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Kayahan Satış N, Naharcı Mİ. Investigating the association of anticholinergic burden with depression in older adults: a cross-sectional study. Psychogeriatrics 2024; 24:597-604. [PMID: 38484758 DOI: 10.1111/psyg.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/09/2024] [Accepted: 02/15/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND Although depression and anticholinergic drug use are common comorbidities that impair health status in later life, there are insufficient data on their relationship. This study aimed to investigate the relationship between depressive symptoms and anticholinergic use in older individuals. METHODS Community-dwelling older adults (≥65 years) admitted to the tertiary referral geriatric outpatient clinic were included. Participants were evaluated for depressive symptoms using the Geriatric Depression Scale (GDS) with a cut-off score of ≥6 for depression. Exposure to anticholinergic drugs was assessed using the anticholinergic cognitive burden (ACB) scale and three subgroups were created: ACB = 0, ACB = 1, and ACB ≥ 2. The relationship between these two parameters was assessed using multivariate logistic regression analysis considering other potential variables. RESULTS The study included 1232 participants (mean age 78.4 ± 7.2 years and 65.2% female) and the prevalence of depression was 24%. After adjusting for potential confounders, compared to ACB = 0, having ACB ≥ 2 was related to depression symptoms (odds ratio (OR): 1.56, 95% CI: 1.04-2.35, P = 0.034), whereas having ACB = 1 did not increase the risk (OR: 1.27, 95% CI: 0.88-1.83, P = 0.205). CONCLUSION Our findings indicate that special attention should be paid to drug therapy in preventing depression in older adults, as exposure to a high anticholinergic load is negatively associated with psychological status.
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Affiliation(s)
- Neslihan Kayahan Satış
- Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Turkey
| | - Mehmet İlkin Naharcı
- Gülhane Faculty of Medicine and Gülhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Turkey
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Saz HG, Yalçın N, Demirkan K, Halil MG. Clinical pharmacist-led assessment and management of anticholinergic burden and fall risk in geriatric patients. BMC Geriatr 2023; 23:863. [PMID: 38102545 PMCID: PMC10724986 DOI: 10.1186/s12877-023-04599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/14/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The aim of this study was to examine the risk of fall with the surrogate outcome of the Aachen Falls Prevention Scale and to assess the clinical pharmacist interventions in order to minimize anticholinergic drug burden and associated risk of fall according to a fall risk assessment scale in the older adults. METHODS Patients who admitted to the geriatric outpatient clinic of a university hospital and taking at least one anticholinergic drug were evaluated both retrospectively and prospectively as groups of different patients by the clinical pharmacist. Patients' anticholinergic burden was assessed using the Anticholinergic Cognitive Burden Scale. For fall risk assessment, the Aachen Falls Prevention Scale was also administered to each patient whose anticholinergic burden was determined in the prospective phase of the study. RESULTS A total of 601 patients were included. Risk of falls increased 2.50 times in patients with high anticholinergic burden (OR (95% CI) = 2.503 (1.071-5.852); p = 0.034), and the existing history of falls increased the risk of high anticholinergic burden 2.02 times (OR (95%CI) = 2.026 (1.059-3.876); p = 0.033). In addition, each unit increase in the fall scale score in the prospective phase increased the risk of high anticholinergic burden by 22% (p = 0.028). Anticholinergic burden was significantly reduced as a result of interventions by the clinical pharmacist in the prospective phase (p = 0.010). CONCLUSION Our study revealed that incorporating a clinical pharmacist in the handling of geriatric patients aids in the detection, reduction, and prevention of anticholinergic adverse effects.
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Affiliation(s)
- Hilal Gökçay Saz
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, 06230, Turkey
| | - Nadir Yalçın
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, 06230, Turkey.
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, 06230, Turkey
| | - Meltem Gülhan Halil
- Division of Geriatric Medicine, Department of Internal Medine, Faculty of Medicine, Hacettepe University, Ankara, 06230, Turkey
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Sargent L, Zimmerman KM, Mohammed A, Barrett MJ, Nawaz H, Wyman-Chick K, Mackiewicz M, Roman Y, Slattum P, Russell S, Dixon DL, Lageman SK, Hobgood S, Thacker LR, Price ET. Low-Income Older Adults' Vulnerability to Anticholinergic Medication-Associated Frailty. Drugs Aging 2023; 40:1123-1131. [PMID: 37856064 DOI: 10.1007/s40266-023-01069-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND A growing body of research supports the negative impact of anticholinergic drug burden on physical frailty. However, prior research has been limited to homogeneous white European populations, and few studies have evaluated how anticholinergic burden tools compare in their measurement function and reliability with minority community-dwelling adult populations. This study investigated the association between anticholinergic drug exposure and frailty by conducting a sensitivity analysis using multiple anticholinergic burden tools in a diverse cohort. METHODS A comprehensive psychometric approach was used to assess the performance of five clinical Anticholinergic Burden Tools: Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), average daily dose, total standardized daily doses (TSDD), and Cumulative Anticholinergic Burden scale (CAB). Spearman correlation matrix and intraclass correlation coefficients (ICC) were used to determine the association among the variables. Ordinal logistic regression is used to evaluate the anticholinergic burden measured by each scale to determine the prediction of frailty. Model performance is determined by the area under the curve (AUC). RESULTS The cohort included 80 individuals (mean age 69 years; 55.7% female, 71% African American). All anticholinergic burden tools were highly correlated (p < 0.001), ICC3 0.66 (p < 0.001, 95% confidence interval (CI) 0.53-0.73). Among individuals prescribed anticholinergics, 33% were robust, 44% were prefrail, and 23% were frail. All five tools predicted prefrail and frail status (p < 0.05) with low model misclassification rates for frail individuals (AUC range 0.78-0.85). CONCLUSION Anticholinergic burden tools evaluated in this cohort of low-income African American older adults were highly correlated and predicted prefrail and frail status. Findings indicate that clinicians can select the appropriate instrument for the clinic setting and research question while maintaining confidence that all five tools will produce reliable results. Future anticholinergic research is needed to unravel the association between interventions such as deprescribing on incident frailty in longitudinal data.
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Affiliation(s)
- Lana Sargent
- School of Nursing, Virginia Commonwealth University, 1100 E Leigh St., Richmond, VA, 23298, USA.
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA.
- Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA.
| | - Kristin M Zimmerman
- Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
| | - Almutairi Mohammed
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, 51452, Buraydah, Saudi Arabia
| | - Matthew J Barrett
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Huma Nawaz
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | | | - Marissa Mackiewicz
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
- Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA
| | - Youssef Roman
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
| | - Patricia Slattum
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
- Virginia Center on Aging, Virginia Commonwealth University, 900 E Leigh St, Richmond, VA, 23298, USA
| | - Sally Russell
- School of Nursing, Virginia Commonwealth University, 1100 E Leigh St., Richmond, VA, 23298, USA
| | - Dave L Dixon
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
| | - Sarah K Lageman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Sarah Hobgood
- School of Medicine, Department of Geriatrics, Virginia Commonwealth University, 1101 E. Marshall St., Richmond, VA, 23298, USA
| | - Leroy R Thacker
- School of Medicine, Department of Biostatistics, Virginia Commonwealth University, 830 East Main Street, Richmond, VA, 23298, USA
| | - Elvin T Price
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
- Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
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Dent E, Hanlon P, Sim M, Jylhävä J, Liu Z, Vetrano DL, Stolz E, Pérez-Zepeda MU, Crabtree DR, Nicholson C, Job J, Ambagtsheer RC, Ward PR, Shi SM, Huynh Q, Hoogendijk EO. Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology. Ageing Res Rev 2023; 91:102082. [PMID: 37797723 DOI: 10.1016/j.arr.2023.102082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/07/2023]
Abstract
Frailty is an age-related clinical condition characterised by an increased susceptibility to stressors and an elevated risk of adverse outcomes such as mortality. In the light of global population ageing, the prevalence of frailty is expected to soar in coming decades. This narrative review provides critical insights into recent developments and emerging practices in frailty research regarding identification, management, risk factors, and prevention. We searched journals in the top two quartiles of geriatrics and gerontology (from Clarivate Journal Citation Reports) for articles published between 01 January 2018 and 20 December 2022. Several recent developments were identified, including new biomarkers and biomarker panels for frailty screening and diagnosis, using artificial intelligence to identify frailty, and investigating the altered response to medications by older adults with frailty. Other areas with novel developments included exercise (including technology-based exercise), multidimensional interventions, person-centred and integrated care, assistive technologies, analysis of frailty transitions, risk-factors, clinical guidelines, COVID-19, and potential future treatments. This review identified a strong need for the implementation and evaluation of cost-effective, community-based interventions to manage and prevent frailty. Our findings highlight the need to better identify and support older adults with frailty and involve those with frailty in shared decision-making regarding their care.
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Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
| | - Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Marc Sim
- Nutrition and Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Faculty of Social Sciences, Unit of Health Sciences and Gerontology Research Center, University of Tampere, Tampere, Finland
| | - Zuyun Liu
- Second Affiliated Hospital and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Mario Ulises Pérez-Zepeda
- Instituto Nacional de Geriatría, Dirección de Investigación, ciudad de México, Mexico; Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan Edo. de México
| | | | - Caroline Nicholson
- Centre for Health System Reform & Integration, Mater Research Institute-University of Queensland, Brisbane, Australia
| | - Jenny Job
- Centre for Health System Reform & Integration, Mater Research Institute-University of Queensland, Brisbane, Australia
| | - Rachel C Ambagtsheer
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
| | - Paul R Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
| | - Sandra M Shi
- Hinda and Arthur Marcus Institute for Aging, Hebrew Senior Life, Boston, Massachusetts, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science and Department of General Practice, Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands; Amsterdam Public Health research institute, Ageing & Later Life Research Program, Amsterdam UMC, Amsterdam, the Netherlands.
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Bag Soytas R, Levinoff EJ, Smith L, Doventas A, Morais JA, Veronese N, Soysal P. Predictive Strategies to Reduce the Risk of Rehospitalization with a Focus on Frail Older Adults: A Narrative Review. EPIDEMIOLOGIA 2023; 4:382-407. [PMID: 37873884 PMCID: PMC10594531 DOI: 10.3390/epidemiologia4040035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/16/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023] Open
Abstract
Frailty is a geriatric syndrome that has physical, cognitive, psychological, social, and environmental components and is characterized by a decrease in physiological reserves. Frailty is associated with several adverse health outcomes such as an increase in rehospitalization rates, falls, delirium, incontinence, dependency on daily living activities, morbidity, and mortality. Older adults may become frailer with each hospitalization; thus, it is beneficial to develop and implement preventive strategies. The present review aims to highlight the epidemiological importance of frailty in rehospitalization and to compile predictive strategies and related interventions to prevent hospitalizations. Firstly, it is important to identify pre-frail and frail older adults using an instrument with high validity and reliability, which can be a practically applicable screening tool. Comprehensive geriatric assessment-based care is an important strategy known to reduce morbidity, mortality, and rehospitalization in older adults and aims to meet the needs of frail patients with a multidisciplinary approach and intervention that includes physiological, psychological, and social domains. Moreover, effective multimorbidity management, physical activity, nutritional support, preventing cognitive frailty, avoiding polypharmacy and anticholinergic drug burden, immunization, social support, and reducing the caregiver burden are other recommended predictive strategies to prevent post-discharge rehospitalization in frail older adults.
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Affiliation(s)
- Rabia Bag Soytas
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Elise J. Levinoff
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Lee Smith
- Center for Health Performance and Wellbeing, Anglia Ruskin University, East Road, Cambridge CB1 1PT, UK
| | - Alper Doventas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34320, Turkey;
| | - José A. Morais
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, 90133 Palermo, Italy;
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34320, Turkey;
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Katipoglu B, Demircan SK, Naharci MI. Association of drug burden index with delirium in community-dwelling older adults with dementia: a longitudinal observational study. Int J Clin Pharm 2023; 45:1267-1276. [PMID: 36933080 DOI: 10.1007/s11096-023-01551-7] [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: 09/30/2022] [Accepted: 02/02/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND The Drug Burden Index (DBI) is a validated tool for assessing the dose-dependent cumulative exposure to sedative and anticholinergic medications. However, the increased risk of delirium superimposed dementia (DSD) with high DBI levels has not yet been investigated. AIM This study aimed to examine the potential association between DBI scores and delirium in community-dwelling older adults with dementia. METHOD A total of 1105 participants with cognitive impairment underwent a comprehensive geriatric assessment. Experienced geriatricians made the final diagnosis of delirium based on DSM-IV-TR and DSM-V. We calculated the DBI as the sum of all sedatives and anticholinergics taken continuously for at least four weeks before admission. Polypharmacy was defined as regular use of five or more medications. We classified the participants as having no exposure (DBI = 0), low exposure (0 < DBI < 1), and high exposure (DBI ≥ 1). RESULTS Of the 721 patients with dementia, the mean age was 78.3 ± 6.7 years, and the majority were female (64.4%). In the whole sample, low and high exposures to anticholinergic and sedative medications at admission were 34.1% (n = 246) and 38.1% (n = 275), respectively. Patients in the high-exposure group had higher physical impairment (p = 0.01), higher polypharmacy (p = 0.01), and higher DBI scores (p = 0.01). In the multivariate Cox regression analysis, high exposure to anticholinergic and sedative medications increased the risk of delirium 4.09-fold compared to the no exposure group (HR = 4.09, CI: 1.63-10.27, p = 0.01). CONCLUSION High exposure to drugs with sedative and anticholinergic properties was common in community-dwelling older adults. A high DBI was associated with DSD, highlighting the need for an optimal prescription in this vulnerable population. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov. Identifier: NCT04973709 Registered on 22 July 2021.
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Affiliation(s)
- Bilal Katipoglu
- Division of Geriatrics, Department of Internal Medicine, Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, University of Health Sciences, 06010, Ankara, Turkey.
| | - Sultan Keskin Demircan
- Division of Geriatrics, Department of Internal Medicine, Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, University of Health Sciences, 06010, Ankara, Turkey
| | - Mehmet Ilkin Naharci
- Division of Geriatrics, Department of Internal Medicine, Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, University of Health Sciences, 06010, Ankara, Turkey
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Yan LC, Lu HY, Wang XY, Xiao G, Chang Y, Yuan P, Wang B. Prevalence and risk factors of frailty in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis. Eur Geriatr Med 2023; 14:789-802. [PMID: 37436687 PMCID: PMC10447286 DOI: 10.1007/s41999-023-00800-2] [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: 02/19/2023] [Accepted: 05/10/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To systematically review the prevalence and risk factors for frailty in patients with chronic obstructive pulmonary disease (COPD). METHODS A systematic review and meta-analysis were conducted, and a search of the PubMed, Embase and Web of Science databases was carried out to collect Chinese and English studies on frailty and COPD published up to September 5, 2022. RESULTS A total of 38 articles were included for the quantitative analysis after the collected literature was either included or omitted based on pertinent criteria. The results indicated that the estimated overall pooled prevalence of frailty was 36% (95% confidence interval [CI] = 31-41%), and the estimated pre-frailty was 43% (95% CI = 37-49%). A higher age (odds ratio [OR] = 1.04; 95% CI = 1.01-1.06) and higher COPD assessment test (CAT) score (OR = 1.19; 95% CI = 1.12-1.27) were associated with a significantly increased likelihood of frailty in patients with COPD. However, a higher educational attainment (OR = 0.55; 95% CI = 0.43-0.69) and higher income (OR = 0.63; 95% CI = 0.45-0.88) were associated with a significantly reduced risk of frailty in patients with COPD. A total of 17 other risk factors for frailty were identified via qualitative synthesis. CONCLUSION The incidence of frailty in patients with COPD is high, and there are many influencing factors.
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Affiliation(s)
- Li-Cong Yan
- Department of Respiratory and Critical Care Medicine, The General Hospital of Ningxia Medical University, Ningxia, 750004, China
| | - Hong-Yan Lu
- Department of Nursing, The General Hospital of Ningxia Medical University, No. 804, Shengli Street, Yinchuan City, 750004, Ningxia, China.
| | - Xiao-Yan Wang
- College of Nursing, He Xi College, Zhangye, 734000, China
| | - Gang Xiao
- Department of Radiology, Yinchuan Stomatology Hospital, Ningxia, 750000, China
| | - Yan Chang
- Department of Nursing, The General Hospital of Ningxia Medical University, No. 804, Shengli Street, Yinchuan City, 750004, Ningxia, China
| | - Ping Yuan
- Department of Respiratory and Critical Care Medicine, The General Hospital of Ningxia Medical University, Ningxia, 750004, China
| | - Bei Wang
- Department of Respiratory and Critical Care Medicine, The General Hospital of Ningxia Medical University, Ningxia, 750004, China
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8
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van der Ploeg T, Gobbens RJJ, Salem BE. Bayesian Techniques in Predicting Frailty among Community-Dwelling Older Adults in the Netherlands. Arch Gerontol Geriatr 2023; 105:104836. [PMID: 36343439 DOI: 10.1016/j.archger.2022.104836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
Background Frailty is a syndrome that is defined as an accumulation of deficits in physical, psychological, and social domains. On a global scale, there is an urgent need to create frailty-ready healthcare systems due to the healthcare burden that frailty confers on systems and the increased risk of falls, healthcare utilization, disability, and premature mortality. Several studies have been conducted to develop prediction models for predicting frailty. Most studies used logistic regression as a technique to develop a prediction model. One area that has experienced significant growth is the application of Bayesian techniques, partly due to an increasing number of practitioners valuing the Bayesian paradigm as matching that of scientific discovery. Objective We compared ten different Bayesian networks as proposed by ten experts in the field of frail elderly people to predict frailty with a choice from ten dichotomized determinants for frailty. Methods We used the opinion of ten experts who could indicate, using an empty Bayesian network graph, the important predictors for frailty and the interactions between the different predictors. The candidate predictors were age, sex, marital status, ethnicity, education, income, lifestyle, multimorbidity, life events, and home living environment. The ten Bayesian network models were evaluated in terms of their ability to predict frailty. For the evaluation, we used the data of 479 participants that filled in the Tilburg Frailty indicator (TFI) questionnaire for assessing frailty among community-dwelling older people. The data set contained the aforementioned variables and the outcome "frail". The model fit of each model was measured using the Akaike information criterion (AIC) and the predictive performance of the models was measured using the area under the curve (AUC) of the receiver operator characteristic (ROC). The AUCs of the models were validated using bootstrapping with 100 repetitions. The relative importance of the predictors in the models was calculated using the permutation feature importance algorithm (PFI). Results The ten Bayesian networks of the ten experts differed considerably regarding the predictors and the connections between the predictors and the outcome. However, all ten networks had corrected AUCs >0.700. Evaluating the importance of the predictors in each model, "diseases or chronic disorders" was the most important predictor in all models (10 times). The predictors "lifestyle" and "monthly income" were also often present in the models (both 6 times). One or more diseases or chronic disorders, an unhealthy lifestyle, and a monthly income below 1800 euro increased the likelihood of frailty. Conclusions Although the ten experts all made different graphs, the predictive performance was always satisfying (AUCs >0.700). While it is true that the predictor importance varied all the time, the top three of the predictor importance consisted of "diseases or chronic disorders", "lifestyle" and "monthly income". All in all, asking for the opinion of experts in the field of frail elderly to predict frailty with Bayesian networks may be more rewarding than a data-driven forecast with Bayesian networks because they have expert knowledge regarding interactions between the different predictors.
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Affiliation(s)
- Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, the Netherlands
| | - Benissa E Salem
- School of Nursing, University of California, Los Angeles, USA
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Zeng XK, Shen SS, Guan HL, Chen LY, Chen XJ. Coexisting Frailty and Cognitive Impairment as a Predictor of Adverse Outcomes in Older Inpatients After Discharge: Results from a One-Year Follow-Up Study. Clin Interv Aging 2022; 17:1697-1706. [DOI: 10.2147/cia.s376691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/17/2022] [Indexed: 11/30/2022] Open
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10
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Xu Q, Ou X, Li J. The risk of falls among the aging population: A systematic review and meta-analysis. Front Public Health 2022; 10:902599. [PMID: 36324472 PMCID: PMC9618649 DOI: 10.3389/fpubh.2022.902599] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/20/2022] [Indexed: 01/22/2023] Open
Abstract
Aim This study aims to clarify the risk factors for falls to prevent severe consequences in older adults. Methods We searched the PubMed, Web of Science, Embase, and Google Scholar databases using the terms "risk factors" OR "predicting factors" OR "predictor" AND "fall" OR "drop" to identify all relevant studies and compare their results. The study participants were divided into two groups, the "fall group" and the "control group", and differences in demographic characteristics, lifestyles, and comorbidities were compared. Results We included 34 articles in the analysis and analyzed 22 factors. Older age, lower education level, polypharmacy, malnutrition, living alone, living in an urban area, smoking, and alcohol consumption increased the risk of falls in the aging population. Additionally, comorbidities such as cardiac disease, hypertension, diabetes, stroke, frailty, previous history of falls, depression, Parkinson's disease, and pain increased the risk of falls. Conclusion Demographic characteristics, comorbidities, and lifestyle factors can influence the risk of falls and should be taken into consideration.
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Affiliation(s)
| | | | - Jinfeng Li
- Department of Geriatrics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
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Naharci MI. Letter to the Editor Regarding "Cognitive Decline Is Associated With an Accelerated Rate of Bone Loss and Increased Fracture Risk in Women: A Prospective Study from the Canadian Multicentre Osteoporosis Study". J Bone Miner Res 2022; 37:1073-1074. [PMID: 35072297 DOI: 10.1002/jbmr.4510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Mehmet Ilkin Naharci
- Division of Geriatrics, University of Health Sciences, Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Ankara, Turkey
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12
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Abstract
INTRODUCTION The use of medications with anticholinergic (ACh) properties is associated with numerous adverse effects especially in older adults. Emerging evidence suggests the presence of long-term effects with ACh use. AREAS COVERED Our article presents an overview of ACh effects and falls in older individuals including examination of emerging evidence on ACh use and cumulative exposure on short-term and long-term falls risk. The databases CINAHL, MEDLINE, EMBASE, and Web of Science were searched for articles published from January 2002 to December 2021. EXPERT OPINION Anticholinergic side effects include muscle weakness, blurred vision, and mental confusion which are likely to lead to increased falls risk. Many commonly used medications such as beta-blockers, calcium-channel blockers, and antihistamines are now known to have mild ACh properties. With polypharmacy now considered unavoidable in older patients, the cumulative effects of the use of multiple drugs with mild ACh properties may also lead to increased falls risk. The relationship between ACh drugs and falls may also be irreversible as ACh effects may extend beyond the period of drug use, due to cognitive and physical deconditioning following the initial exposure to ACh drugs. Future long-term studies with accurate quantification of cumulative ACh exposure and measurement of actual falls outcomes are urgently required.
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Affiliation(s)
- Xiang Jiang Xu
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Selangor, Malaysia
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13
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Avci C, Ozsurekci C, Naharci Mİ. Comment on: Falls in older adults after hospitalization for acute myocardial infarction. J Am Geriatr Soc 2022; 70:1878-1880. [PMID: 35332522 DOI: 10.1111/jgs.17741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Candeniz Avci
- Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Türkiye
| | - Cemile Ozsurekci
- Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Türkiye
| | - M İlkin Naharci
- Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Türkiye
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14
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Naharci MI, Katipoglu B, Tasci I. Association of anticholinergic burden with undernutrition in older adults: A cross-sectional study. Nutr Clin Pract 2022; 37:1215-1224. [PMID: 34994474 DOI: 10.1002/ncp.10821] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Limited data are available concerning the contribution of drugs with anticholinergic properties (DAPs) to undernutrition among older adults. This study aimed to determine the potential association of anticholinergic burden (ACB) to nutrition status in older people. METHODS We prospectively enrolled participants aged over 65 who underwent a comprehensive geriatric assessment between January 2017 and June 2020. Nutrition status was assessed by the Mini Nutritional Assessment-Short Form (MNA-SF). The ACB was assessed using the ACB scale. RESULTS A total of 615 participants were included in the analysis (mean age ± SD, 78.5 ± 6.6 years; male, 55.3%). The prevalence of undernutrition (MNA-SF score <12) was 22.6% (n = 139). Participants with undernutrition were predominantly older (P < 0.001), had lower mean body mass index scores (undernutrition, 27.3 ± 5.4 vs healthy, 29.5 ± 8.0; P = 0.007), had a lower educational level (P = 0.016), had higher cardiovascular disease morbidity (P < 0.001), and had a higher ACB (P < 0.001) when compared with those with normal nutrition status. In adjusted analysis, the odds of having undernutrition were higher among participants with an ACB score >1 (odds ratio, 1.20; 95% CI, 1.01-1.43; P = 0.044). The weighted multivariate linear regression analysis showed a significant inverse association between the total ACB score and MNA-SF score controlling for multiple confounders. CONCLUSION ACB appears to be inversely correlated with nutrition status among older adults. Undernutrition may be considered an additional reason to consider deprescribing DAPs in this population.
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Affiliation(s)
- Mehmet Ilkin Naharci
- Division of Geriatrics, Gulhane Faculty of Medicine, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Bilal Katipoglu
- Division of Geriatrics, Gulhane Faculty of Medicine, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ilker Tasci
- Department of Internal Medicine, Gulhane Faculty of Medicine, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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15
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Moving Through COVID-19: Perspectives of Older Adults in the Getting Older Adults Outdoors Study. J Aging Phys Act 2021; 30:705-715. [PMID: 34920416 DOI: 10.1123/japa.2021-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/29/2021] [Accepted: 10/08/2021] [Indexed: 11/18/2022]
Abstract
Safety guidelines resulting from the coronavirus disease 2019 pandemic may reduce physical activity participation of older adults, particularly prefrail and frail individuals. The objective was to explore older adults' experiences with physical activity during the coronavirus disease 2019 pandemic. Using a qualitative descriptive approach, interviews were conducted with 16 older adults. Data were analyzed thematically. Two themes emerged: (a) coming to a standstill and (b) small steps. Participants described that imposed provincial and federal recommendations caused them to reduce their physical activity with negative consequences. As time progressed, participants used emerging public health knowledge about coronavirus disease 2019 to safely increase physical activity. Many participants developed strategies to remain active during the pandemic (e.g., wearing a pedometer, walking outdoors at particular times of day). Findings from this study can better inform the development of programs, clinical practice, and policy for physical activity promotion in older adults during periods of physical distancing and isolation.
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16
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Yasin AI, Topcu A, Akuc MN, Türk HM, Soysal P. A comparison of anticholinergic burden in older patients with and without cancer. Future Oncol 2021; 17:5067-5075. [PMID: 34704458 DOI: 10.2217/fon-2021-0469] [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: 11/21/2022] Open
Abstract
Aim: To compare anticholinergic burden (ACB) in older patients with and without cancer and evaluate the effects of ACB on geriatric syndromes. Methods: A total of 291 patients from the geriatric clinic and 301 patients from the oncology clinic were evaluated. ACB <2 was categorized as low ACB and ACB ≥2 was categorized as high ACB. A comprehensive geriatric assessment was performed on patients from the geriatric clinic. Results: ACB scores were significantly higher in patients without cancer compared with those with cancer (p < 0.005). Number of falls and Geriatric Depression Scale 15 scores were higher and Mini-Nutritional Assessment and Barthel/Lawton activities of daily living scores were lower in geriatric patients with high ACB scores compared with those with low ACB scores (p < 0.005). Conclusion: It is crucial to understand the potential effects of ACB for rational drug use and optimum cancer management in older patients with cancer.
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Affiliation(s)
- Ayse Irem Yasin
- Department of Medical Oncology, Bezmialem Vakıf University, Istanbul 34093, Turkey
| | - Atakan Topcu
- Department of Medical Oncology, Bezmialem Vakıf University, Istanbul 34093, Turkey
| | - Meysere Nur Akuc
- Department of Internal Medicine, Bezmialem Vakıf University, Istanbul 34093, Turkey
| | - Hacı Mehmet Türk
- Department of Medical Oncology, Bezmialem Vakıf University, Istanbul 34093, Turkey
| | - Pinar Soysal
- Department of Geriatrics, Bezmialem Vakıf University, Istanbul 34093, Turkey
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17
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Wilczyński K, Gorczyca M, Gołębiowska J, Szewieczek J. Anticholinergic Burden of Geriatric Ward Inpatients. MEDICINA-LITHUANIA 2021; 57:medicina57101115. [PMID: 34684152 PMCID: PMC8540218 DOI: 10.3390/medicina57101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Anticholinergic drug use in the pharmacotherapy of elderly persons is common despite the increased risk of side effects. We examined the prevalence of anticholinergic drug use and total anticholinergic drug burden among patients admitted to an acute care geriatric ward in Poland. Materials and Methods: Cross-sectional study of 329 subjects hospitalized at the geriatric ward. Patient condition was assessed with a comprehensive geriatric assessment. The Anticholinergic Cognitive Burden (ACB) scale was used to estimate the total anticholinergic load. Results: Mean patient age was 79.61 ± 6.82 years. 40.73% of them were burdened with at least one anticholinergic drug. The clinically significant anticholinergic burden was observed in 13.98% of subjects. Patients with dementia, risk of falls, and severe disability had significantly higher total ACB scores compared to other groups. The receiver operating characteristics (ROC) curve revealed that the total ACB score ≥ 1 was significantly associated with dementia and the risk of falls. Total ACB score ≥ 2 was significantly associated with severe disability. Conclusions: Patients admitted to an acute care geriatric ward had an anticholinergic cognitive burden score comparable to other patient populations. We found associations at both low and elevated levels of anticholinergic burden with dementia and risk of falls. At elevated anticholinergic burden levels, we found associations with severe disability. Despite recommendations against the use of anticholinergics in older adults these medications are still commonly prescribed. Further study is necessary to define the characteristics of anticholinergic medication most closely associated with negative outcomes in elderly populations.
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Affiliation(s)
- Krzysztof Wilczyński
- Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland;
- Correspondence: ; Tel.: +48-(32)-359-8239; Fax: +48-(32)-205-9483
| | - Marta Gorczyca
- Student Scientific Interest Group, Department of Geriatrics, Faculty of Medical Sciences, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland; (M.G.); (J.G.)
| | - Jagna Gołębiowska
- Student Scientific Interest Group, Department of Geriatrics, Faculty of Medical Sciences, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland; (M.G.); (J.G.)
| | - Jan Szewieczek
- Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland;
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18
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Ruiz SJ, Cevallos V, Baskaran D, Mintzer MJ, Ruiz JG. The cross-sectional association of frailty with past and current exposure to strong anticholinergic drugs. Aging Clin Exp Res 2021; 33:2283-2289. [PMID: 33180283 DOI: 10.1007/s40520-020-01742-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anticholinergic drugs may contribute to frailty by impairing cognitive and physical functions. Strong anticholinergic drugs in particular may have adverse effects among older adults. OBJECTIVES Determine the association between frailty and the use of strong anticholinergic drugs among older US Veterans. METHODS This is a cross-sectional study of community-dwelling Veterans 65 years and older who had determinations of frailty status. Prescription data for patients using strong anticholinergic medications (never/past/current) was obtained via electronic health records. A 31-item VA Frailty Index (VA-FI) was generated at the time of the assessment. We dichotomized the groups into non-frail (FI = < 0.21) and frail (FI ≥ 0.21) patients. We used binomial logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Frailty was the dependent variable and use of strong anticholinergic drugs was the independent variable. Multivariate adjustment was conducted for age, gender, race, ethnicity, marital status, and BMI. RESULTS Population sample consisted of 17,084 Veterans who were 71.05% Caucasian, 97.34% male, and with a mean age 75.60 (SD = 8.04) years. Among the population, 9940 (58.18%) patients had no previous use of strong anticholinergic drugs, whereas 5182 (30.33%) had past exposure and 1962 (11.49%) had current exposure. In binomial logistic regression, individuals with past (OR 3.27, 95% CI 3.03-3.54, p < 0.0005) or current (OR 4.78, 95% CI 4.30-5.31, p < 0.0005) exposure showed a higher association with frailty as compared to individuals who were never exposed. CONCLUSIONS Past and current use of strong anticholinergic drugs were associated with frailty in older Veterans. These results suggest that screening for frailty in patients with past or current exposure to strong anticholinergic medications may be necessary for proper management.
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Affiliation(s)
- Sergio J Ruiz
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Veterans Successful Aging for Frail Elders (VSAFE), 1201 NW 16th Street, Miami, FL, 33125, USA
| | - Victor Cevallos
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Veterans Successful Aging for Frail Elders (VSAFE), 1201 NW 16th Street, Miami, FL, 33125, USA
| | - Dhanya Baskaran
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Veterans Successful Aging for Frail Elders (VSAFE), 1201 NW 16th Street, Miami, FL, 33125, USA
| | - Michael J Mintzer
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Veterans Successful Aging for Frail Elders (VSAFE), 1201 NW 16th Street, Miami, FL, 33125, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jorge G Ruiz
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Veterans Successful Aging for Frail Elders (VSAFE), 1201 NW 16th Street, Miami, FL, 33125, USA.
- University of Miami Miller School of Medicine, Miami, FL, USA.
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19
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Mehdizadeh D, Hale M, Todd O, Zaman H, Marques I, Petty D, Alldred DP, Johnson O, Faisal M, Gardner P, Clegg A. Associations Between Anticholinergic Medication Exposure and Adverse Health Outcomes in Older People with Frailty: A Systematic Review and Meta-analysis. Drugs Real World Outcomes 2021; 8:431-458. [PMID: 34164795 PMCID: PMC8605959 DOI: 10.1007/s40801-021-00256-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction There are robust associations between use of anticholinergic medicines and adverse effects in older people. However, the nature of these associations for older people living with frailty is yet to be established. Objectives The aims were to identify and investigate associations between anticholinergics and adverse outcomes in older people living with frailty and to investigate whether exposure is associated with greater risks according to frailty status. Methods MEDLINE, CINAHL, EMBASE, Cochrane Database of Systematic Reviews, Web of Science and PsycINFO were searched to 1 August 2019. Observational studies reporting associations between anticholinergics and outcomes in older adults (average age ≥ 65 years) that reported frailty using validated measures were included. Primary outcomes were physical impairment, cognitive dysfunction, and change in frailty status. Risk of bias was evaluated using the Cochrane Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Meta-analysis was undertaken where appropriate. Results Thirteen studies (21,516 participants) were included (ten community, one residential aged-care facility and two hospital studies). Observed associations included reduced ability for chair standing, slower gait speeds, poorer physical performance, increased risk of falls and mortality. Conflicting results were reported for grip strength, timed up and go test, cognition and activities of daily living. No associations were observed for transitions between frailty states, psychological wellbeing or benzodiazepine-related adverse reactions. There was no clear evidence of differences in risks according to frailty status. Conclusions Anticholinergics are associated with adverse outcomes in older people living with frailty; however, the literature has significant methodological limitations. There is insufficient evidence to suggest greater risks based on frailty, and there is an urgent need to evaluate this further in well-designed studies stratifying by frailty. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-021-00256-5.
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Affiliation(s)
- David Mehdizadeh
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, BD7 1DP, UK. .,NIHR Yorkshire and Humber Patient Safety Translational Research Centre (YHPSTRC), Bradford, UK. .,Health Data Research UK North (HDRUK North), Leeds, UK. .,Wolfson Centre for Applied Health Research, Bradford, UK.
| | - Matthew Hale
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,Department of Geriatrics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Oliver Todd
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Hadar Zaman
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, BD7 1DP, UK.,NIHR Yorkshire and Humber Patient Safety Translational Research Centre (YHPSTRC), Bradford, UK.,Health Data Research UK North (HDRUK North), Leeds, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Iuri Marques
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre (YHPSTRC), Bradford, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Duncan Petty
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, BD7 1DP, UK.,NIHR Yorkshire and Humber Patient Safety Translational Research Centre (YHPSTRC), Bradford, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - David P Alldred
- School of Healthcare, University of Leeds, Leeds, UK.,NIHR Yorkshire and Humber Patient Safety Translational Research Centre (YHPSTRC), Bradford, UK.,Health Data Research UK North (HDRUK North), Leeds, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Owen Johnson
- School of Computing, University of Leeds, Leeds, UK.,NIHR Yorkshire and Humber Patient Safety Translational Research Centre (YHPSTRC), Bradford, UK.,Health Data Research UK North (HDRUK North), Leeds, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Muhammad Faisal
- Faculty of Health Studies, University of Bradford, Bradford, UK.,NIHR Yorkshire and Humber Patient Safety Translational Research Centre (YHPSTRC), Bradford, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Peter Gardner
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, BD7 1DP, UK.,NIHR Yorkshire and Humber Patient Safety Translational Research Centre (YHPSTRC), Bradford, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,NIHR Applied Research Collaboration Yorkshire and Humber (NIHR ARC YH), Bradford, UK.,NIHR Yorkshire and Humber Patient Safety Translational Research Centre (YHPSTRC), Bradford, UK.,Health Data Research UK North (HDRUK North), Leeds, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
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20
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Song Y, Deng Y, Li J, Hao B, Cai Y, Chen J, Shi H, Xu W. Associations of falls and severe falls with blood pressure and frailty among Chinese community-dwelling oldest olds: The Chinese Longitudinal Health and Longevity Study. Aging (Albany NY) 2021; 13:16527-16540. [PMID: 34160365 PMCID: PMC8266320 DOI: 10.18632/aging.203174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/31/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Falls are a leading cause of death among Chinese oldest olds. However, studies on Chinese community-dwelling older adults are lacking. We aimed to identify the associations of falls and severe falls with blood pressure and frailty among Chinese community-dwelling oldest olds. METHODS Cross-sectional analyses were conducted with 6,595 community-dwelling oldest olds (aged ≥80 years) from 22 Chinese provinces from the Chinese Longitudinal Health and Longevity Study (CLHLS). Systolic BP (SBP) and diastolic BP (DBP) were measured twice at participants' homes, and a 38-item frailty index was used to assess the frailty status of participants. Falls and severe falls were confirmed through face-to-face interviews. Multivariate logistic regression was used to investigate the associations of BP and frailty with falls and severe falls. RESULTS The mean participant age was 91.0 years, and 56.1% were female. In total, 24.2% participants had a history of fall and 8.3% had a history of severe falls. The multivariate-adjusted odds ratio (OR) for falls among the oldest old with SBP ≥140 mm Hg compared to those with an SBP of 120-129 mm Hg was 1.20 (95% confidence interval [CI], 1.01-1.44). The adjusted OR for falls among frail participants compared to robust participants was 1.39 (95% CI, 1.02-1.89). DBP and pre-frailty were not associated with falls after multivariate adjustment. SBP, DBP, and frailty status were not associated with severe falls after multivariate adjustment. CONCLUSIONS SBP and frailty but not DBP and pre-frailty are associated with increased odds of falls among Chinese community-dwelling oldest olds.
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Affiliation(s)
- Yujian Song
- Graduate School of Medical School of Chinese PLA, Beijing 100853, China
| | - Yujiao Deng
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Jianhua Li
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Benchuan Hao
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Yulun Cai
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Jianqiao Chen
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Haiyan Shi
- Department of Gastroenterology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Weihao Xu
- Haikou Cadre's Sanitarium of Hainan Military Region, Haikou 570203, China
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21
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Soysal T, Akın S, Durmuş NŞ, Gökçekuyu BM, Özer FF, Zararsız GE. Comparison of Anticholinergic Burden Measured with Three Different Anticholinergic Risk Scales and Association with Cognitive and Physical Functions in Older Adults. Arch Gerontol Geriatr 2021; 96:104451. [PMID: 34130072 DOI: 10.1016/j.archger.2021.104451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Tuba Soysal
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Kayseri, 38090, Turkey.
| | - Sibel Akın
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Kayseri, 38090, Turkey
| | - Nurdan Şentürk Durmuş
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Kayseri, 38090, Turkey
| | - Bilge Müge Gökçekuyu
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Kayseri, 38090, Turkey
| | - Firuzan Fırat Özer
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Kayseri, 38090, Turkey
| | - Gözde Ertürk Zararsız
- Erciyes University Faculty of Medicine, Department of Biostatistics, Kayseri, 38090, Turkey
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22
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Towards Appropriate Prescribing for Older Persons with Multiple Chronic Conditions. Arch Gerontol Geriatr 2021; 94:104397. [PMID: 33765568 DOI: 10.1016/j.archger.2021.104397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Naharci MI, Katipoglu B, Veizi B, Tasci I. Gait Speed is independently associated with Depression Symptoms in Mild Cognitive Impairment. AGING NEUROPSYCHOLOGY AND COGNITION 2021; 29:637-650. [PMID: 33554744 DOI: 10.1080/13825585.2021.1882932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Depression symptoms are known to influence gait speed in cognitively healthy adults. In this study, we aimed to examine the relationship between gait speed and depression symptoms in older patients with mild cognitive impairment. The participants were classified as slow and normal gait speed based on the Fried criteria. A total of 152 subjects with mild cognitive impairment were included. Of these, 39.5% (n=60) had slow gait speed. Compared to normal speed group (n=92), patients with slow speed had more clinically significant depression (geriatric depression scale score ≥ 6) (p=0.004), cardiovascular disease (p=0.007), recent falls (p<0.001), and anticholinergic burden (p=0.005). Multivariable logistic regression analysis yielded statistically significant associations between slow gait speed and depression in age and gender adjusted [OR:3.30 (1.46-7.46), p=0.004] and fully adjusted [OR: 2.80 (1.10-7.08), p=0.030] models. This study showed an independent association between slow gait speed and depression symptoms in older people with mild cognitive impairment.
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Affiliation(s)
- Mehmet Ilkin Naharci
- Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Turkiye
| | - Bilal Katipoglu
- Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Turkiye
| | - Betul Veizi
- Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, Ankara, Turkiye
| | - Ilker Tasci
- Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Department of Internal Medicine, University of Health Sciences, Ankara, Turkiye
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