of gonadotropins LH and FSH, estrogens, androgens and the aromatase activity index in the blood. We enrolled 47 post-menopausal women with localized breast cancer (mean age 66.8 ± 1.3 years (range 52−83)) prior to the starting of adjuvant endocrine therapy. Patients were identified as “non-frail” (robust) or “prefrail/frail” if they fulfilled at least one frailty criteria. In order to determine associations among variables and to control for other variables potentially affecting frailty syndrome (age, comorbidity index and previous chemotherapy treatment), we performed a logistic regression analysis. The receiver operating characteristic curve was performed to assess the sensitivity and specificity of the hormonal concentration to discriminate prefrail/frail versus non-frail individuals. Significant positive associations were observed between the severity of frailty syndrome and estrone, FSH and LH concentrations and the aromatase activity index in the blood (p < 0.05). Further research into the role of hormonal biomarkers should be evaluated in follow-up studies in order to recommend their use as suitable biomarkers of frailty syndrome in breast cancer patients.
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Affiliation(s)
- Javier García-Sánchez
- Medical Oncology Department, Doctor Peset University Hospital, 46017 Valencia, Spain; (J.G.-S.); (M.D.T.)
- Medical Oncology Department, Hospital Center of Wallonie Picardy, 7500 Tournai, Belgium
| | - Mayra Alejandra Mafla-España
- Frailty Research Organized Group, University of Valencia, 46010 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (C.T.-C.); (O.A.-C.)
| | - Carlos Tejedor-Cabrera
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (C.T.-C.); (O.A.-C.)
| | - Olga Avellán-Castillo
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (C.T.-C.); (O.A.-C.)
| | - María Dolores Torregrosa
- Medical Oncology Department, Doctor Peset University Hospital, 46017 Valencia, Spain; (J.G.-S.); (M.D.T.)
| | - Omar Cauli
- Frailty Research Organized Group, University of Valencia, 46010 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain; (C.T.-C.); (O.A.-C.)
- Correspondence:
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8
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Sezgin D, O'Donovan M, Woo J, Bandeen-Roche K, Liotta G, Fairhall N, Rodríguez-Laso A, Apóstolo J, Clarnette R, Holland C, Roller-Wirnsberger R, Illario M, Mañas LR, Vollenbroek-Hutten M, Doğu BB, Balci C, Pernas FO, Paul C, Ahern E, Romero-Ortuno R, Molloy W, Cooney MT, O'Shea D, Cooke J, Lang D, Hendry A, Kennelly S, Rockwood K, Clegg A, Liew A, O'Caoimh R. Early identification of frailty: Developing an international delphi consensus on pre-frailty. Arch Gerontol Geriatr 2022; 99:104586. [DOI: 10.1016/j.archger.2021.104586] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 01/07/2023]
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9
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Navarro-Martínez R, Cauli O. Lymphocytes as a Biomarker of Frailty Syndrome: A Scoping Review. Diseases 2021; 9:diseases9030053. [PMID: 34287298 PMCID: PMC8293122 DOI: 10.3390/diseases9030053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Frailty is a geriatric syndrome characterized by a decrease in physiological reserve and reduced resistance to stress, as a result of an accumulation of multiple deficits in physiological systems. Frailty increases the vulnerability to adverse events and is associated with the aging process. Several studies show an association between frailty syndrome and altered blood lymphocyte levels, which is therefore potentially useful for monitoring interventions to improve or delay frailty. The main objective of this review is to provide an analysis of the current evidence related to changes in lymphocyte counts and their associations with frailty syndrome. To that end, the literature published in this field until March 2021 was in several databases: PubMed, SCOPUS, and Cochrane. Eighteen studies analyzed the association between lymphocyte counts, lymphocyte subtypes, and frailty syndrome. Eighteen studies were analyzed, and most of them reported associations. Interestingly, the association between frailty syndrome and lower lymphocytes counts appears in different clinical conditions. Further studies are needed to determine the sensitivity of lymphocyte counts and lymphocyte subtypes in the diagnosis and monitoring of frailty syndrome, and for this measure to be used as a biomarker of frailty status.
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Affiliation(s)
- Rut Navarro-Martínez
- Haematology Department, Hospital General Universitario, 46014 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
- Frailty and Cognitive Impairment Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Omar Cauli
- Haematology Department, Hospital General Universitario, 46014 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-96-386-41-82
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10
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Saint-Criq V, Lugo-Villarino G, Thomas M. Dysbiosis, malnutrition and enhanced gut-lung axis contribute to age-related respiratory diseases. Ageing Res Rev 2021; 66:101235. [PMID: 33321253 DOI: 10.1016/j.arr.2020.101235] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/23/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022]
Abstract
Older people are at an increased risk of developing respiratory diseases such as chronic obstructive pulmonary diseases, asthma, idiopathic pulmonary fibrosis or lung infections. Susceptibility to these diseases is partly due to the intrinsic ageing process, characterized by genomic, cellular and metabolic hallmarks and immunosenescence, and is associated with changes in the intestinal microbiota. Importantly, in the lungs, ageing is also associated with a dysbiosis and loss of resilience of the resident microbiota and alterations of the gut-lung axis. Notably, as malnutrition is often observed in the elderly, nutrition is one of the most accessible modifiable factors affecting both senescence and microbiota. This article reviews the changes affecting the lung and its resident microbiota during ageing, as well as the interconnections between malnutrition, senescence, microbiota, gut-lung axis and respiratory health. As the communication along the gut-lung axis becomes more permissive with ageing, this review also explores the evidence that the gut and lung microbiota are key players in the maintenance of healthy lungs, and as such, are potential targets for nutrition-based preventive strategies against lung disease in elderly populations.
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Álvarez-Sánchez N, Álvarez-Ríos AI, Guerrero JM, García-García FJ, Rodríguez-Mañas L, Cruz-Chamorro I, Lardone PJ, Carrillo-Vico A. Homocysteine and C-Reactive Protein Levels Are Associated With Frailty in Older Spaniards: The Toledo Study for Healthy Aging. J Gerontol A Biol Sci Med Sci 2021; 75:1488-1494. [PMID: 31304964 DOI: 10.1093/gerona/glz168] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Indexed: 01/12/2023] Open
Abstract
High-sensitivity C-reactive protein (hsCRP) and homocysteine (Hcy) are inflammation markers but are also related to cardiovascular diseases, disability, or higher risk of death. Although inflammation is considered to be associated with frailty, data regarding the association between hsCRP or Hcy and frailty are controversial or scarce, especially with respect to their association with prefrailty. Thus, our objective was to study the association of hsCRP and Hcy with prefrailty and frailty in 1,211 Spanish men and women aged 65-98 years from the Toledo Study for Healthy Aging (TSHA) cohort, classified according to Fried's criteria. Hcy was independently associated with frailty (odds ratio [OR] = 1.06; 95% confidence interval [CI]: 1.01-1.12), whereas hsCRP was independently associated with both prefrailty (OR = 1.03; 95% CI: 1.01-1.06) and frailty (OR = 1.07; 95% CI: 1.02-1.12). Furthermore, both markers were positively correlated with the number of Fried's criteria that were met and were independently associated with the criteria of exhaustion (Hcy: OR = 1.03, 95% CI: 1.00-1.06), weakness (hsCRP: OR = 1.03, 95% CI: 1.01-1.05), and low physical activity (hsCRP: OR = 1.04, 95% CI: 1.02-1.06). Thus, our results highlight the importance of inflammation in age-related physical decline and, in particular, its association with fatigue, low strength, and decreased physical activity.
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Affiliation(s)
- Nuria Álvarez-Sánchez
- Instituto de Biomedicina de Sevilla, IBiS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Spain
| | | | - Juan Miguel Guerrero
- Instituto de Biomedicina de Sevilla, IBiS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Spain.,Department of Clinical Biochemistry, Virgen del Rocío University Hospital, Sevilla, Spain.,Departamento de Bioquímica Médica y Biología Molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
| | | | - Leocadio Rodríguez-Mañas
- Servicio de Geriatría y Fundación para la Investigación Biomédica, Hospital Universitario de Getafe Madrid, Spain
| | - Ivan Cruz-Chamorro
- Instituto de Biomedicina de Sevilla, IBiS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Spain.,Departamento de Bioquímica Médica y Biología Molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
| | - Patricia Judith Lardone
- Instituto de Biomedicina de Sevilla, IBiS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Spain.,Departamento de Bioquímica Médica y Biología Molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
| | - Antonio Carrillo-Vico
- Instituto de Biomedicina de Sevilla, IBiS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Spain.,Departamento de Bioquímica Médica y Biología Molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
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12
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Paixão V, Almeida EB, Amaral JB, Roseira T, Monteiro FR, Foster R, Sperandio A, Rossi M, Amirato GR, Santos CAF, Pires RS, Leal FB, Durigon EL, Oliveira DBL, Vieira RP, Vaisberg M, Santos JMB, Bachi ALL. Elderly Subjects Supplemented with L-Glutamine Shows an Improvement of Mucosal Immunity in the Upper Airways in Response to Influenza Virus Vaccination. Vaccines (Basel) 2021; 9:vaccines9020107. [PMID: 33572639 PMCID: PMC7911866 DOI: 10.3390/vaccines9020107] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although glutamine is able to improve the immune response, its action in the upper airway immunity against the influenza virus vaccine remains unclear. Therefore, we aimed to evaluate the L-glutamine supplementation effect on the mucosal immune/inflammatory response of elderly subjects vaccinated against the influenza virus. METHODS Saliva sampling from 83 physically active elderly volunteers were collected pre- and 30 days after influenza virus vaccination and supplementation with L-glutamine (Gln, n = 42) or placebo (PL, n = 41). RESULTS Gln group showed higher salivary levels of interleukin (IL)-17, total secretory immunoglobulin A (SIgA), and specific-SIgA post-vaccination than values found pre-vaccination and in the PL group post-vaccination. Whereas higher salivary levels of IL-6 and IL-10 were observed post-vaccination in the Gln group, IL-37 levels were lower post-vaccination in both groups than the values pre-vaccination. Tumor necrosis factor (TNF)-α levels were unchanged. Positive correlations between IL-6 and IL-10 were found in all volunteer groups pre- and post-vaccination and also between IL-17 and IL-6 or IL-10 in the Gln group post-vaccination. A negative correlation between IL-37 and IL-10 was found pre- and post-vaccination in the PL group. CONCLUSION Gln supplementation was able to modulate salivary cytokine profile and increase SIgA levels, both total and specific to the influenza virus vaccine, in physically active elderly subjects.
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Affiliation(s)
- Vitória Paixão
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, Brazil; (V.P.); (E.B.A.); (J.B.A.); (T.R.); (F.R.M.); (R.F.); (M.R.); (G.R.A.); (M.V.); (A.L.L.B.)
| | - Ewin B. Almeida
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, Brazil; (V.P.); (E.B.A.); (J.B.A.); (T.R.); (F.R.M.); (R.F.); (M.R.); (G.R.A.); (M.V.); (A.L.L.B.)
| | - Jonatas B. Amaral
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, Brazil; (V.P.); (E.B.A.); (J.B.A.); (T.R.); (F.R.M.); (R.F.); (M.R.); (G.R.A.); (M.V.); (A.L.L.B.)
| | - Tamaris Roseira
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, Brazil; (V.P.); (E.B.A.); (J.B.A.); (T.R.); (F.R.M.); (R.F.); (M.R.); (G.R.A.); (M.V.); (A.L.L.B.)
- Method Faculty of São Paulo (FAMESP), São Paulo 04046-200, Brazil;
| | - Fernanda R. Monteiro
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, Brazil; (V.P.); (E.B.A.); (J.B.A.); (T.R.); (F.R.M.); (R.F.); (M.R.); (G.R.A.); (M.V.); (A.L.L.B.)
- Method Faculty of São Paulo (FAMESP), São Paulo 04046-200, Brazil;
| | - Roberta Foster
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, Brazil; (V.P.); (E.B.A.); (J.B.A.); (T.R.); (F.R.M.); (R.F.); (M.R.); (G.R.A.); (M.V.); (A.L.L.B.)
- Method Faculty of São Paulo (FAMESP), São Paulo 04046-200, Brazil;
| | | | - Marcelo Rossi
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, Brazil; (V.P.); (E.B.A.); (J.B.A.); (T.R.); (F.R.M.); (R.F.); (M.R.); (G.R.A.); (M.V.); (A.L.L.B.)
| | - Gislene R. Amirato
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, Brazil; (V.P.); (E.B.A.); (J.B.A.); (T.R.); (F.R.M.); (R.F.); (M.R.); (G.R.A.); (M.V.); (A.L.L.B.)
| | - Carlos A. F. Santos
- Department of Medicine, Geriatry, Paulista School of Medicine (EPM), São Paulo 04023-062, Brazil;
| | - Renier S. Pires
- Post-Graduation Program in Health Science, Santo Amaro University (UNISA), São Paulo 04743-030, Brazil;
| | - Fabyano B. Leal
- Institute of Biomedical Science, University of São Paulo (USP), São Paulo 05508-060, Brazil; (F.B.L.); (E.L.D.); (D.B.L.O.)
| | - Edison L. Durigon
- Institute of Biomedical Science, University of São Paulo (USP), São Paulo 05508-060, Brazil; (F.B.L.); (E.L.D.); (D.B.L.O.)
- Scientific Platform Pasteur, University of São Paulo (USP), São Paulo 05508-060, Brazil
| | - Danielle B. L. Oliveira
- Institute of Biomedical Science, University of São Paulo (USP), São Paulo 05508-060, Brazil; (F.B.L.); (E.L.D.); (D.B.L.O.)
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | - Rodolfo P. Vieira
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São Paulo 12245-520, Brazil;
- Post-Graduation Program in Bioengineering and Biomedical Engineering, Universidade Brasil, São Paulo 15600-000, Brazil
- Post-Graduation Program in Science of Human and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos 11015-020, Brazil
| | - Mauro Vaisberg
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, Brazil; (V.P.); (E.B.A.); (J.B.A.); (T.R.); (F.R.M.); (R.F.); (M.R.); (G.R.A.); (M.V.); (A.L.L.B.)
| | - Juliana M. B. Santos
- Post-Graduation Program in Science of Human and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos 11015-020, Brazil
- Correspondence:
| | - André L. L. Bachi
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, Brazil; (V.P.); (E.B.A.); (J.B.A.); (T.R.); (F.R.M.); (R.F.); (M.R.); (G.R.A.); (M.V.); (A.L.L.B.)
- Post-Graduation Program in Health Science, Santo Amaro University (UNISA), São Paulo 04743-030, Brazil;
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São Paulo 12245-520, Brazil;
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The joint effects of frailty and telomere length for predicting mortality in older adults: the National Health and Nutrition Examination Survey 1999-2002. Aging Clin Exp Res 2020; 32:1839-1847. [PMID: 31646458 DOI: 10.1007/s40520-019-01376-3] [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: 05/20/2019] [Accepted: 10/04/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Frailty and short telomere length, which address different aspects of biological aging, are separately associated with mortality in older adults. AIMS To evaluate whether the combination of these two biomarkers would be a better predictor of mortality than either alone. METHODS This present study included participants 60 years of age or older from the National Health and Nutrition Examination Survey in the 1999-2002 phase. The frailty phenotype was identified based on the Fried definition. Telomere length relative to standard reference DNA (T/S ratio) was assessed using quantitative polymerase chain reaction (PCR). Cox proportional hazards regression models were used to estimate the individual and combined effects of frailty phenotype and telomere length on all-cause and cardiovascular mortality. RESULTS Compared with participants with neither impairment, the mortality risks increased slightly among participants with short telomere length only (hazard ratio [HR] 1.19, 95% confidence interval [CI]: 1.00-1.42) or pre-frailty only (HR 2.16, 95% CI 1.80-2.60) and gradually elevated approximately 3 folds with both short telomere length and pre-frailty (HR 2.23, 95% CI 1.81-2.74) or frailty (HR 3.57, 95% CI 2.56-4.98). Moreover, participants with both short telomere length and frailty had the highest increased all-cause mortality (HR 5.16, 95% CI 3.38-7.85) and cardiovascular mortality (HR 4.67, 95% CI 2.02-10.82). DISCUSSION AND CONCLUSIONS The combined predictor had more capability of predicting mortality, which suggested that integrating both molecular biomarkers and physiological functional parameters would be a more informative measure of biological aging.
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Batra RK. Utility of Liver Transplantation Within the Bounds of Non-futility. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00288-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Angulo J, El Assar M, Álvarez-Bustos A, Rodríguez-Mañas L. Physical activity and exercise: Strategies to manage frailty. Redox Biol 2020; 35:101513. [PMID: 32234291 PMCID: PMC7284931 DOI: 10.1016/j.redox.2020.101513] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/25/2022] Open
Abstract
Frailty, a consequence of the interaction of the aging process and certain chronic diseases, compromises functional outcomes in the elderly and substantially increases their risk for developing disabilities and other adverse outcomes. Frailty follows from the combination of several impaired physiological mechanisms affecting multiple organs and systems. And, though frailty and sarcopenia are related, they are two different conditions. Thus, strategies to preserve or improve functional status should consider systemic function in addition to muscle conditioning. Physical activity/exercise is considered one of the main strategies to counteract frailty-related physical impairment in the elderly. Exercise reduces age-related oxidative damage and chronic inflammation, increases autophagy, and improves mitochondrial function, myokine profile, insulin-like growth factor-1 (IGF-1) signaling pathway, and insulin sensitivity. Exercise interventions target resistance (strength and power), aerobic, balance, and flexibility work. Each type improves different aspects of physical functioning, though they could be combined according to need and prescribed as a multicomponent intervention. Therefore, exercise intervention programs should be prescribed based on an individual's physical functioning and adapted to the ensuing response.
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Affiliation(s)
- Javier Angulo
- Servicio de Histología-Investigación, Unidad de Investigación Traslacional en Cardiología (IRYCIS-UFV), Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mariam El Assar
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
| | | | - Leocadio Rodríguez-Mañas
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Spain.
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Interleukin-6 and Lymphocyte Count Associated and Predicted the Progression of Frailty Syndrome in Prostate Cancer Patients Undergoing Antiandrogen Therapy. Cancers (Basel) 2020; 12:cancers12071716. [PMID: 32610428 PMCID: PMC7408184 DOI: 10.3390/cancers12071716] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Abstract
Frailty syndrome is a functional state that includes a loss of ability to react to stressors, and is associated with poor outcomes, morbidity and premature mortality. The first line treatment in many men with prostate cancer (PCa) consists of an androgen-deprivation therapy (ADT) which can promote or favor frailty syndrome and ADT may therefore favor the progression of frailty over time. Among the pathophysiological bases of frailty, the presence of chronic low-grade inflammation has been associated with its adverse outcomes, but longitudinal studies are needed to validate these biomarkers. In this study, we prospectively evaluate frailty syndrome and blood inflammatory markers (IL1-beta, IL-6, IL-8, TNF alpha, C reactive protein) and leukocytes were measured at baseline and an average of 1 year later in PCa under ADT. Frailty was defined as having three or more of the following components: low lean mass, weakness, self-reported exhaustion, low activity level, and slow walking speed; prefrailty was defined as having one or two of those components. Multinomial regression analysis showed that among the inflammatory biomarkers, those significantly and repeatedly (baseline and follow-up time points) (p < 0.05) associated with frailty syndrome were high IL-6 levels and low lymphocyte counts in blood. Other biomarkers such as IL-8, monocyte counts and C reactive protein were significantly associated with frailty syndrome (p < 0.05) in cross-sectional analyses, but they do not predict frailty progression at 1 year-follow-up. Receiver operating characteristic curve analysis showed that both lymphocyte counts and IL-6 concentration significantly (p < 0.05) (although moderately) discriminate PCa patients that progressed in the severity of frailty syndrome. IL-6 and lymphocytes count are possible biomarkers, useful for identifying frail patients and predicting the progression of frailty in PCa under ADT. Our study suggests the use of these biomarkers to guide clinical decisions on prostate cancer treatment based on a multidisciplinary approach.
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Sex Differences in Factors Affecting Depressive Symptoms in Older People in the Prefrailty Phase. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124207. [PMID: 32545620 PMCID: PMC7344412 DOI: 10.3390/ijerph17124207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022]
Abstract
Depressive symptoms experienced late in life have considerable effects on the prevalence of comorbidity with physical and cognitive disabilities. By identifying and intervening on modifiable indicators for depression in prefrail older individuals, progression to the frailty phase can be delayed, and physical, psychosocial, and cognitive health problems of older people can be reduced and prevented. This study assessed sex differences in factors affecting depressive symptoms in older people in the prefrailty phase in Korea. Data from the 2014 National Survey of Older Koreans revealed 1706 women and 662 men in the early stages of old age. Regression analysis showed that economic status, number of medications, social support, nutritional status, and fear of falling collectively accounted for 39.0% of the variance among older men. Using the same analysis method, economic status, number of chronic diseases, number of medications, chewing discomfort, regular exercise, social support, mobility, nutritional status, and fear of falling collectively accounted for 37.5% of the variance among older women. Based on differences in characteristics with respect to the sex of older people in the prefrailty phase, public health workers in the community should consider sex differences when planning a frailty management program.
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Rasiah J, Cummings GG, Gruneir A, Oelke ND, Estabrooks C, Holroyd-Leduc J. Prefrailty in older adults: A concept analysis. Int J Nurs Stud 2020; 108:103618. [PMID: 32450406 DOI: 10.1016/j.ijnurstu.2020.103618] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/24/2020] [Accepted: 04/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The concept of prefrailty lacks clarity. Often, prefrailty is defined in relation to frailty and less often as a distinct concept. Theoretical evidence for prefrailty is minimal unlike frailty, which has been examined for decades although consensus about how to measure frailty has not been achieved. OBJECTIVE The aim of this study was to conduct a concept analysis of prefrailty to provide greater understanding of this phenomenon in the context of older adults. DESIGN Rodgers and Knafl's evolutionary concept analysis approach. DATA SOURCES The literature search for the concept analysis was conducted as follows: three databases (MEDLINE, CINAHL, and Abstracts in Social Gerontology databases) were searched using carefully selected search terms; and grey literature was not included. REVIEW METHODS In phase one, we used the search strategy and search terms to narrow the search for relevant articles. We selected articles that met the following inclusion criteria: (1) how prefrailty was conceptualized; (2) how prefrailty was measured; and (3) interventions targeted towards prefrailty. In phase two, we extracted data from included articles. In phase three, we analyzed data using thematic analysis and findings were presented as attributes, antecedents, consequences, and related concepts of prefrailty. One example of prefrailty in older adults was presented to highlight the concept in praxis. In phase four, methodological and substantive area experts reviewed and contributed to discussion and interpretation of findings including disciplinary perspectives of prefrailty. RESULTS A total of 41 articles were included for synthesis. The attributes of prefrailty were predisposing in nature, non-specific, multidimensional, and cumulative in effects. Antecedents of prefrailty were categorized into the following domains: sociodemographic characteristics, comorbidity, behaviours, and laboratory/clinical markers. Consequences of prefrailty were separated into two themes: increased risk of adverse outcomes and advancing levels of frailty. Surrogate and related terms (noted in the literature) that had shared attributes with prefrailty were increased vulnerability, transitional stage, dynamic process, progressive process with latent phase, and physical frailty. CONCLUSIONS As a result of conducting this concept analysis, we found that prefrailty was defined as a clinically silent process that predisposes individuals to frailty. Prefrailty, as a concept, was derived from the Fried's operational definition for frailty. Attributes, antecedents, consequences, and related terms will help clinicians consider how prefrailty presents in older adults separate from frailty. Further research is needed to build upon our understanding from this concept analysis. Tweetable Abstract: Prefrailty is unclear as a concept - Research on sociodemographic characteristics of older adults living with frailty will help clarify.
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Affiliation(s)
- Jananee Rasiah
- Faculty of Nursing, University of Alberta, 3-141 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB Canada T6G 1C9.
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, 3-141 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB Canada T6G 1C9.
| | - Andrea Gruneir
- Faculty of Medicine and Dentistry, University of Alberta, 6-10 University Terrace, University of Alberta, Edmonton, Alberta, Canada T6G 2R7.
| | - Nelly D Oelke
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Okanagan, 1147 Research Road, Kelowna, BC Canada V1V 1V7.
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, 3-141 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB Canada T6G 1C9.
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, University of Calgary, 11th Floor South Tower, Room 1104, 1403-29 Street NW, Calgary, Alberta, Canada T2N 2T9.
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Teixeira-Gomes A, Lage B, Esteves F, Sousa AC, Pastorinho MR, Valdiglesias V, Costa S, Laffon B, Teixeira JP. Frailty syndrome, biomarkers and environmental factors - A pilot study. Toxicol Lett 2020; 330:14-22. [PMID: 32380123 DOI: 10.1016/j.toxlet.2020.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/31/2020] [Accepted: 04/29/2020] [Indexed: 12/30/2022]
Abstract
Frailty is an age-related syndrome expected to increase over the next decades. This syndrome has been identified to be the most common condition leading to disability, institutionalisation and death in the elderly. The aim of this pilot study is to investigate a possible link between frailty status, biomarkers and environmental exposures. A group of 71 older adults (≥65 years old) was engaged in this study. The study population was classified as 45.1% robust, 45.1% pre-frail and 9.8% frail. A significant higher prevalence of second-hand smokers was found in the pre-frail group when compared to robust. Furthermore, a higher prevalence of robust individuals was found among those consuming home-produced vegetables and water from well/springs. Significant differences were found between data collected in a lifetime exposure questionnaire (LTEQ) and the levels of genotoxicity endpoints and the mercury levels analysed regarding some exposure-related parameters, namely, smoking habits, intake of home-produced vegetables and the use of pesticides in agriculture. Understanding if the way we live(d) or worked can impact the way we age are important questions to be explored. Data obtained in this pilot study encourage further studies on this matter, exploring the role of exposures history and its impact on health.
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Affiliation(s)
- Armanda Teixeira-Gomes
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; Environmental Health Department, National Institute of Health, Porto, Portugal; ICBAS - Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Bruna Lage
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; Environmental Health Department, National Institute of Health, Porto, Portugal
| | - Filipa Esteves
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; Environmental Health Department, National Institute of Health, Porto, Portugal
| | - Ana Catarina Sousa
- CICS-UBI, University of Beira Interior, Covilhã, Portugal; NuESA, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; CICECO, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - M Ramiro Pastorinho
- CICS-UBI, University of Beira Interior, Covilhã, Portugal; NuESA, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Vanessa Valdiglesias
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; DICOMOSA Group, Area of Psychobiology, Department of Psychology, University of A Coruña, A Coruña, Spain
| | - Solange Costa
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; Environmental Health Department, National Institute of Health, Porto, Portugal.
| | - Blanca Laffon
- DICOMOSA Group, Area of Psychobiology, Department of Psychology, University of A Coruña, A Coruña, Spain
| | - João Paulo Teixeira
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; Environmental Health Department, National Institute of Health, Porto, Portugal
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Crow RS, Petersen CL, Cook SB, Stevens CJ, Titus AJ, Mackenzie TA, Batsis JA. Reported Weight Change in Older Adults and Presence of Frailty. J Frailty Aging 2020; 9:74-81. [PMID: 32259180 DOI: 10.14283/jfa.2019.44] [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] [Indexed: 12/20/2022]
Abstract
OBJECTIVE A 5% change in weight is a significant predictor for frailty and obesity. We ascertained how self-reported weight change over the lifespan impacts rates of frailty in older adults. METHODS We identified 4,984 subjects ≥60 years with body composition measures from the National Health and Nutrition Examination Survey. An adapted version of Fried's frailty criteria was used as the primary outcome. Self-reported weight was assessed at time current,1 and 10 years earlier and at age 25. Weight changes between each time point were categorized as ≥ 5%, ≤5% or neutral. Logistic regression assessed the impact of weight change on the outcome of frailty. RESULTS Among 4,984 participants, 56.5% were female, mean age was 71.1 years, and mean BMI was 28.2kg/m2. A weight loss of ≥ 5% had a higher association with frailty compared to current weight, age 25 (OR 2.94 [1.72,5.02]), 10 years ago (OR 1.68 [1.05,2.69]), and 1 year ago (OR 1.55 [1.02,2.36]). Weight gain in the last year was associated with increased rate of frailty (1.59 [1.09,2.32]). CONCLUSION There is an association between frailty and reported weight loss over time while only weight gain in the last year has an association with frailty.
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Affiliation(s)
- R S Crow
- Rebecca Crow DO, Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, Telephone: (603) 653-9500, Facsimile: (603) 650-0915, E-mail:
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Hammami S, Zarrouk A, Piron C, Almas I, Sakly N, Latteur V. Prevalence and factors associated with frailty in hospitalized older patients. BMC Geriatr 2020; 20:144. [PMID: 32306905 PMCID: PMC7168944 DOI: 10.1186/s12877-020-01545-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 03/25/2020] [Indexed: 01/28/2023] Open
Abstract
Background Frailty is a multidimensional syndrome that leads to an increase of an age-related disorder of several physiological systems, and cognitive abilities decline. The aim of this study was to evaluate the prevalence of frailty among older persons in Belgium and we examined the factors associated with frailty with a principal focus en cognitive, dietary status, and inflammatory parameters. Methods A total of 124 participants (90 women, 34 men; age: mean ± SD: 85.9 ± 5.5 years) were studied, recruited from the Geriatrics department, Belgium. Nutritional, cognitive status and physical activity were assessed using Mini Mental State Examination score (MMSE), Mini Nutritional Assessment score (MNA), and Katz score, respectively. Frailty syndrome was evaluated using the modified Short Emergency Geriatric Assessment (SEGA) score. Medication and medical history were recorded. Analyzed biochemical parameters included C-reactive protein (CRP), complete blood count, blood creatinine, vitamin D level, and serum protein electrophoresis. According to SEGA score, participants were divided into non-frail (n = 19), frail (n = 25) and severely frail patients (n = 80). Results The SEGA score was inversely correlated with MMSE, MNA and Katz score. SEGA. score was negatively correlated to albumin levels (r = − 0.30; p < 0.001) and positively correlated to CRP, polypharmacy and age (r = 0.28, r = 0.37, r = 0.33 and p < 0.01 respectively). Logistic regression showed a strong association between frailty, Katz score, dementia, polypharmacy and living in nursing home. Conclusion Our results provide useful information for understanding mechanisms of frailty. This will help to develop preventive strategies for the elderly at the pre-frailty stage.
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Affiliation(s)
- Sonia Hammami
- Department of Internal Medicine CHU F Bourguiba Monastir, Geriatric unit, University Hospital F. Bourguiba, Monastir, Tunisia. .,Biochemistry Laboratory, LR12ES05 LR-NAFS 'Nutrition - Functional Food & Vascular Health'Faculty of Medicine, University of Monastir, Monastir, Tunisia. .,Geriatric Department, GHdC, Charleroi, Belgium.
| | - Amira Zarrouk
- Biochemistry Laboratory, LR12ES05 LR-NAFS 'Nutrition - Functional Food & Vascular Health'Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Biochemistry Laboratory, Faculty of Medicine of Sousse, Sousse, Tunisia
| | | | - Ioana Almas
- Geriatric Department, GHdC, Charleroi, Belgium
| | - Nabil Sakly
- Department of Immunology, CHU F Bourguiba, Monastir, Tunisia
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22
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Sezgin D, Liew A, O'Donovan MR, O'Caoimh R. Pre-frailty as a multi-dimensional construct: A systematic review of definitions in the scientific literature. Geriatr Nurs 2020; 41:139-146. [DOI: 10.1016/j.gerinurse.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
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Yin MJ, Xiong YZ, Xu XJ, Huang LF, Zhang Y, Wang XJ, Xiu LC, Huang JX, Lian TY, Liang DM, Zen JM, Ni JD. Tfh cell subset biomarkers and inflammatory markers are associated with frailty status and frailty subtypes in the community-dwelling older population: a cross-sectional study. Aging (Albany NY) 2020; 12:2952-2973. [PMID: 32039831 PMCID: PMC7041730 DOI: 10.18632/aging.102789] [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: 10/17/2019] [Accepted: 01/19/2020] [Indexed: 12/12/2022]
Abstract
We conducted a cross-sectional study investigating community-dwelling older population to determine association between immunoscenescence marker, inflammatory cytokines and frailty. Frailty status was classified with 33-item modified frailty index and latent class analysis was applied to explore the latent classes (subtypes) of frailty. In multivariable analysis, higher Tfh2 cells were associated with a higher risk of frailty [1.13(1.03–1.25)] in females, but a lower risk of cognitive and functional frail [0.92(0.86–0.99)] and physiological frail [0.92(0.87–0.98)]. Additionally, a greater risk of multi-frail and physiological frail correlated with low Tfh1 [0.77(0.60–0.99); 0.87(0.79–0.96)] and Tfh17 cells [0.79(0.65–0.96); 0.86(0.78–0.94)], respectively. Higher B cells were associated with decreased frailty/pre-frailty both in females [0.89(0.81–0.98)] and males [0.82(0.71–0.96)], but did not correlate with frailty subtypes. Regarding inflammatory markers, participants in the TGF-β 2nd quartile showed a decreased risk of pre-frailty/frailty in females [0.39(0.17–0.89)] and psychological frail [0.37(0.16–0.88)], compared with those in the top tertile. Moreover, we found participants in the 2nd tertile for IL-12 levels showed a decreased risk of physiological frail [0.40 (0.17–0.97)]. Our study highlights the importance of Tfh cell subsets and inflammatory markers in frailty in a sex-specific manner, particularly in terms of frailty subtype.
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Affiliation(s)
- Ming-Juan Yin
- Department of Preventive Medicine, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Yong-Zhen Xiong
- School Clinic, Guangdong Medical University, Dongguan, China
| | - Xiu-Juan Xu
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Ling-Feng Huang
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Yan Zhang
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Xiao-Jun Wang
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Liang-Chang Xiu
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Jing-Xiao Huang
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Ting-Yu Lian
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Dong-Mei Liang
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Jin-Mei Zen
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Jin-Dong Ni
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
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24
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Hu YL, Patel P, Fritz H. Detecting Prefrailty: Comparing Subjective Frailty Assessment and the Paulson-Lichtenberg Frailty Index. Gerontol Geriatr Med 2020; 6:2333721420904234. [PMID: 32076629 PMCID: PMC7003161 DOI: 10.1177/2333721420904234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 11/17/2022] Open
Abstract
We examined the level of agreement between subjective frailty assessments (SFA) and frailty classifications derived from the validated Paulson-Lichtenberg Frailty Index (PLFI). Clinic patients (n = 202) were classified as healthy, prefrail, or frail first by screening using the PLFI and later by two geriatric nurses and two geriatricians according to SFA. Of the 202 participants (mean age = 76.7 ± 8.6), 52 (26%) were prefrail and 57 (28%) were frail based on the PLFI. Geriatrician SFA aligned with the PLFI in 43.0% of prefrail and 65.7% of frail cases. Nurse SFA aligned with the PLFI in 43.9% of prefrail and 17.0% of frail cases. There was slight-to-fair agreement between SFA and PLFI (geriatrician: Cohen's κ = .23; 95% confidence interval (CI) = [.11, .35], p < .001; nurse: Cohen's κ = .20; 95% CI = [.08, .33], p = .001). Clinician SFA did not align well with PLFI classifications.
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Affiliation(s)
- Yi-Ling Hu
- Wayne State University, Detroit, MI, USA
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25
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Kehler DS, Clara I, Hiebert B, Stammers AN, Hay JL, Schultz A, Arora RC, Tangri N, Duhamel TA. Sex-differences in relation to the association between patterns of physical activity and sedentary behavior with frailty. Arch Gerontol Geriatr 2019; 87:103972. [PMID: 31739110 DOI: 10.1016/j.archger.2019.103972] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the sex-difference in relation to the association between moderate-vigorous physical activity (MVPA) and sedentary time (ST) patterns with frailty. METHOD Accelerometry from ≥50 year olds from the National Health and Nutrition Examination Survey (2003-04/2005-06 cycles) were included. Bouted and sporadic MVPA were defined as MVPA in ≥10 min or <10 min durations, respectively. MVPA was analyzed based on meeting 0 %, 1-49 %, 50-99 %, and ≥100 % of the physical activity guidelines of 150 min/week. A duration of ≥30 minutes defined prolonged ST. The frequency (≥1 min interruption in ST), intensity and duration of breaks from ST were calculated. A 46-item frailty index (FI) quantified frailty. Multivariable linear regression models adjusted for demographics, total sedentary time, and accelerometer wear time. RESULTS There were 1143 females and 1174 males available for analysis. Bouted MVPA was associated with lower frailty levels; the association peaked at meeting 50-99 % of the guidelines in females and ≥1.0 % in males (p = NS for sex-interaction). Meeting a higher proportion of the guidelines through sporadic MVPA was significantly associated with a lower FI in males only (p = NS for sex-interaction). Prolonged ST bouts were associated with worse frailty in females but not males (p < 0.05 sex-interaction). Average break intensity was associated with a lower FI in both sexes, whereas, total sedentary breaks were not (p = NS for sex-interaction). Average break duration was associated with frailty in males (p = NS for sex-interaction). CONCLUSION Prolonged ST was more detrimentally associated with frailty in females than males, which could influence tailored movement prescriptions and guidelines.
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Affiliation(s)
- D Scott Kehler
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, Canada.
| | - Ian Clara
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | - Brett Hiebert
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Canada
| | - Andrew N Stammers
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Canada
| | - Jacqueline L Hay
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Canada
| | - Annette Schultz
- College of Nursing, Max Rady College of Medicine, Faculty of Heath Sciences, University of Manitoba Winnipeg, Canada
| | - Rakesh C Arora
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Canada
| | | | - Todd A Duhamel
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Canada; Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Canada
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26
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Frailty syndrome is associated with changes in peripheral inflammatory markers in prostate cancer patients undergoing androgen deprivation therapy. Urol Oncol 2019; 37:976-987. [PMID: 31521528 DOI: 10.1016/j.urolonc.2019.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/28/2019] [Accepted: 08/12/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the role of peripheral inflammation (leukocyte differential count, the proinflammatory cytokines IL-beta, TNF-α, IL-6, IL-8, and the inflammatory markers fibrinogen and C-reactive protein [CRP]) in frailty syndrome in patients with prostate cancer (CaP) undergoing antiandrogen therapy (ADT). METHODS A total of 46 men between 51 and 92 years of age with CaP and receiving ADT were classified as frail, prefrail or robust according to the Fried scale. A geriatric assessment was performed, based on the Minimental State Examination for cognitive function, the Barthel index for basic activities of daily living, the Yesavage scale for geriatric depression, and the Athens insomnia scale. In addition, blood samples were collected to assess peripheral inflammation biomarkers including proinflammatory cytokines, fibrinogen, CRP and leukocyte differential count, as well as other biochemical and hematological parameters. RESULTS A significant negative correlation between the severity of frailty syndrome and lymphocyte count was observed (P < 0.01). The concentration of IL-6 (P < 0.05), CRP (P < 0.05), and fibrinogen (P < 0.01) were significantly associated with frailty syndrome, but not of TNF-α, IL-beta, or IL-8. The severity of frailty syndrome was not dependent upon the clinical disease stage at diagnosis, the time elapsed since CaP diagnosis, the presence of metastases, or prostatectomy. CONCLUSIONS Further research into the role of leukocyte subtypes and peripheral inflammation and the associated adverse outcomes in patients with CaP under ADT is warranted in order to tailor interventions aimed at reducing symptoms of frailty syndrome, such as loss of muscle strength and low physical activity.
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Fritz H, Seidarabi S, Barbour R, Vonbehren A. Occupational Therapy Intervention to Improve Outcomes Among Frail Older Adults: A Scoping Review. Am J Occup Ther 2019; 73:7303205130p1-7303205130p12. [PMID: 31120843 DOI: 10.5014/ajot.2019.030585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Frailty is common in later life and increases older adults' risk for early disability, institutionalization, and mortality. OBJECTIVE To explore the research literature on occupational therapy interventions to improve outcomes among frail, community-dwelling older adults. DESIGN Scoping review of the peer-reviewed literature about occupational therapy interventions and frailty published between January 1996 and January 2017. RESULTS Ten studies met the inclusion criteria. The majority of the studies focused on adults age 65 yr or older, operationalized frailty as activities of daily living disability, and did not use validated frailty measures to identify frail older adults. Interventions were delivered both as a stand-alone intervention and as part of a multidisciplinary approach. Treatments focused on recommendations and training in use of adaptive devices or assistive technologies, performance of self-care, and recommendations for home modifications. CONCLUSION Additional research is warranted to build the evidence base and better inform the design and selection of occupational therapy interventions to improve outcomes among frail older adults.
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Affiliation(s)
- Heather Fritz
- Heather Fritz, PhD, OTR/L, is Assistant Professor of Occupational Therapy and Gerontology, Eugene Applebaum College of Pharmacy and Health Sciences and Institute of Gerontology, Wayne State University, Detroit, MI;
| | - Sara Seidarabi
- Sara Seidarabi, MOT, is Occupational Therapy Student, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Ryan Barbour
- Ryan Barbour, MOT, is Occupational Therapy Student, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Alexandra Vonbehren
- Alexandra Vonbehren, MOT, is Occupational Therapy Student, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
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28
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Ipson BR, Fletcher MB, Espinoza SE, Fisher AL. Identifying Exosome-Derived MicroRNAs as Candidate Biomarkers of Frailty. J Frailty Aging 2019; 7:100-103. [PMID: 29741193 DOI: 10.14283/jfa.2017.45] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Frailty is a geriatric syndrome associated with progressive physical decline and significantly increases risk for falls, disability, hospitalizations, and death. However, much remains unknown regarding the biological mechanisms that contribute to aging and frailty, and to date, there are no clinically used prognostic or diagnostic molecular biomarkers. The present study profiled exosome-derived microRNAs isolated from the plasma of young, robust older, and frail older individuals and identified eight miRNAs that are uniquely enriched in frailty: miR-10a-3p, miR-92a-3p, miR-185-3p, miR-194-5p, miR-326, miR-532-5p, miR-576-5p, and miR-760. Furthermore, since exosomes can deliver miRNAs to alter cellular activity and behavior, these miRNAs may also provide insights into the biological mechanisms underlying frailty; KEGG analysis of their target genes revealed multiple pathways implicated in aging and age-related processes. Although further validation and research studies are warranted, our study identified eight novel candidate biomarkers of frailty that may help to elucidate the multifactorial pathogenesis of frailty.
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Affiliation(s)
- B R Ipson
- Alfred L. Fisher, GRECC-182, Audie L. Murphy VA Hospital, 7400 Merton Minter Blvd., San Antonio, TX 78229, USA; Phone: 210-617-5197, Fax: 210-617-5312,
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29
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Rodríguez-Gómez I, Mañas A, Losa-Reyna J, Rodríguez-Mañas L, Chastin SFM, Alegre LM, García-García FJ, Ara I. The Impact of Movement Behaviors on Bone Health in Elderly with Adequate Nutritional Status: Compositional Data Analysis Depending on the Frailty Status. Nutrients 2019; 11:nu11030582. [PMID: 30857291 PMCID: PMC6472191 DOI: 10.3390/nu11030582] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to determine the relationship between bone mass (BM) and physical activity (PA) and sedentary behavior (SB) according to frailty status and sex using compositional data analysis. We analyzed 871 older people with an adequate nutritional status. Fried criteria were used to classify by frailty status. Time spent in SB, light intensity PA (LPA) and moderate-to-vigorous intensity PA (MVPA) was assessed from accelerometry for 7 days. BM was determined by dual-energy X-ray absorptiometry (DXA). The combined effect of PA and SB was significantly associated with BM in robust men and women (p ≤ 0.05). In relation to the other behaviors, SB was negatively associated with BM in robust men while BM was positively associated with SB and negatively with LPA and MVPA in robust women. Moreover, LPA also was positively associated with arm BM (p ≤ 0.01). Finally, in pre-frail women, BM was positively associated with MVPA. In our sample, to decrease SB could be a good strategy to improve BM in robust men. In contrast, in pre-frail women, MVPA may be an important factor to consider regarding bone health.
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Affiliation(s)
- Irene Rodríguez-Gómez
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain.
- CIBER of Frailty and Healthy Aging (CIBERFES), 28001 Madrid, Spain.
| | - Asier Mañas
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain.
- CIBER of Frailty and Healthy Aging (CIBERFES), 28001 Madrid, Spain.
| | - José Losa-Reyna
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain.
- CIBER of Frailty and Healthy Aging (CIBERFES), 28001 Madrid, Spain.
- Geriatric Department, Hospital Virgen del Valle, 45071 Toledo, Spain.
| | - Leocadio Rodríguez-Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), 28001 Madrid, Spain.
- Geriatric Department, Hospital Universitario de Getafe, 28901 Getafe, Spain.
| | - Sebastien F M Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G1 1BX, UK.
- Department Movement and Sport Sciences, Ghent University, 9000 Ghent, Belgium.
| | - Luis M Alegre
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain.
- CIBER of Frailty and Healthy Aging (CIBERFES), 28001 Madrid, Spain.
| | - Francisco J García-García
- CIBER of Frailty and Healthy Aging (CIBERFES), 28001 Madrid, Spain.
- Geriatric Department, Hospital Virgen del Valle, 45071 Toledo, Spain.
| | - Ignacio Ara
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain.
- CIBER of Frailty and Healthy Aging (CIBERFES), 28001 Madrid, Spain.
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Kunimoto M, Shimada K, Yokoyama M, Matsubara T, Aikawa T, Ouchi S, Shimizu M, Fukao K, Miyazaki T, Kadoguchi T, Fujiwara K, Honzawa A, Yamada M, Shimada A, Yamamoto T, Amano A, Daida H. Relationship between the Kihon Checklist and the clinical parameters in patients who participated in cardiac rehabilitation. Geriatr Gerontol Int 2019; 19:287-292. [PMID: 30793829 DOI: 10.1111/ggi.13617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/10/2018] [Accepted: 12/25/2018] [Indexed: 11/28/2022]
Abstract
AIM The Kihon Checklist is a useful screening tool for assessing frailty in older individuals. However, the clinical significance of the Kihon Checklist in cardiac rehabilitation patients remains unclear. The present study aimed to evaluate the relationship between the Kihon Checklist and the clinical parameters in patients who participated in cardiac rehabilitation. METHODS We enrolled 845 consecutive patients (584 men, mean age 71 years) who participated in cardiac rehabilitation at Juntendo University Hospital, Tokyo, Japan, between November 2015 and October 2017. The patients were divided into non-frailty (n = 287), pre-frailty (n = 270) and frailty (n = 288) groups according to their Kihon Checklist scores. Cardiopulmonary exercise testing was carried out in 302 patients. RESULTS The frailty group was older and had a higher prevalence of history of heart failure than the non-frailty group, although left ventricular ejection fraction did not differ significantly between groups. Nutritional index, trunk and limb muscle mass, lean body weight, and grip strength were significantly lower in the frailty and pre-frailty groups than those in the non-frailty group. In the cardiopulmonary exercise test, a stepwise significant decrease in peak oxygen uptake was observed across the three groups (non-frailty 17.2 ± 3.6, pre-frailty 16.0 ± 3.4, frailty 14.4 ± 3.5 mL/kg/min, P < 0.01). Multivariate regression analyses showed that the Kihon Checklist score was significantly and independently associated with peak oxygen uptake (r = -0.34, P < 0.0001). CONCLUSIONS The Kihon Checklist, which was associated with frailty and exercise tolerance, could be used as a clinical assessment method for patients who participated in cardiac rehabilitation. Geriatr Gerontol Int 2019; 19: 287-292.
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Affiliation(s)
- Mitsuhiro Kunimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Miho Yokoyama
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Tomomi Matsubara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tatsuro Aikawa
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Megumi Shimizu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kosuke Fukao
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuro Miyazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoyasu Kadoguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kei Fujiwara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akio Honzawa
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Miki Yamada
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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31
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Pujos-Guillot E, Pétéra M, Jacquemin J, Centeno D, Lyan B, Montoliu I, Madej D, Pietruszka B, Fabbri C, Santoro A, Brzozowska A, Franceschi C, Comte B. Identification of Pre-frailty Sub-Phenotypes in Elderly Using Metabolomics. Front Physiol 2019; 9:1903. [PMID: 30733683 PMCID: PMC6353829 DOI: 10.3389/fphys.2018.01903] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 12/18/2018] [Indexed: 01/14/2023] Open
Abstract
Aging is a dynamic process depending on intrinsic and extrinsic factors and its evolution is a continuum of transitions, involving multifaceted processes at multiple levels. It is recognized that frailty and sarcopenia are shared by the major age-related diseases thus contributing to elderly morbidity and mortality. Pre-frailty is still not well understood but it has been associated with global imbalance in several physiological systems, including inflammation, and in nutrition. Due to the complex phenotypes and underlying pathophysiology, the need for robust and multidimensional biomarkers is essential to move toward more personalized care. The objective of the present study was to better characterize the complexity of pre-frailty phenotype using untargeted metabolomics, in order to identify specific biomarkers, and study their stability over time. The approach was based on the NU-AGE project (clinicaltrials.gov, NCT01754012) that regrouped 1,250 free-living elderly people (65–79 y.o., men and women), free of major diseases, recruited within five European centers. Half of the volunteers were randomly assigned to an intervention group (1-year Mediterranean type diet). Presence of frailty was assessed by the criteria proposed by Fried et al. (2001). In this study, a sub-cohort consisting in 212 subjects (pre-frail and non-frail) from the Italian and Polish centers were selected for untargeted serum metabolomics at T0 (baseline) and T1 (follow-up). Univariate statistical analyses were performed to identify discriminant metabolites regarding pre-frailty status. Predictive models were then built using linear logistic regression and ROC curve analyses were used to evaluate multivariate models. Metabolomics enabled to discriminate sub-phenotypes of pre-frailty both at the gender level and depending on the pre-frailty progression and reversibility. The best resulting models included four different metabolites for each gender. They showed very good prediction capacity with AUCs of 0.93 (95% CI = 0.87–1) and 0.94 (95% CI = 0.87–1) for men and women, respectively. Additionally, early and/or predictive markers of pre-frailty were identified for both genders and the gender specific models showed also good performance (three metabolites; AUC = 0.82; 95% CI = 0.72–0.93) for men and very good for women (three metabolites; AUC = 0.92; 95% CI = 0.86–0.99). These results open the door, through multivariate strategies, to a possibility of monitoring the disease progression over time at a very early stage.
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Affiliation(s)
- Estelle Pujos-Guillot
- Université Clermont Auvergne, Institut National de la Recherche Agronomique, Unité de Nutrition Humaine, Centre Auvergne Rhône Alpes, Clermont-Ferrand, France.,Université Clermont Auvergne, Institut National de la Recherche Agronomique, Unité de Nutrition Humaine, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Mélanie Pétéra
- Université Clermont Auvergne, Institut National de la Recherche Agronomique, Unité de Nutrition Humaine, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Jérémie Jacquemin
- Université Clermont Auvergne, Institut National de la Recherche Agronomique, Unité de Nutrition Humaine, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Delphine Centeno
- Université Clermont Auvergne, Institut National de la Recherche Agronomique, Unité de Nutrition Humaine, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Bernard Lyan
- Université Clermont Auvergne, Institut National de la Recherche Agronomique, Unité de Nutrition Humaine, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Ivan Montoliu
- Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - Dawid Madej
- Department of Human Nutrition, Warsaw University of Life Sciences - Szkoła Główna Gospodarstwa Wiejskiego, Warsaw, Poland
| | - Barbara Pietruszka
- Department of Human Nutrition, Warsaw University of Life Sciences - Szkoła Główna Gospodarstwa Wiejskiego, Warsaw, Poland
| | - Cristina Fabbri
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Aurelia Santoro
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.,Interdepartmental Center "L. Galvani", University of Bologna, Bologna, Italy
| | - Anna Brzozowska
- Department of Human Nutrition, Warsaw University of Life Sciences - Szkoła Główna Gospodarstwa Wiejskiego, Warsaw, Poland
| | | | - Blandine Comte
- Université Clermont Auvergne, Institut National de la Recherche Agronomique, Unité de Nutrition Humaine, Centre Auvergne Rhône Alpes, Clermont-Ferrand, France
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Crow RS, Lohman MC, Titus AJ, Cook SB, Bruce ML, Mackenzie TA, Bartels SJ, Batsis JA. Association of Obesity and Frailty in Older Adults: NHANES 1999-2004. J Nutr Health Aging 2019; 23:138-144. [PMID: 30697622 PMCID: PMC6371801 DOI: 10.1007/s12603-018-1138-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Body composition changes with aging can increase rates of obesity, frailty and impact function. Measuring adiposity using body fat (%BF) or central adiposity using waist circumference (WC) have greater diagnostic accuracy than traditional measures such as body mass index (BMI). DESIGN This is an observational study. SETTING This study focused on older community-dwelling participants. PARTICIPANTS We identified individuals age ≥ 60 years old using the 1999-2004 cross-sectional National Health and Nutrition Survey (NHANES). INTERVENTION The primary analysis evaluated the association between frailty and %BF or WC. Frailty was the primary predictor (robust=referent) and %BF and WC were considered continuous outcomes. Multiple imputation analyses accounted for missing characteristics. MEASUREMENT Dual energy x-ray absorptiometry was used to assess %BF and WC was objectively measured. Frailty was defined using an adapted version of Fried's criteria that was self-reported: (low BMI<18.5kg/m2; slow walking speed [<0.8m/s]; weakness [unable to lift 10lbs]; exhaustion [difficulty walking between rooms on same floor] and low physical activity [compared to others]). Robust, pre-frail and frail persons met zero, 1 or 2, and ≥3 criteria, respectively. RESULTS Of the 4,984 participants, the mean age was 71.1±0.2 (SE) years and 56.5% were females. We classified 2,246 (50.4%), 2,195 (40.3%), and 541 (9.2%) individuals as robust, pre-frail and frail, respectively. Percent BF was 35.9±0.13, 38.3±0.20 and 40.0±0.46 in the robust, pre-frail and frail individuals, respectively. WC was 99.5±0.32 in the robust, 100.1±0.43 in pre-frail, 104.7±1.17 in frail individuals. Compared to robust individuals, only frail individuals had greater %BF on average (β=0.97±0.43,p=0.03); however, pre-frail and frail individuals had 2.18 and 4.80 greater WC, respectively (β=2.18±0.64,p=0.002, and β=4.80±1.1,p<0.001). CONCLUSION Our results demonstrate that in older adults, frailty and pre-frailty are associated with a greater likelihood of high WC (as dichotomized) and a greater average WC (continuous).
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Affiliation(s)
- R S Crow
- Rebecca Crow, DO, Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, Telephone: (603) 653-9500, Facsimile: (603) 650-0915, E-mail:
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Schulman IH, Balkan W, Hare JM. Mesenchymal Stem Cell Therapy for Aging Frailty. Front Nutr 2018; 5:108. [PMID: 30498696 PMCID: PMC6249304 DOI: 10.3389/fnut.2018.00108] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/26/2018] [Indexed: 12/11/2022] Open
Abstract
Chronic diseases and degenerative conditions are strongly linked with the geriatric syndrome of frailty and account for a disproportionate percentage of the health care budget. Frailty increases the risk of falls, hospitalization, institutionalization, disability, and death. By definition, frailty syndrome is characterized by declines in lean body mass, strength, endurance, balance, gait speed, activity and energy levels, and organ physiologic reserve. Collectively, these changes lead to the loss of homeostasis and capability to withstand stressors and resulting vulnerabilities. There is a strong link between frailty, inflammation, and the impaired ability to repair tissue injury due to decreases in endogenous stem cell production. Although exercise and nutritional supplementation provide benefit to frail patients, there are currently no specific therapies for frailty. Bone marrow-derived allogeneic mesenchymal stem cells (MSCs) provide therapeutic benefits in heart failure patients irrespective of age. MSCs contribute to cellular repair and tissue regeneration through their multilineage differentiation capacity, immunomodulatory, and anti-inflammatory effects, homing and migratory capacity to injury sites, and stimulatory effect on endogenous tissue progenitors. The advantages of using MSCs as a therapeutic strategy include standardization of isolation and culture expansion techniques and safety in allogeneic transplantation. Based on this evidence, we performed a randomized, double-blinded, dose-finding study in elderly, frail individuals and showed that intravenously delivered allogeneic MSCs are safe and produce significant improvements in physical performance measures and inflammatory biomarkers. We thus propose that frailty can be treated and the link between frailty and chronic inflammation offers a potential therapeutic target, addressable by cell therapy.
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Affiliation(s)
- Ivonne Hernandez Schulman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, United States.,Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Wayne Balkan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, United States
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Niccoli S, Kolobov A, Bon T, Rafilovich S, Munro H, Tanner K, Pearson T, Lees SJ. Whey Protein Supplementation Improves Rehabilitation Outcomes in Hospitalized Geriatric Patients: A Double Blinded, Randomized Controlled Trial. J Nutr Gerontol Geriatr 2018; 36:149-165. [PMID: 29252150 DOI: 10.1080/21551197.2017.1391732] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Whey protein supplementation (WPS) has been shown to improve functional outcomes in populations that are able to participate in high-intensity resistance training. The purpose of the study was to evaluate the efficacy of WPS on rehabilitation outcomes in a frail, hospitalized elderly population. Men and women (n = 47) were randomly assigned to either a control group or WPS group for the length of their hospital stay. Several functional and serum measures were determined pre- and post-intervention. WPS significantly increased average daily protein intake and was well tolerated. The WPS group exhibited significant improvements in grip strength and knee extensor force over the control group, and a significant positive correlation was found between change in prealbumin and percent-increase knee extensor force. These findings support the use of WPS to improve protein nutritional status and rehabilitation outcomes in a clinical setting involving a frail, elderly population.
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Affiliation(s)
- Sarah Niccoli
- a Medical Sciences Division , Northern Ontario School of Medicine , Thunder Bay , Ontario , Canada
| | - Anton Kolobov
- b Geriatric Assessment and Rehabilitative Care , St. Joseph's Care Group , Thunder Bay , Ontario , Canada.,c Clinical Sciences Division , Northern Ontario School of Medicine , Thunder Bay , Ontario , Canada
| | - Trevor Bon
- b Geriatric Assessment and Rehabilitative Care , St. Joseph's Care Group , Thunder Bay , Ontario , Canada.,c Clinical Sciences Division , Northern Ontario School of Medicine , Thunder Bay , Ontario , Canada
| | - Seda Rafilovich
- b Geriatric Assessment and Rehabilitative Care , St. Joseph's Care Group , Thunder Bay , Ontario , Canada.,c Clinical Sciences Division , Northern Ontario School of Medicine , Thunder Bay , Ontario , Canada
| | - Heather Munro
- b Geriatric Assessment and Rehabilitative Care , St. Joseph's Care Group , Thunder Bay , Ontario , Canada
| | - Kim Tanner
- b Geriatric Assessment and Rehabilitative Care , St. Joseph's Care Group , Thunder Bay , Ontario , Canada
| | - Trina Pearson
- b Geriatric Assessment and Rehabilitative Care , St. Joseph's Care Group , Thunder Bay , Ontario , Canada
| | - Simon J Lees
- a Medical Sciences Division , Northern Ontario School of Medicine , Thunder Bay , Ontario , Canada.,d Department of Biology , Lakehead University , Thunder Bay , Ontario , Canada.,e Health and Exercise Science , Colorado State University , Fort Collins , Colorado , USA
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Appetite, Metabolism and Hormonal Regulation in Normal Ageing and Dementia. Diseases 2018; 6:diseases6030066. [PMID: 30036957 PMCID: PMC6164971 DOI: 10.3390/diseases6030066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/12/2022] Open
Abstract
Feeding and nutrition follow the growth trajectory of the course of life. The profound physiological changes that human body experiences during ageing affect separate aspects of food intake, from tastant perception to satiety. Concurrent morbidities, such as neurodegeneration, as seen in dementia, and metabolic syndrome, may further shape nutritional behaviours, status and adequacy. In an effort to fill the gap between the exhausting basic research and the actual needs of professionals caring for the exponentially expanding ageing population, the current review addresses major factors relevant to appetite and eating disturbances. Does age alter the perception of food modalities? Is food generally still perceived as alluring and delicious with age? Is there an interplay between ageing, cognitive decline, and malnutrition? What tools can we adopt for proper and timely monitoring? Finally, what anatomical and pathophysiological evidence exists to support a hypothesis of central regulation of metabolic perturbations in normal and accelerated cognitive impairment, and how can we benefit from it in health practice?
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Mitochondrial function is impaired in the skeletal muscle of pre-frail elderly. Sci Rep 2018; 8:8548. [PMID: 29867098 PMCID: PMC5986740 DOI: 10.1038/s41598-018-26944-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/23/2018] [Indexed: 01/15/2023] Open
Abstract
Aging is accompanied by a gradual decline in both muscle mass and strength over time, which can eventually lead to pathologies, such as frailty and sarcopenia. While these two conditions are well characterized, further investigation of the early biological signs present in pre-frail elderly is still needed to help identify strategies for preventative therapeutic intervention. The goal of the present clinical study was to evaluate the level of mitochondrial (dys)function in a well-defined population of pre-frail elderly (>60 years of age). Pre-frail elderly were compared with an age-matched population of active elderly. Muscle mitochondrial function was assessed in vivo using phosphorus magnetic resonance spectroscopy (31P-MRS) and a comprehensive set of biological biomarkers were measured ex vivo in vastus lateralis muscle biopsies. In pre-frail subjects, phosphocreatine recovery was impaired and mitochondrial respiratory complex protein and activity levels were significantly lower when compared with active elderly. Analysis of microarray data showed that mitochondrial genes were also significantly down-regulated in muscle of pre-frail compared to active elderly. These results show that mitochondrial impairment is a hallmark of pre-frailty development and the onset of decline in muscle function in the elderly.
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[Detection of the largest population susceptible to prescription of a program of exercises in Primary Care to prevent frailty]. Aten Primaria 2018; 51:135-141. [PMID: 29555215 PMCID: PMC6837154 DOI: 10.1016/j.aprim.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/08/2017] [Accepted: 11/22/2017] [Indexed: 11/20/2022] Open
Abstract
Objetivo Identificar a la población mayor de 70 años atendida en Atención Primaria, susceptible de participar en un programa de ejercicio físico para prevenir fragilidad. Analizar la concordancia entre 2 criterios para seleccionar la población beneficiaria del programa. Diseño Estudio transversal de base poblacional. Emplazamiento Atención Primaria. Participantes Mayores de 70 años no frágiles residentes del Barrio Peñagrande (distrito Fuencarral, Madrid) pertenecientes a la cohorte de Peñagrande localizables en 2015 y que aceptaron participar (n = 307). Mediciones principales La variable principal del estudio es la necesidad de prescripción de ejercicio en Atención Primaria en personas mayores de 70 años; se identificó a través de 2 definiciones diferentes: personas prefrágiles (1 o 2 de los 5 criterios de Fried) y personas independientes con desempeño físico limitado, definida por los criterios del documento de consenso sobre prevención de fragilidad y caídas en la persona mayor (mayor de 70 años independiente y con puntuación total del SPPB < 10). Resultados El 63,84% de los participantes (n = 196) necesitan prescripción del ejercicio por ser prefrágiles y/o por cumplir los criterios definidos en el documento de consenso. En 82 casos cumplían los 2 criterios (prefragilidad y desempeño físico disminuido), 80 eran prefrágiles con desempeño físico normal y 34 eran robustos con desempeño físico limitado. La concordancia entre ambos criterios es débil (índice kappa 0,27). Conclusión Casi 2 tercios de los mayores presentan algún tipo de limitación funcional. Los criterios del documento de consenso para prevenir la fragilidad detectan a la mitad de los individuos prefrágiles de la comunidad.
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Crow RS, Lohman MC, Titus AJ, Bruce ML, Mackenzie TA, Bartels SJ, Batsis JA. Mortality Risk Along the Frailty Spectrum: Data from the National Health and Nutrition Examination Survey 1999 to 2004. J Am Geriatr Soc 2018; 66:496-502. [PMID: 29368330 DOI: 10.1111/jgs.15220] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the relationship between frailty and overall and cardiovascular mortality. DESIGN Longitudinal mortality analysis. SETTING National Health and Nutrition Examination Survey (NHANES) 1999-2004. PARTICIPANTS Community-dwelling older adults aged 60 and older (N = 4,984; mean age 71.1 ± 0.19, 56% female). MEASUREMENTS We used data from 1999-2004 cross-sectional NHANES and mortality data from the National Death Index, updated through December 2011. An adapted version of Fried's frailty criteria was used (low body mass index, slow walking speed, weakness, exhaustion, low physical activity). Frailty was defined as persons meeting 3 or more criteria, prefrailty as meeting 1 or 2 criteria, and robust (reference) as not meeting any criteria. The primary outcome was to evaluate the association between frailty and overall and cardiovascular mortality. Cox proportional hazard models were used to evaluate the association between risk of death and frailty category adjusted for age, sex, race, smoking, education, coronary artery disease, heart failure, nonskin cancer, diabetes, and arthritis. RESULTS Half (50.4%) of participants were classified as robust, 40.3% as prefrail, and 9.2% as frail. Fully adjusted models demonstrated that prefrail (hazard ratio (HR) = 1.64, 95% confidence interval (CI) = 1.45-1.85) and frail (HR = 2.79, 95% CI = 2.35-3.30) participants had a greater risk of death and of cardiovascular death (prefrail: HR = 1.84, 95% CI = 1.45-2.34; frail: HR = 3.39, 95% CI = 2.45-4.70). CONCLUSION Frailty and prefrailty are associated with increased risk of death. Demonstrating the association between prefrail status and mortality is the first step to identifying potential targets of intervention in future studies.
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Affiliation(s)
- Rebecca S Crow
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire
| | - Matthew C Lohman
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire
| | - Alexander J Titus
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Martha L Bruce
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire
| | - Todd A Mackenzie
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.,Dartmouth Institute for Health Policy and Clinical Research, Lebanon, New Hampshire
| | - Stephen J Bartels
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire.,Dartmouth Institute for Health Policy and Clinical Research, Lebanon, New Hampshire
| | - John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire.,Dartmouth Institute for Health Policy and Clinical Research, Lebanon, New Hampshire.,Dartmouth Weight & Wellness Center, Lebanon, New Hampshire
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Fernandez-Garrido J, Ruiz-Ros V, Navarro-Martínez R, Buigues C, Martínez-Martínez M, Verdejo Y, Sanantonio-Camps L, Mascarós MC, Cauli O. Frailty and leucocyte count are predictors of all-cause mortality and hospitalization length in non-demented institutionalized older women. Exp Gerontol 2018; 103:80-86. [PMID: 29326085 DOI: 10.1016/j.exger.2018.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/09/2017] [Accepted: 01/04/2018] [Indexed: 01/10/2023]
Abstract
Alteration in the immune system such as the number of white blood cells count (WBC) has been associated with frailty syndrome but their role in institutionalized older individuals have been rarely investigated. We evaluated the relationships between white blood cell subtypes, geriatric assessment, depression and frailty syndrome based on the criteria of physical phenotype. In particular, we aimed to analyze by a two-year follow-up and prospective study the predictive value of alterations in WBC, frailty and functional impairment in terms of hospitalizations and all-cause mortality in institutionalized older women. There was a significant and inverse correlation between the frailty score and lymphocyte count at baseline but it did not display any predictive effect for the outcomes (hospitalizations and mortality). In contrast, monocytes count was significantly correlated with number of hospital stays and predicted hospitalizations in the follow-up. High frailty score directly and better functional status (Barthel score) inversely predicted mortality in the follow-up with an HR of 1.87 (95%CI: 1.04-3.35), and 0.97 (95% CI: 0.96-0.99) (p < .05 in both cases). Further investigation into the role of white blood cell subtypes in aging and its associated adverse outcomes in older adults is warranted. Physical phenotype of frailty besides general population, also predicted mortality in older institutionalized women and deserves specific intervention in this subgroup of older individuals.
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Affiliation(s)
| | - Vicente Ruiz-Ros
- Department of Nursing, University of Valencia, Valencia, Spain; Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | | | | | | | | | | | | | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia, Spain.
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Sacha J, Sacha M, Soboń J, Borysiuk Z, Feusette P. Is It Time to Begin a Public Campaign Concerning Frailty and Pre-frailty? A Review Article. Front Physiol 2017; 8:484. [PMID: 28744225 PMCID: PMC5504234 DOI: 10.3389/fphys.2017.00484] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 06/23/2017] [Indexed: 01/06/2023] Open
Abstract
Frailty is a state that encompasses losses in physical, psychological or social domains. Therefore, frail people demonstrate a reduced potential to manage external stressors and to respond to life incidents. Consequently, such persons are prone to various adverse consequences such as falls, cognitive decline, infections, hospitalization, disability, institutionalization, and death. Pre-frailty is a condition predisposing and usually preceding the frailty state. Early detection of frailty (i.e., pre-frailty) may present an opportunity to introduce effective management to improve outcomes. Exercise training appears to be the basis of such management in addition to periodic monitoring of food intake and body weight. However, various nutritional supplements and other probable interventions, such as treatment with vitamin D or androgen, require further investigation. Notably, many societies are not conscious of frailty as a health problem. In fact, people generally do not realize that they can change this unfavorable trajectory to senility. As populations age, it is reasonable to begin treating frailty similarly to other population-affecting disorders (e.g., obesity, diabetes or cardiovascular diseases) and implement appropriate preventative measures. Social campaigns should inform societies about age-related frailty and pre-frailty and suggest appropriate lifestyles to avoid or delay these conditions. In this article, we review current information concerning therapeutic interventions in frailty and pre-frailty and discuss whether a greater public awareness of such conditions and some preventative and therapeutic measures may decrease their prevalence.
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Affiliation(s)
- Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of TechnologyOpole, Poland
- Department of Cardiology, University Hospital of the University of OpoleOpole, Poland
| | | | - Jacek Soboń
- Faculty of Physical Education and Physiotherapy, Opole University of TechnologyOpole, Poland
| | - Zbigniew Borysiuk
- Faculty of Physical Education and Physiotherapy, Opole University of TechnologyOpole, Poland
| | - Piotr Feusette
- Department of Cardiology, University Hospital of the University of OpoleOpole, Poland
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Laur CV, McNicholl T, Valaitis R, Keller HH. Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition. Appl Physiol Nutr Metab 2017; 42:449-458. [PMID: 28322060 DOI: 10.1139/apnm-2016-0652] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
There is increasing awareness of the detrimental health impact of frailty on older adults and of the high prevalence of malnutrition in this segment of the population. Experts in these 2 arenas need to be cognizant of the overlap in constructs, diagnosis, and treatment of frailty and malnutrition. There is a lack of consensus regarding the definition of malnutrition and how it should be assessed. While there is consensus on the definition of frailty, there is no agreement on how it should be measured. Separate assessment tools exist for both malnutrition and frailty; however, there is intersection between concepts and measures. This narrative review highlights some of the intersections within these screening/assessment tools, including weight loss/decreased body mass, functional capacity, and weakness (handgrip strength). The potential for identification of a minimal set of objective measures to identify, or at least consider risk for both conditions, is proposed. Frailty and malnutrition have also been shown to result in similar negative health outcomes and consequently common treatment strategies have been studied, including oral nutritional supplements. While many of the outcomes of treatment relate to both concepts of frailty and malnutrition, research questions are typically focused on the frailty concept, leading to possible gaps or missed opportunities in understanding the effect of complementary interventions on malnutrition. A better understanding of how these conditions overlap may improve treatment strategies for frail, malnourished, older adults.
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Affiliation(s)
- Celia V Laur
- a Faculty of Applied Health Science, University of Waterloo, 200 University Ave., Waterloo, ON N2L 3G1, Canada
| | - Tara McNicholl
- a Faculty of Applied Health Science, University of Waterloo, 200 University Ave., Waterloo, ON N2L 3G1, Canada
| | - Renata Valaitis
- a Faculty of Applied Health Science, University of Waterloo, 200 University Ave., Waterloo, ON N2L 3G1, Canada
| | - Heather H Keller
- b Faculty of Applied Health Science, University of Waterloo, 200 University Ave., Waterloo, ON N2L 3G1, Canada.,c Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, 200 University Ave., Waterloo, ON N2L 3G1, Canada
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Bertoli A, Valentini A, Cianfarani MA, Gasbarra E, Tarantino U, Federici M. Low FT3: a possible marker of frailty in the elderly. Clin Interv Aging 2017; 12:335-341. [PMID: 28228654 PMCID: PMC5312686 DOI: 10.2147/cia.s125934] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction Frailty is associated with a functional decline of multiple physiological systems, of which they may be a cause or consequence. The objective of the study was to evaluate the prevalence of thyroid hormone modifications in elderly frail subjects and its relationship with frailty. Study population and methods An observational study was carried out at the University Hospital “Tor Vergata” in Rome among ambulatory and hospitalized patients. The study population consisted of 112 elderly subjects: 62 were hospitalized following hip fracture and 50 control subjects were outpatients. Participating patients received a multidimensional geriatric evaluation. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) was used to assess the degree of frailty. Thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were measured to evaluate thyroid status. Results FT3, but not FT4, was significantly correlated with Frailty score, both in patients with hip fracture and in patients from the control group. In the entire study population, FT3 under normal limits is effective in discriminating frail/prefrail subjects from nonfrail subjects. Discussion The reduction in serum concentrations of FT3 is a clear manifestation of stress associated with fractures. Numerous preexisting factors, such as the fracture patients’ nutritional status, sarcopenia, disability and comorbidities, which characterize the condition of frailty and influence its pathogenesis, are strongly correlated with FT3 values, suggesting the existence of latent nonthyroidal illness syndrome (NTIS). Conclusion We conclude that measuring FT3 can be a useful laboratory parameter in clinical assessment, which can play an important role in identifying vulnerable elderly subjects and in quantifying the condition of frailty.
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Affiliation(s)
- Aldo Bertoli
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alessia Valentini
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Elena Gasbarra
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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Lekan DA, Wallace DC, McCoy TP, Hu J, Silva SG, Whitson HE. Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record. Biol Res Nurs 2017; 19:213-228. [PMID: 27913742 DOI: 10.1177/1099800416679730] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes. PURPOSE The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization. METHODS The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined. RESULTS The mean age of the sample was 70.2 years and mean FRS was 9.4 ( SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77-2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS ( p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]). DISCUSSION Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.
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Affiliation(s)
- Deborah A Lekan
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Debra C Wallace
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Thomas P McCoy
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Jie Hu
- 2 College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Susan G Silva
- 3 School of Nursing, Duke University, Durham, NC, USA
| | - Heather E Whitson
- 4 Departments of Medicine and Opthalmology, School of Medicine, Duke University, Durham, NC, USA.,5 Durham VA Geriatrics Research Education and Clinical Center (GRECC), Durham, NC, USA
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Dhamoon MS, Cheung YK, Moon YP, Wright CB, Willey JZ, Sacco R, Elkind MS. C-reactive protein is associated with disability independently of vascular events: the Northern Manhattan Study. Age Ageing 2017; 46:77-83. [PMID: 28181636 DOI: 10.1093/ageing/afw179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/14/2016] [Indexed: 12/26/2022] Open
Abstract
Background High-sensitivity C-reactive protein (CRP) has been associated with cardiovascular events and mortality, but the association of CRP with functional status is not well defined. We hypothesised that serum levels of high-sensitivity CRP are associated with long-term trajectories of functional status independently of vascular risk factors and stroke and myocardial infarction (MI) occurring during follow-up. Design Prospective, population-based. Setting Northern Manhattan Study. Participants Stroke-free participants aged ≥40 years. Measurements Annual assessments of disability with the Barthel index (BI) for a median of 13 years. BI was analysed as a continuous variable (range 0–100). Baseline demographics, risk factors and laboratory studies were collected, including CRP (n = 2,240). Separate generalised estimating equation models estimated standardised associations between CRP and (i) baseline functional status and (ii) change in function over time, adjusting for demographics, vascular risk factors, social variables, cognition, and depression measured at baseline, and stroke and MI occurring during follow-up. Results Mean age was 69 (SD 10) years, 36% were male, 55% Hispanic, 75% hypertensive and 21% diabetic; 337 MIs and 369 first strokes occurred during follow-up. Mean CRP level was 5.24 mg/l (SD 8.86). logCRP was associated with baseline BI (−0.34 BI points per unit logCRP, 95% confidence interval −0.62, −0.06) but not with change over time. Conclusions In this large population-based study, higher serum CRP levels were associated with higher baseline disability, even when adjusting for baseline covariates and stroke and MI occurring during follow-up. Systemic inflammation may contribute to disability independently of clinical vascular events.
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Affiliation(s)
- Mandip S Dhamoon
- Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | | | - Yeseon P Moon
- Biostatistics, Columbia University, New York, NY, USA
| | | | | | - Ralph Sacco
- Medicine, University of Miami, Miami, FL, USA
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47
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Ng TP, Nyunt MSZ, Feng L, Feng L, Niti M, Tan BY, Chan G, Khoo SA, Chan SM, Yap P, Yap KB. Multi-Domains Lifestyle Interventions Reduces Depressive Symptoms among Frail and Pre-Frail Older Persons: Randomized Controlled Trial. J Nutr Health Aging 2017; 21:918-926. [PMID: 28972245 DOI: 10.1007/s12603-016-0867-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND We investigated the effect of multi-domain lifestyle (physical, nutritional, cognitive) interventions among frail and pre-frail community-living older persons on reducing depressive symptoms. METHOD Participants aged 65 and above were randomly allocated to 24 weeks duration interventions with nutritional supplementation (N=49), physical training (N=48), cognitive training (N=50), combination intervention (N=49) and usual care control (N=50). Depressive symptoms were assessed by the Geriatric Depression Scale (GDS-15) at baseline (0M), 3 month (3M), 6 month (6M) and 12 month (12M). RESULTS Mean GDS scores in the control group increased from 0.52 (0M) and 0.54 (3M) to 0.74 (6M), and 0.83 (12M). Compared to the control group, interventions showed significant differences (∆=change) at 6M for cognitive versus control (∆=-0.39, p=0.021, group*time interaction p=0.14); physical versus control (∆ =-0.37, p=0.026, group*time interaction p=0.13), and at 12M for nutrition versus control (∆ =-0.46, p=0.016, group*time interaction p=0.15). The effect for combination versus control was significant at 6M (∆ =-0.43, p=0.020) and 12M (∆ =-0.51, p=0.005, group*time interaction p=0.026). Estimated 12-month cumulative incidence of depressive symptoms (GDS≥2) relative to control were OR=0.38, p=0.037 (nutrition); OR=0.71, p=0.40 (cognitive); OR=0.39, p=0.042 (physical training) and OR=0.38, p=0.037 (combination). Changes in gait speed and energy level were significantly associated with changes in GDS scores over time. CONCLUSION Multi-domain interventions that reverse frailty among community-living older persons also reduce depressive symptomatology. Public health education and programmatic measures combining nutritional, physical and cognitive interventions for at-risk frail older people may likely benefit psychological wellbeing.
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Affiliation(s)
- T P Ng
- A/P Tze-Pin Ng, Gerontology Research Programme, National University of Singapore, Department of Psychological Medicine, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore 119228 Fax: 65-67772191, Tel: 65-67723478
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48
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Vieira AI, Nogueira D, de Azevedo Reis E, da Lapa Rosado M, Vânia Nunes M, Castro-Caldas A. Hand tactile discrimination, social touch and frailty criteria in elderly people: A cross sectional observational study. Arch Gerontol Geriatr 2016; 66:73-81. [DOI: 10.1016/j.archger.2016.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/07/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
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49
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Buigues C, Fernández-Garrido J, Pruimboom L, Hoogland AJ, Navarro-Martínez R, Martínez-Martínez M, Verdejo Y, Mascarós MC, Peris C, Cauli O. Effect of a Prebiotic Formulation on Frailty Syndrome: A Randomized, Double-Blind Clinical Trial. Int J Mol Sci 2016; 17:ijms17060932. [PMID: 27314331 PMCID: PMC4926465 DOI: 10.3390/ijms17060932] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 12/21/2022] Open
Abstract
Aging can result in major changes in the composition and metabolic activities of bacterial populations in the gastrointestinal system and result in impaired function of the immune system. We assessed the efficacy of prebiotic Darmocare Pre(®) (Bonusan Besloten Vennootschap (BV), Numansdorp, The Netherlands) to evaluate whether the regular intake of this product can improve frailty criteria, functional status and response of the immune system in elderly people affected by the frailty syndrome. The study was a placebo-controlled, randomized, double blind design in sixty older participants aged 65 and over. The prebiotic product was composed of a mixture of inulin plus fructooligosaccharides and was compared with placebo (maltodextrin). Participants were randomized to a parallel group intervention of 13 weeks' duration with a daily intake of Darmocare Pre(®) or placebo. Either prebiotic or placebo were administered after breakfast (between 9-10 a.m.) dissolved in a glass of water carefully stirred just before drinking. The primary outcome was to study the effect on frailty syndrome. The secondary outcomes were effect on functional and cognitive behavior and sleep quality. Moreover, we evaluated whether prebiotic administration alters blood parameters (haemogram and biochemical analysis). The overall rate of frailty was not significantly modified by Darmocare Pre(®) administration. Nevertheless, prebiotic administration compared with placebo significantly improved two frailty criteria, e.g., exhaustion and handgrip strength (p < 0.01 and p < 0.05, respectively). No significant effects were observed in functional and cognitive behavior or sleep quality. The use of novel therapeutic approaches influencing the gut microbiota-muscle-brain axis could be considered for treatment of the frailty syndrome.
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Affiliation(s)
- Cristina Buigues
- Department of Nursing, University of Valencia, Valencia 46010, Spain.
| | | | - Leo Pruimboom
- Natura Foundation, Numansdorp 3281 NC, The Netherlands.
- University of Groningen, University Medical Center Groningen (UMCG), Groningen 9712 CP, The Netherlands.
| | | | | | | | | | | | - Carlos Peris
- GeroResidencias La Saleta, Valencia 46015, Spain.
| | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia 46010, Spain.
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