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Vankova H, Schmalz M, Andel R, Rajnochova Bloudickova S. Frailty and depressive symptoms in older kidney transplant recipients: opportunities for collaboration between transplant nephrologists and geriatricians. BMC Geriatr 2024; 24:423. [PMID: 38741066 DOI: 10.1186/s12877-024-04972-9] [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: 08/19/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Frailty is one of the key syndromes in geriatric medicine and an important factor for post-transplant outcomes. We aimed to describe the prevalence of frailty and examine the correlates of frailty and depressive symptoms in older kidney transplant recipients (KTRs). METHODS This cross-sectional study involved 112 kidney transplant recipients (KTRs) aged 70 and above. Frailty syndrome was assessed using the Fried frailty criteria, and patients were categorized as frail, pre-frail, or non-frail based on five frailty components: muscle weakness, slow walking speed, low physical activity, self-reported exhaustion, and unintentional weight loss. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS). The relationship between frailty and depressive symptoms was evaluated using multinomial logistic regression, with the three frailty categories as the dependent variable and the severity of depressive symptoms as the independent variable, while controlling for age, gender, renal graft function, and time since transplant surgery. RESULTS The participants had a mean age of 73.3 ± 3.3 years, and 49% were female. The prevalence of frailty syndrome was 25% (n = 28), pre-frailty was 46% (n = 52), and 29% (n = 32) of the KTRs were non-frail. The mean score for depressive symptoms was 3.1 ± 2.4 points, with 18% scoring above the clinical depression cutoff. Depressive symptoms were positively correlated with frailty (r = .46, p < .001). Among the frailty components, self-reported exhaustion (r = .43, p < .001), slow walking speed (r = .26, p < .01), and low physical activity (r = .44, p < .001) were significantly positively correlated with depressive symptoms, while muscle strength (p = .068) and unintentional weight loss (p = .050) were not. A multinomial logistic regression adjusted for covariates indicated that, compared to being non-frail, each additional point on the GDS increased the odds of being pre-frail by 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.01-1.96) and roughly doubled the odds of being frail (OR = 2.01, 95% CI 1.39-2.89). CONCLUSION There is a strong association between frailty and depression in KTRs aged 70 years and older. Targeted detection has opened up a new avenue for collaboration between geriatricians and transplant nephrologists.
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Affiliation(s)
- Hana Vankova
- Department of Internal Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruska 87, 10000 Praha 10, Prague, Czech Republic.
| | - Michal Schmalz
- Department of Internal Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruska 87, 10000 Praha 10, Prague, Czech Republic
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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van der Klei VMGTH, Drewes YM, van Raaij BFM, van Dalsen MDW, Julien AG, Festen J, Polinder-Bos H, Mooijaart SP, Gussekloo J, van den Bos F. Older people's goals of care in relation to frailty status-the COOP-study. Age Ageing 2024; 53:afae097. [PMID: 38796317 PMCID: PMC11127771 DOI: 10.1093/ageing/afae097] [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: 12/01/2023] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Literature relating older people's goals of care to their varying frailty status is scarce. OBJECTIVE To investigate goals of care in case of acute and/or severe disease in relationship to frailty status among the general older population. METHOD Older people aged ≥70 in the Netherlands completed a questionnaire. They were divided into three subgroups based on a self-reported Clinical Frailty Scale: fit (CFS 1-3), mildly frail (CFS 4-5) and severely frail (CFS 6-8). Seven goals were graded as unimportant (1-5), somewhat important (6-7) or very important (8-10): extending life, preserving quality of life (QoL), staying independent, relieving symptoms, supporting others, preventing hospital admission and preventing nursing home admission. RESULTS Of the 1,278 participants (median age 76 years, 63% female), 57% was fit, 32% mildly frail and 12% severely frail. Overall, participants most frequently considered preventing nursing home admission as very important (87%), followed by staying independent (84%) and preserving QoL (83%), and least frequently considered extending life as very important (31%). All frailty subgroups reported similar preferences out of the surveyed goals as the overall study population. However, participants with a higher frailty status attached slightly less importance to each individual goal compared with fit participants (Ptrend-values ≤ 0.037). CONCLUSION Preferred goals of care are not related to frailty status, while the importance ascribed to individual goals is slightly lower with higher frailty status. Future research should prioritise outcomes related to the shared goals of fit, mildly frail and severely frail older people to improve personalised medicine for older patients.
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Affiliation(s)
- Veerle M G T H van der Klei
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
| | - Yvonne M Drewes
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Bas F M van Raaij
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
| | - Maaike D W van Dalsen
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
| | - Anneke G Julien
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
| | | | - Harmke Polinder-Bos
- Department of Geriatrics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Simon P Mooijaart
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
| | - Jacobijn Gussekloo
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederiek van den Bos
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
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Ticinesi A, Parise A, Delmonte D, Coppi C, Prati B, Cerundolo N, Guerra A, Nouvenne A, Meschi T. Factors associated with delirium in a real-world acute-care setting: analysis considering the interdependence of clinical variables with the frailty syndrome. Eur Geriatr Med 2024; 15:411-421. [PMID: 38329618 PMCID: PMC10997727 DOI: 10.1007/s41999-024-00934-x] [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: 09/21/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Delirium risk assessment in the acute-care setting generally does not account for frailty. The objective of this retrospective study was to identify factors associated with delirium, considering the interdependency of clinical variables with frailty syndrome in complex older patients. METHODS The clinical records of 587 participants (248 M, median age 84) were reviewed, collecting clinical, anamnestic and pharmacological data. Frailty syndrome was assessed with the Clinical Frailty Scale (CFS). Delirium was the main study endpoint. The correlations of the considered anamnestic and clinical variables with delirium and its subtypes were investigated selecting only those variables not showing a high overlap with frailty. Correlations associated with a 25% excess of frequency of delirium in comparison with the average of the population were considered as statistically significant. RESULTS Delirium was detected in 117 (20%) participants. The presence of one among age > 85 years old, CFS > 4 and invasive devices explained 95% of delirium cases. The main factors maximizing delirium incidence at the individual level were dementia, other psychiatric illness, chronic antipsychotic treatment, and invasive devices. The coexistence of three of these parameters was associated with a peak frequency of delirium, ranging from 57 to 61%, mostly hypoactive forms. CONCLUSIONS In acute-care wards, frailty exhibited a strong association with delirium during hospitalization, while at the individual level, dementia and the use of antipsychotics remained important risk factors. Modern clinical prediction tools for delirium should account for frailty syndrome.
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Affiliation(s)
- Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy.
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy.
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Davide Delmonte
- Institute of Materials for Electronics and Magnetism, National Research Council (CNR), Parco Area delle Scienze 7/A, 43124, Parma, Italy
| | - Chiara Coppi
- Doctoral School in Material Science, Department of Chemistry, Life Science and Environmental Sustainability, University of Parma, Parco Area delle Scienze 7/A, 43124, Parma, Italy
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Antonio Nouvenne
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
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Wang L, Zhang X, Liu X. Association between the frailty index and readmission risk in hospitalised elderly Chinese patients: a retrospective cohort study. BMJ Open 2024; 14:e076861. [PMID: 38417955 PMCID: PMC10900421 DOI: 10.1136/bmjopen-2023-076861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/16/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES Frailty is a common and important concern of the ageing population. This study examined the association between the frailty index and negative outcomes of hospitalised elderly Chinese patients. DESIGN Retrospective cohort study. SETTING Geriatrics Department of Peking University First Hospital. PARTICIPANTS 470 hospitalised elderly patients. MAIN OUTCOMES AND MEASURES Frailty was measured using a 30-item deficit-accumulation frailty index. The outcomes were the hospitalisation duration and readmission. RESULTS The frailty index was available for 470 patients: 72 (15.32%) were categorised as robust, 272 (57.87%) as prefrail and 126 (26.81%) as frail. The frail group had a longer hospital stay than the robust and prefrail groups. After adjustment for age, sex and cause of hospitalisation at baseline, frailty remained a strong independent risk factor for all-cause readmission and cardiocerebrovascular disease readmission (HR 2.41, 95% CI 1.49 to 3.91, p<0.001; HR 4.92, 95% CI 1.47 to 6.31, p<0.001, respectively). CONCLUSIONS The frailty index predicted a longer length of stay and higher all-cause and cardiocerebrovascular disease readmission risk in hospitalised elderly patients.
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Affiliation(s)
- Lina Wang
- Geriatric Department, Peking University First Hospital, Beijing, China
| | - Xiaolin Zhang
- Geriatric Department, Peking University First Hospital, Beijing, China
| | - Xinmin Liu
- Geriatric Department, Peking University First Hospital, Beijing, China
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Feng C, Wu H, Qi Z, Wei Y, Yang B, Yin H, Yan S, Wang L, Yu Y, Xie J, Xing X, Tu S, Zhang H. Association of preoperative frailty with the risk of postoperative delirium in older patients undergoing hip fracture surgery: a prospective cohort study. Aging Clin Exp Res 2024; 36:16. [PMID: 38294584 PMCID: PMC10830592 DOI: 10.1007/s40520-023-02692-5] [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: 09/22/2023] [Accepted: 12/31/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE This study aimed to explore the correlation between preoperative frailty and the risk of postoperative delirium (POD) in older patients undergoing hip fracture surgery. METHODS In total, 148 patients with hip fractures who were admitted to Tsinghua Changgung Hospital (Beijing, China) between January 2022 and January 2023 were involved in this study. Preoperative frailty scales were assessed, of which the CAM scale was postoperatively administered every morning and evening on days 1, 2, 3, 5, and 7. Binary logistic regression analysis was conducted to determine the correlation between preoperative frailty and the risk of POD. RESULTS Among 148 older patients with hip fractures, 71 (48.0%) were identified as preoperative frail and 77 (52.0%) as non-frail. The overall incidence of POD on day 7 was 24.3% (36/148), and preoperative frailty was associated with a significantly higher risk of POD compared with non-frailty (42.3% vs. 7.8%, P < 0.001). The binary logistic regression analysis revealed that preoperative frailty was noted as an independent risk factor for the risk of POD in older patients undergoing hip fracture surgery (P = 0.002). CONCLUSION Preoperative frailty increased the risk of POD in older patients undergoing hip fracture surgery. DISCUSSION Preoperative assessment of frailty in geriatric hip surgery can timely identify potential risks and provide interventions targeting frailty factors to reduce the incidence of POD in older patients undergoing hip fracture surgery. The findings suggested that preoperative frailty could increase the risk of POD in older patients undergoing hip fracture surgery. Further research is necessary to determine whether perioperative interventions aimed at enhancing frailty can mitigate the risk of POD and improve prognosis in older patients undergoing hip fracture surgery.
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Affiliation(s)
- Chunyu Feng
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Haotian Wu
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Ziheng Qi
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Yuzhi Wei
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Bo Yang
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Haolin Yin
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Siyi Yan
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Lu Wang
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Yangyang Yu
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Juanjuan Xie
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Xueyan Xing
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Shumin Tu
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Huan Zhang
- School of Clinical Medicine, Tsinghua University, Beijing, China.
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China.
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Canevelli M, Wallace LMK, Bruno G, Cesari M, Rockwood K, Ward DD. Frailty is associated with the clinical expression of neuropsychological deficits in older adults. Eur J Neurol 2024; 31:e16072. [PMID: 37738515 DOI: 10.1111/ene.16072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE The aim was to determine whether frailty is associated with the relationship between neuropsychological markers and global cognition in older adults. METHODS Cross-sectional analyzes were conducted of baseline data from three large cohort studies: National Alzheimer's Coordinating Center (NACC), Rush Memory and Aging Project (MAP) and Alzheimer's Disease Neuroimaging Initiative (ADNI). Studies recruited North American participants along the spectrum of cognitive functioning (44% no cognitive impairment at baseline). A frailty index was computed in each dataset. Frailty indices, neuropsychological tests (including measures of processing speed, episodic, semantic and working memory) and Mini-Mental State Examination (MMSE) scores were the variables of interest, with age, sex, education and apolipoprotein E ε4 evaluated as confounders. RESULTS Across all studies, 23,819 participants aged 55-104 (57% female) were included in analyzes. Frailty index scores were significantly and inversely associated with MMSE scores and significantly moderated relationships between neuropsychological test scores and MMSE scores. In participants with higher frailty index scores, lower neuropsychological test scores were more strongly associated with lower MMSE scores (standardized interaction coefficients ranged from -0.19 to -1.17 in NACC, -0.03 to -2.27 in MAP and -0.04 to -0.38 in ADNI, depending on the neuropsychological test). These associations were consistent across the different databases and were mostly independent of the composition of frailty indices (i.e., after excluding possible symptoms of dementia). CONCLUSIONS Amongst older Americans, frailty is associated with the cognitive expression of neuropsychological deficits. Implementation of frailty assessment in routine neurological and neuropsychological practice should be considered to optimize care outcomes for older adults.
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Affiliation(s)
- Marco Canevelli
- Department of Human Neuroscience, Sapienza University, Rome, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | | | - Giuseppe Bruno
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Kenneth Rockwood
- Divisions of Geriatric Medicine, Department of Medicine & Neurology, Dalhousie University, Halifax, Nova Scotia, Canada
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Kathryn Allen Weldon Professor of Alzheimer Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David D Ward
- Divisions of Geriatric Medicine, Department of Medicine & Neurology, Dalhousie University, Halifax, Nova Scotia, Canada
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
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Er AT, Sng LH. Overcoming ageism: Ensuring quality geriatric care during radiology examinations. J Med Imaging Radiat Sci 2023; 54:S32-S37. [PMID: 37741709 DOI: 10.1016/j.jmir.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/19/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023]
Affiliation(s)
- Amanda Tw Er
- Department of Radiology, Changi General Hospital, Singapore; Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, VIC 3800, Australia.
| | - Li Hoon Sng
- Department of Radiology, Sengkang General Hospital, Singapore; Health and Social Sciences, Singapore Institute of Technology (SIT), Singapore
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Navarra A, Porcellini I, Mongelli F, Popeskou SG, Grass F, Christoforidis D. Long-term outcomes in elderly patients after elective surgery for colorectal cancer within an ERAS protocol: a retrospective analysis. Langenbecks Arch Surg 2023; 408:438. [PMID: 37978074 DOI: 10.1007/s00423-023-03179-7] [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: 08/21/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The number of elderly patients with a diagnosis of colorectal cancer (CRC) is increasing. Considering short life expectancy and multiple comorbidities, surgery may not always be the best treatment option. METHODS We included all consecutive patients aged 80 years and older who underwent elective resection for CRC following Enhanced Recovery after Surgery (ERAS) protocol between January 2011 and May 2021. The primary endpoint was overall survival, secondary endpoints were 30-day morbidity, and the rate of return to pre-operative living conditions 3 months after surgery. RESULTS Ninety-four patients were included. Mean age was 84.6 ± 3.6 years, 49 patients (52%) were female. Most patients (77.6%) were ASA score ≥ 3. Laparoscopic resections were performed in 85 patients (90.4%), involving 69 (73.4%) colonic and 25 (26.6%) rectal resections. A stoma was constructed in 22 patients (23%), and reversed in 12 (54.5%). Twenty-two patients (23.4%) experienced a Clavien-Dindo ≥ 3 complication, and 2 patients (2.1%) died. The median length of hospital stay was 8 (interquartiles: 6-15) days. Sixty-six patients (70.2%) were discharged home directly and 26 (27.7%) to rehabilitation or postacute care institutes. At three months after surgery, eighty-two patients (96.5%) returned to their pre-operative living conditions directly or after short-term rehabilitation. Mean follow-up was 53 ± 33 months, estimated 5-year overall survival was 60.3% (95%CI 49.5-71.1%), and disease-free survival was 86.3% (95%CI 78.1-94.4%). CONCLUSIONS Our study suggests that elderly patients undergoing elective surgery have a high potential to return to preoperative living conditions and good overall- and disease-free survivals, despite significant postoperative morbidity.
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Affiliation(s)
- Andrea Navarra
- University of Lausanne, Quartier Centre, 1015, Lausanne, Switzerland
| | - Iride Porcellini
- Department of Surgery, Ospedale Regionale Di Lugano, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, EOC, Via Ospedale 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Science, Università Della Svizzera Italiana, Via La Santa 1, 6900, Lugano, Switzerland.
| | | | - Fabian Grass
- University of Lausanne, Quartier Centre, 1015, Lausanne, Switzerland
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Dimitri Christoforidis
- Department of Surgery, Ospedale Regionale Di Lugano, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Science, Università Della Svizzera Italiana, Via La Santa 1, 6900, Lugano, Switzerland
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Wang GM, Teng MY, Yu WJ, Ren H, Cui XS. Life-space mobility among community-dwelling older persons: A scoping review. Geriatr Nurs 2023; 54:108-117. [PMID: 37722235 DOI: 10.1016/j.gerinurse.2023.08.021] [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: 07/21/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023]
Abstract
To describe and analyze the current research status of life-space mobility of the older persons in community. The literature in PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, Scopus, OpenGrey, SinoMed, CNKI, WanFang, and VIP databases was computer searched, and the time frame was build to May 23, 2023. A total of 42 literatures were included, including 35 in English and 7 in Chinese, 30 of which were cross-sectional studies. Theoretical models related to spatial mobility included the "concentric circles" model and the "cone" model. 33 literatures reported the prevalence or level of spatial mobility limitations, and 9 assessment instruments were used, The influencing factors can be divided into four categories. 9 literatures reported on the adverse effects, and 9 literatures reported on the prevention and intervention. The limitation of life-space mobility is a common and under-recognized phenomenon among the older persons in the community,with serious adverse effects, complex and diverse influencing factors.
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Affiliation(s)
- Gui-Meng Wang
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Meng-Yuan Teng
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Wen-Jing Yu
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Hui Ren
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Xiang-Shu Cui
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China.
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Ashikali EM, Ludwig C, Mastromauro L, Périvier S, Tholomier A, Ionita I, Graf C, Busnel C. Intrinsic Capacities, Functional Ability, Physiological Systems, and Caregiver Support: A Targeted Synthesis of Effective Interventions and International Recommendations for Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4382. [PMID: 36901392 PMCID: PMC10002353 DOI: 10.3390/ijerph20054382] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
The ageing population calls for interventions that can assist older people to age healthily. This study aimed to provide a targeted synthesis of high-level research and current evidence-based recommendations on effective interventions for maintaining or preventing the decline in intrinsic capacity, functional ability, and physiological systems, or for caregiver support. Nestled within the healthy ageing framework by the World Health Organization, available evidence was selected in a targeted manner, with the purpose of providing a synthesis that would allow the application of this knowledge in real life. As such, the outcome variables were examined through an Evidence and Gap Map of interventions for functional ability and through guidelines from leading institutions. Systematic reviews, meta-analyses, and guidelines on community-dwelling older adults with or without minor health limitations were considered. Thirty-eight documents were included and over fifty interventions identified. Physical activity interventions were consistently effective across several domains. Recommendations point to screening, whilst highlighting the importance of behavioural factors in the endeavour to age healthily. There is a wide range of activities which are likely to foster healthy ageing. To encourage their uptake, it is important for communities to offer suitable promotion and support, and to make these accessible to the public.
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Affiliation(s)
| | - Catherine Ludwig
- Geneva School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
| | - Laura Mastromauro
- Geneva Institution for Home Care and Assistance (imad), 1227 Carouge, Switzerland
- Geneva School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
| | - Samuel Périvier
- Geneva Institution for Home Care and Assistance (imad), 1227 Carouge, Switzerland
- Department of Rehabilitation and Geriatrics, Geneva University Hospital, 1226 Geneva, Switzerland
| | - Aude Tholomier
- Geneva Institution for Home Care and Assistance (imad), 1227 Carouge, Switzerland
| | - Irina Ionita
- PLATEFORME du Réseau Seniors Genève, 1227 Geneva, Switzerland
| | - Christophe Graf
- Department of Rehabilitation and Geriatrics, Geneva University Hospital, 1226 Geneva, Switzerland
| | - Catherine Busnel
- Geneva Institution for Home Care and Assistance (imad), 1227 Carouge, Switzerland
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11
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Kokorelias KM, Leung G, Jamshed N, Grosse A, Sinha SK. Identifying the areas of low self-reported confidence of internal medicine residents in geriatrics: a descriptive study of findings from a structured geriatrics skills assessment survey. BMC MEDICAL EDUCATION 2022; 22:870. [PMID: 36522619 PMCID: PMC9756669 DOI: 10.1186/s12909-022-03934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Currently, no standardized methods exist to assess the geriatric skills and training needs of internal medicine trainees to enable them to become confident in caring for older patients. This study aimed to describe the self-reported confidence and training requirements in core geriatric skills amongst internal medicine residents in Toronto, Ontario using a standardized assessment tool. METHODS This study used a novel self-rating instrument, known as the Geriatric Skills Assessment Tool (GSAT), among incoming and current internal medicine residents at the University of Toronto, to describe self-reported confidence in performing, teaching and interest in further training with regard to 15 core geriatric skills previously identified by the American Board of Internal Medicine. RESULTS 190 (75.1%) out of 253 eligible incoming (Year 0) and current internal medicine residents (Years 1-3) completed the GSAT. Year 1-3 internal medicine residents who had completed a geriatric rotation reported being significantly more confident in performing 13/15 (P < 0.001 to P = 0.04) and in teaching 9/15 GSAT skills (P < 0.001 to P = 0.04). Overall, the residents surveyed identified their highest confidence in administering the Mini-Mental Status Examination and lowest confidence in assessing fall risk using a gait and balance tool, and in evaluating and managing chronic pain. CONCLUSION A structured needs assessment like the GSAT can be valuable in identifying the geriatric training needs of internal medicine trainees based on their reported levels of self-confidence. Residents in internal medicine could further benefit from completing a mandatory geriatric rotation early in their training, since this may improve their overall confidence in providing care for the mostly older patients they will work with during their residency and beyond.
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Affiliation(s)
- Kristina Marie Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada
| | - Grace Leung
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada
| | - Namirah Jamshed
- Division of Geriatric Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Anna Grosse
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
| | - Samir K Sinha
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada.
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, USA.
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12
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Fiore F, Cacciatore S, Tupputi S, Agostino C, Montenero R, Spaziani G, Elmi D, Medei M, Antocicco M, Mammarella F, Taddei E, Manes-Gravina E, Bernabei R, Landi F. A Case of Ralstonia pickettii Bloodstream Infection and the Growing Problem of Healthcare Associated Infections in Frail Older Adults. Ann Geriatr Med Res 2022; 26:363-366. [PMID: 36472066 PMCID: PMC9830072 DOI: 10.4235/agmr.22.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Frailty is a clinically measurable state of vulnerability to developing increased dependency and/or mortality when exposed to a stressor. Chronic diseases, aggressive treatments, antibiotic overuse, microbiota changes, immune senescence, and increased use of medical devices and implants (i.e., central lines and catheters) expose modern patients to healthcare-associated infections (HAIs), multidrug-resistant bacteria, and new and unusual opportunistic pathogens. Older adults are among the main victims of HAIs and are associated with high costs, disability, morbidity, and mortality. Ralstonia pickettii is an emerging opportunistic pathogen that causes rare nosocomial infections in frail individuals. Herein, we present a case of bloodstream infection caused by R. pickettii in an 88-year-old woman with a relatively mild course. In addition to describing this unusual finding, this report discusses the problem of HAIs in older adults. Older age, comorbidities, and hospital admissions were among the main risk factors for HAIs. Adherence to guidelines, training, auditing, and surveillance is crucial for reducing the burden of HAIs in acute settings. Furthermore, avoiding incongruous hospitalizations would have positive implications both for preventing HAIs and improving patient quality of life.
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Affiliation(s)
- Francesca Fiore
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Cacciatore
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Corresponding Author Stefano Cacciatore, MD Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy E-mail:
| | - Salvatore Tupputi
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Clara Agostino
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rossella Montenero
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Spaziani
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Elmi
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Martina Medei
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Manuela Antocicco
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Mammarella
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eleonora Taddei
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ester Manes-Gravina
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Landi
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Fantinati J, Sabin I, Crosignani S, Zilbershlag Y, Cesari M, Dwolatzky T. Tale of two countries: attitudes towards older persons in Italy and Israel during the COVID-19 pandemic as seen through the looking-glass of the media. JOURNAL OF MEDICAL ETHICS 2022; 48:1010-1014. [PMID: 35428736 PMCID: PMC9044513 DOI: 10.1136/medethics-2021-108011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic has exposed the many challenges and difficulties of healthcare systems caring for older frail people. This public health crisis has indeed jeopardised the concept of the welfare state, in particular the right of older people to uncompromised healthcare. Together with the clinical challenges facing the geriatric patient and the organisational difficulties of the healthcare systems, sociocultural factors may have also played a substantial role in the strategies that countries have applied in coping with the pandemic. In this opinion article, we report attitudes towards the older populations of two countries, Italy and Israel, during the COVID-19 pandemic as viewed through the looking-glass of the media.
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Affiliation(s)
- Jacopo Fantinati
- Fellowship in Geriatrics and Gerontology, University of Milan, Milano, Italy
| | - Irina Sabin
- Geriatric Unit, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Silvia Crosignani
- Fellowship in Geriatrics and Gerontology, University of Milan, Milano, Italy
| | - Yael Zilbershlag
- Department of Occupational Therapy, Faculty of Health Allied Professions - Ono Academic College, Kiryat Ono, Israel
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Tzvi Dwolatzky
- Geriatric Unit, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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14
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Cechinel C, Lenardt MH, Rodrigues JAM, Binotto MA, Aristides MM, Kraus R. Frailty and delirium in hospitalized older adults: A systematic review with meta-analysis. Rev Lat Am Enfermagem 2022; 30:e3687. [PMID: 36287400 PMCID: PMC9580989 DOI: 10.1590/1518-8345.6120.3687] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to estimate the prevalence and synthesize diverse evidence about the relationship between frailty and delirium in hospitalized older adults. METHOD a systematic review with meta-analysis in which observational studies conducted with older adults about frailty, delirium and hospitalization, were selected without time of language restrictions. The search was conducted in the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and CENTRAL databases during August 2021. The precepts set forth by the Joanna Briggs Institute (JBI) - Evidence Synthesis Groups were followed. The meta-analysis model estimated the relative risk corresponding to the prevalence of frailty and delirium. The inverse variance method for proportions was used to estimate the prevalence values and relative risks for binary outcomes. RESULTS initially, 1,244 articles were identified, of which 26 were included in the meta-analysis (n=13,502 participants), with 34% prevalence of frailty (95% CI:0.26-0.42; I 2=99%; t 2=0.7618, p=0) and 21% for delirium (95% CI:0.17-0,25; I 2=95%; t 2=0.3454, p<0.01). The risk for hospitalized older adults to develop delirium was 66% (RR: 1.66; 95% CI:1.23-2.22; I2=92%; t2=0.4154; p<0.01). CONCLUSION 34% prevalence of frailty and 21% of delirium in hospitalized older adults, with frailty being an independent risk factor for developing delirium, with an increased chance of 66% when compared to non-frail individuals.
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Affiliation(s)
- Clovis Cechinel
- Universidade Federal do Paraná, Curitiba, PR, Brazil.,Secretaria Municipal de Saúde, Hospital Municipal do Idoso Zilda Arns, Curitiba, PR, Brazil
| | | | | | - Maria Angélica Binotto
- Universidade Estadual do Centro-Oeste, Departamento de Educação Fisica, Irati, PR, Brazil
| | | | - Rosane Kraus
- Universidade Federal do Paraná, Curitiba, PR, Brazil., Fundação Estatal de Atencão a Saúde, Hospital Municipal do Idoso Zilda Arns, Curitiba, PR, Brazil
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15
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Zheng Z, Xu W, Wang F, Qiu Y, Xue Q. Association between vitamin D3 levels and frailty in the elderly: A large sample cross-sectional study. Front Nutr 2022; 9:980908. [PMID: 36238456 PMCID: PMC9553132 DOI: 10.3389/fnut.2022.980908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Frailty is recognized as a cornerstone of geriatric medicine. Accurately screening and identifying frailty can promote better quality and personalized medical services for the elderly. Previous studies have shown that the association between vitamin D and frailty in the elderly population is still controversial. More research is needed to explore the association between them. Materials and methods We used three waves of data from the National Health and Nutrition Examination Survey (NHANES). Based on the widely accepted AAH FRAIL Scale, we measured and evaluated the participants’ frailty from five aspects: fatigue, resistance, ambulation, illness, and loss of weight. All possible relevant variables are included. Machine learning XGboost algorithm, the Least Absolute Shrinkage Selection Operator (LASSO) regression and univariate logistic regression were used to screen variables, and multivariate logistic regression and generalized additive model (GAM) were used to build the model. Finally, subgroup analysis and interaction test were performed to further confirm the association. Results In our study, XGboost machine learning algorithm explored the relative importance of all included variables, which confirmed the close association between vitamin D and frailty. After adjusting for all significant covariates, the result indicated that for each additional unit of 25-hydroxyvitamin D3, the risk of frailty was reduced by 1.3% with a statisticaldifference. A smooth curve was constructed based on the GAM. It was found that there was a significant negative correlation between 25-hydroxyvitamin D3 and the risk of frailty. Conclusion There may be a negative correlation between 25-hydroxyvitamin D3 and the risk of frailty. However, more well-designed studies are needed to verify this relationship.
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Affiliation(s)
- Zitian Zheng
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Peking University Fifth School of Clinical Medicine, Beijing, China
| | - Wennan Xu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fei Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yudian Qiu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingyun Xue
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Peking University Fifth School of Clinical Medicine, Beijing, China
- *Correspondence: Qingyun Xue,
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16
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De Cock AM, Strens D, Van Osta P, Standaert B. Infections and hospital bed-days among aging adults: A five-year retrospective study in a Belgian general hospital. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:912469. [PMID: 36340588 PMCID: PMC9632861 DOI: 10.3389/fmedt.2022.912469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Infectious disease in aging adults (≥61 years) often occurs in combination with other health conditions leading to long hospital stays. Detailed studies on infection in aging adults investigating this problem are sparse. Aim To quantify the effect of primary and secondary diagnosed infections on hospitalization bed-days among aging adult patients. Design Retrospective patient-file study. Setting Ziekenhuis Netwerk Antwerpen (ZNA) Hospital, a 1,858-bed general hospital in Belgium, with 364 beds allocated to geriatric patients. Data source Database of hospitalized adult patients aged ≥61 years. Methods All adult patients aged ≥61 years hospitalized on two wards, Geriatrics and Pulmonology, from 2010 to 2014 were included. Primary diagnosed infections were defined as infections known at entry to be treated first. Secondary diagnosed infections included infections known at entry but treated in parallel to primary non-infectious causes of entry, infections unknown at entry, and hospital-acquired (nosocomial) infections. Data were analyzed by patient age, gender, year, ward type, bed-days of hospitalization, infection rates, and seasonality. Results There were 3,306 primary diagnosed infections (18%) and 14,758 secondary infections (82%) identified in the two wards combined (54.7% of all hospital stays at those 2 wards). Secondary diagnosed infections accounted for a significantly higher proportion of hospitalizations in both wards (+40% for Geriatric ward; +20% for Pulmonology ward; p < 0.001) and were associated with a significantly longer average hospital stay (+4 days for Geriatric ward; +5 days for Pulmonology ward; p < 0.001). Nosocomial infections (12% for Geriatric ward; 7% for Pulmonology ward) were associated with particularly high bed-days of hospitalization, at approximately +15 days and +12 days on Geriatric and Pulmonology wards, respectively. Both wards showed marked seasonality for respiratory infections with winter peaks. Conclusion Real-world data showed that secondary diagnosed infections in aging adults imposed a high burden on hospital care along with longer hospital stays. This hampered bed availability during peak seasons.
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Affiliation(s)
- Anne-Marie De Cock
- University Centre of Geriatrics, General Hospital ZNA Middelheim, Antwerpen, Belgium
| | | | - Peter Van Osta
- University Centre of Geriatrics, General Hospital ZNA Middelheim, Antwerpen, Belgium
| | - Baudouin Standaert
- HEBO, Antwerpen, Belgium
- Research Unit Ethics / Patient Care, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
- Correspondence: Baudouin Standaert
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Acosta-Benito MÁ, Martín-Lesende I. [Frailty in primary care: Diagnosis and multidisciplinary management]. Aten Primaria 2022; 54:102395. [PMID: 35700618 PMCID: PMC9198324 DOI: 10.1016/j.aprim.2022.102395] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
El envejecimiento poblacional se asocia a un mayor uso de recursos sociales sanitarios, asociados a la mayor morbimortalidad y discapacidad de este grupo etario. La fragilidad es un síndrome geriátrico previo a la aparición de la dependencia funcional, que permite la identificación de individuos de mayor riesgo de dependencia, institucionalización, efectos adversos de fármacos, mortalidad y otros eventos negativos de salud. Este síndrome es potencialmente reversible con una intervención multicomponente. La atención primaria de salud es el lugar preferente para el diagnóstico y seguimiento de la fragilidad, a través de escalas como la FRAIL scale, el fenotipo de Fried o modelos de acumulación de déficits. Para el seguimiento se precisa la intervención multidimensional y coordinada de diferentes profesionales sanitarios y sociales, con la implicación del paciente y su familia. Se debe fomentar la investigación para determinar las intervenciones más eficaces y los cursos clínicos más frecuentes.
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Affiliation(s)
- Miguel Ángel Acosta-Benito
- Medicina Familiar y Comunitaria. CS Joaquín Rodrigo, Madrid. Servicio Madrileño de Salud, Madrid, España; Miembro del Grupo de Trabajo de Atención al Mayor de semFYC y Coordinador del grupo PAPPS-semFYC del Mayor.
| | - Iñaki Martín-Lesende
- Médico de familia, Centro de Salud Indautxu, Bilbao, País Vasco, España; Miembro del Grupo de Trabajo de Atención al Mayor de semFYC y del grupo PAPPS-semFYC del Mayor
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18
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Nakamya MF, Sil S, Buch S, Hakami RM. Mitochondrial Extracellular Vesicles in CNS Disorders: New Frontiers in Understanding the Neurological Disorders of the Brain. Front Mol Biosci 2022; 9:840364. [PMID: 35433837 PMCID: PMC9005996 DOI: 10.3389/fmolb.2022.840364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Recent findings have highlighted potential diagnostic and prognostic values of extracellular vesicles (EVs) that contain mitochondrial derived components for neurological disorders. Furthermore, functional influences of vesicles carrying mitochondrial components have been reported. In particular, this includes indications of crosstalk with mitophagy to influence progression of various CNS disorders. In this mini-review, we discuss the current state of knowledge about this intriguing class of vesicles in neurological disorders of the CNS, and outline the lacunae and thus scope of further development in this fascinating field of study.
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Affiliation(s)
- Mary F. Nakamya
- School of Systems Biology, George Mason University, Manassas, VA, United States
- Center for Infectious Disease Research, George Mason University, Manassas, VA, United States
| | - Susmita Sil
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States
| | - Shilpa Buch
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ramin M. Hakami
- School of Systems Biology, George Mason University, Manassas, VA, United States
- Center for Infectious Disease Research, George Mason University, Manassas, VA, United States
- *Correspondence: Ramin M. Hakami,
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Frailty predicts failure to discharge patients home from a subacute-care unit: a 3-year Italian experience. Aging Clin Exp Res 2022; 34:95-103. [PMID: 34291406 PMCID: PMC8795051 DOI: 10.1007/s40520-021-01908-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/05/2021] [Indexed: 12/02/2022]
Abstract
Background The primary purpose of Subacute Care Units (SCU) is to decongest acute hospital wards and facilitate the return of older patients to home. Aims We analyzed the clinical characteristics and outcomes of patients admitted to an Italian SCU, and we explored factors associated with discharge to locations other than home (outcome). Methods This retrospective observational cohort study was conducted at a medium-sized suburban hospital, enrolling all patients consecutively admitted to one SCU from October 2017 to February 2020. We collected demographics, cause of admission, comorbidities, cognition, Barthel Index (BI), nutritional status, Clinical Frailty Scale (CFS), length of stay, and discharge destination. Delirium was screened with the 4AT score. We adopted a multivariable conditional logistic regression model to identify the factors associated with the outcome. Results Frail subjects accounted for 58.6% of 406 patients (mean age 78.2 years, SD 11.6), while 61% were classified as functionally dependent. More than half of patients had relevant comorbidity, approximately 80% had a poor nutritional status, and 25% had pre-existing dementia. The overall prevalence of delirium was 14.5%. Most patients came from a hospital setting; recurrent reasons for admission were infections (70.5%) and heart failure (12.7%). Having a urinary bladder catheter at discharge, being overtly frail (CFS > 8), and low BI score were factors independently associated with not being discharged home. Discussion and conclusion The routine assessment of frailty, as expressed by the CFS, may help redirecting the patients eligible for SCU admission.
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Cechinel C, Lenardt MH, Rodrigues JAM, Binotto MA, Aristides MM, Kraus R. Fragilidad y delirium en adultos mayores hospitalizados: revisión sistemática con metanálisis. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6120.3686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Resumen Objetivo: estimar la prevalencia y sintetizar evidencias sobre la relación entre fragilidad y delirium en adultos mayores hospitalizados. Método: revisión sistemática con metanálisis en el que se seleccionaron estudios observacionales realizados con adultos mayores sobre fragilidad, delirium y hospitalización, sin recorte temporal ni de idioma. La búsqueda se realizó en las bases de datos MEDLINE, EMBASE, CINAHL, Scopus, Web of Science y CENTRAL en agosto de 2021. Se siguieron los preceptos del Instituto Joanna Briggs (Joanna Briggs Institute, JBI) - Evidence Synthesis Groups. El modelo de metanálisis estimó el riesgo relativo de la prevalencia de fragilidad y delirium. Se utilizó el método de la varianza inversa para proporciones para estimar la prevalencia y el riesgo relativo de los desenlaces binarios. Resultados: inicialmente se identificaron 1.244 artículos, se incluyen en el metanálisis 26 (n=13.502 participantes), la prevalencia de fragilidad fue del 34% (IC 95% 0,26 a 0,42; I 2=99%; t 2= 0,7618, p=0) y de delirium del 21% (IC 95% 0,17 a 0,25; I 2=95%; t 2= 0,3454, p<0,01). El riesgo de que el adulto mayor frágil hospitalizado desarrolle delirium fue del 66% (RR 1,66; IC 95% 1,23 a 2,22; I2=92%; t2=0,4154; p<0,01). Conclusión: los adultos mayores hospitalizados tienen una prevalencia de fragilidad del 34% y de delirium del 21%, la fragilidad es un factor de riesgo independiente para el desarrollo de delirium, cuando se compara a los frágiles con los no frágiles, la probabilidad de delirium de los primeros es de un 66% más.
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Affiliation(s)
- Clovis Cechinel
- Universidade Federal do Paraná, Brazil; Secretaria Municipal de Saúde, Brazil
| | | | | | | | | | - Rosane Kraus
- Universidade Federal do Paraná, Brazil; Fundação Estatal de Atencão a Saúde, Brazil
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21
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Cechinel C, Lenardt MH, Rodrigues JAM, Binotto MA, Aristides MM, Kraus R. Fragilidade e delirium em idosos hospitalizados: revisão sistemática com metanálise. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6120.3688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Resumo Objetivo: estimar a prevalência e sintetizar evidências sobre a relação entre fragilidade e delirium em idosos hospitalizados. Método: revisão sistemática com metanálise na qual foram selecionados estudos observacionais realizados com idosos sobre fragilidade, delirium e hospitalização, sem recortes temporais e de idioma. A busca foi realizada nas bases de dados MEDLINE, EMBASE, CINAHL, Scopus, Web of Science e CENTRAL durante o mês de agosto de 2021. Foram seguidos os preceitos estabelecidos pelo Joanna Briggs Institute (JBI) - Grupos de Síntese de Evidências.. O modelo de metanálise estimou risco relativo da prevalência de fragilidade e delirium. Utilizou-se método da variância inversa para proporções para estimar as prevalências e risco relativo para desfechos binários. Resultados: identificaram-se, inicialmente, 1.244 artigos, 26 incluídos na metanálise (n=13.502 participantes), sendo a prevalência de fragilidade 34% (IC 95% 0,26 a 0,42; I 2=99%; t 2= 0,7618, p=0) e delirium 21% (IC 95% 0,17 a 0,25; I 2=95%; t 2= 0,3454, p<0,01). O risco do idoso frágil hospitalizado desenvolver delirium foi de 66% (RR 1,66; IC 95% 1,23 a 2,22; I2=92%; t2=0,4154; p<0,01). Conclusão: prevalência de 34% de fragilidade e 21% de delirium em idosos hospitalizados, sendo a fragilidade um fator de risco independente para desenvolvimento de delirium, com um aumento de chance de 66% comparado aos não frágeis.
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Affiliation(s)
- Clovis Cechinel
- Universidade Federal do Paraná, Brazil; Secretaria Municipal de Saúde, Brazil
| | | | | | | | | | - Rosane Kraus
- Universidade Federal do Paraná, Brazil; Fundação Estatal de Atencão a Saúde, Brazil
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22
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Cooper L, Loewenthal J, Frain LN, Tulebaev S, Cardin K, Hshieh TT, Dumontier C, Streiter S, Joseph C, Hilt A, Theou O, Rockwood K, Orkaby AR, Javedan H. From research to bedside: Incorporation of a CGA-based frailty index among multiple comanagement services. J Am Geriatr Soc 2022; 70:90-98. [PMID: 34519037 PMCID: PMC9056009 DOI: 10.1111/jgs.17446] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 01/03/2023]
Abstract
The comprehensive geriatric assessment (CGA) is the core tool used by geriatricians across diverse clinical settings to identify vulnerabilities and estimate physiologic reserve in older adults. In this paper, we demonstrate the iterative process at our institution to identify and develop a feasible, acceptable, and sustainable bedside CGA-based frailty index tool (FI-CGA) that not only quantifies and grades frailty but also provides a uniform way to efficiently communicate complex geriatric concepts such as reserve and vulnerability with other teams. We describe our incorporation of the FI-CGA into the electronic health record (EHR) and dissemination among clinical services. We demonstrate that an increasing number of patients have documented FI-CGA in their initial assessment from 2018 to 2020, while additional comanagement services were established (Figure 2). The acceptability and sustainability of the FI-CGA, and its routine use by geriatricians in our division, were demonstrated by a survey where the majority of clinicians report using the FI-CGA when assessing a new patient and that the FI-CGA informs their clinical management. Finally, we demonstrate how we refined and updated the FI-CGA, we provide examples of applications of the FI-CGA across the institution and describe areas of ongoing process improvement and challenges for the use of this tailored yet standardized tool across diverse inpatient and outpatient services. The process outlined can be used by other geriatric departments to introduce and incorporate an FI-CGA.
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Affiliation(s)
- Lisa Cooper
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julia Loewenthal
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Laura N. Frain
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Samir Tulebaev
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kristin Cardin
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Tammy T. Hshieh
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Clark Dumontier
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA,New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Shoshana Streiter
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Carly Joseph
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Austin Hilt
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California, USA,Department of Family and Community Medicine, University of California, Davis, California, USA
| | - Olga Theou
- Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada,Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada,Centre for Health Care of the Elderly, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Ariela R. Orkaby
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA,New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Houman Javedan
- Division of Aging, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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23
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Liu S, Kang L, Liu X, Zhao S, Wang X, Li J, Jiang S. Trajectory and Correlation of Intrinsic Capacity and Frailty in a Beijing Elderly Community. Front Med (Lausanne) 2021; 8:751586. [PMID: 34957141 PMCID: PMC8695757 DOI: 10.3389/fmed.2021.751586] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The World Health Organization proposed intrinsic capacity (IC) model to guide the implementation of person-centered care plan aimed at preserving or reserving functional ability, especially in frail older adults. We aimed to show the trajectory of IC and the overlap between IC impairment and frailty and investigate the correlation between IC domains and frailty status transitions. Method: Longitudinal observational study covering 230 community-dwelling older adults (mean age 84.0 ± 4.5 years) at baseline, and transition information at 2-year follow-up (n = 196). IC was measured by five domains: locomotion, cognition, vitality, psychological, and sensory. Frailty was defined by FRAIL Scale. IC and frailty status transitions were assessed. Logistic regression, odds ratios (OR) and 95% confidence interval (CI) were used for the analysis. Results: The prevalence of frailty was 23.0% and increased up to 41.8% over two years. Regarding frailty transitions, 38.3% of older adults progressed to more frailty status, and 8.6% regressed to lesser frailty status. The prevalence of IC impairment was 67.9% and increased to 81.6% over two years. Regarding IC transitions, 49.2% of adults with no IC impairment at baseline kept stable, and 50.8% developed new IC impairment. Among individuals with IC impairment at baseline, 57.9% worsened, and 13.5% improved. Importantly, IC impairment at baseline existed in 42.4% robust adults, 83.3% pre-frail adults, and 93.3% frail adults. 47.1% individuals who kept non-frail status within two years experienced IC worsened transition. Univariable analysis illustrated that new impaired locomotion, vitality, cognition, and sensory domains increased the risk of non-frail progressed to frail status. After adjusting for covariables, new impaired locomotion (OR = 3.625, 95% CI: 1.348–9.747) and vitality domains (OR = 3.034, 95% CI: 1.229–7.487) were associated with a higher possibility of non-frail progressed to frail status. Conclusion: IC impairment and frailty overlap and co-exist in older adults. IC impairment, especially new impairment in locomotion and vitality are associated with the transitions from non-frail to frail status. It is important that geriatricians tightly monitor IC trajectory and find the new impaired domains to take early action to minimize the public health burden of frailty.
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Affiliation(s)
- Shuo Liu
- Department of Geriatrics, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - XiaoHong Liu
- Department of Geriatrics, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - SongQi Zhao
- Taikang Yanyuan Continuing Care Retirement Community, Beijing, China.,Yanyuan Rehabilitation Hospital, Beijing, China
| | - XuePing Wang
- Department of Geriatrics, Affiliated Hospital of QingHai University, Xining, China
| | - JiaoJiao Li
- Department of Geriatrics, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shan Jiang
- Department of Geriatrics, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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24
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Lee JY, Yang YS, Cho E. Transitional care from hospital to home for frail older adults: A systematic review and meta-analysis. Geriatr Nurs 2021; 43:64-76. [PMID: 34823079 DOI: 10.1016/j.gerinurse.2021.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022]
Abstract
Frail older adults are vulnerable to hospitalization and transitional care is needed to maintain care continuity; however, there exists no review regarding transitional care focusing on frailty. This study aimed to investigate transitional care for frail older adults and its effectiveness. Search terms were (P) frail older adults; (I) transitional care initiated before discharge; (C) usual care; (O) all health outcomes. Fourteen trials were identified. The most measured outcome was readmission (n = 13), followed by mortality (n = 9), function (n = 7), quality of life (n = 5), and self-rated health (n = 5). Statistical significance effects were reported in the followings: n = 6, readmission; n = 0, mortality; n = 3, function; n = 2, quality of life; and n = 4, self-rated health. The meta-analysis demonstrated that transitional care reduced readmission at six months but not other time points nor mortality or quality of life. The intervention effectiveness was inconclusive; therefore, an evidence-based yet novel approach is necessary to establish an adequate transitional care intervention for frail older adults.
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Affiliation(s)
- Ji Yeon Lee
- Yonsei University College of Nursing, Seoul, 03722, South Korea
| | - Yong Sook Yang
- Yonsei University College of Nursing, Seoul, 03722, South Korea
| | - Eunhee Cho
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, 03722, South Korea.
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25
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Rebora P, Focà E, Salvatori A, Zucchelli A, Ceravolo I, Ornago AM, Finazzi A, Arsuffi S, Bonfanti P, Citerio G, Mazzola P, Ecarnot F, Valsecchi MG, Marengoni A, Bellelli G. The effect of frailty on in-hospital and medium-term mortality of patients with COronaVIrus Disease-19: the FRACOVID study. Panminerva Med 2021; 64:24-30. [PMID: 34761887 DOI: 10.23736/s0031-0808.21.04506-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Older persons hospitalized for COVID-19 are at highest risk of death. Frailty Assessment can detect heterogeneity in risk among people of the same chronological age. We investigated the association between frailty and in-hospital and medium-term mortality in middleaged and older adults with COVID-19 during the first two pandemic waves. METHODS Observational multicenter study. We recorded sociodemographic factors (age, sex), smoking status, date of symptom onset, biological data, need for supplemental oxygen, comorbidities, cognitive and functional status, in-hospital mortality. We calculated a Frailty Index (FI) as the ratio between deficits presented and total deficits considered for each patient (theoretical range 0-1). We also assessed the Clinical Frailty Scale (CFS). Mortality at follow-up was ascertained from a regional registry. RESULTS In total, 1344 patients were included; median age 68 years (Q1-Q3, 56-79); 857 (64%) were men. Median CFS score was 3 (Q1-Q3 2-5) and was lower in younger vs older patients. Median FI was 0.06 (Q1-Q3 0.03-0.09) and increased with increasing age. Overall, 244 (18%) patients died in-hospital and 288 (22%) over a median follow-up of 253 days. FI and CFS were significantly associated with risk of death. In two different models using the same covariates, each increment of 0.1 in FI increased the overall hazard of death by 35% (HR= 1.35, 95%CI 1.23-1.48), similar to the hazard for each increment of CFS (HR=1.37, 95%CI 1.25-1.50). CONCLUSIONS Frailty, assessed with the FI or CFS, predicts in-hospital and medium-term mortality and may help estimate vulnerability in middle-aged and older COVID-19 patients.
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Affiliation(s)
- Paola Rebora
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Emanuele Focà
- Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Brescia Spedali Civili Hospital, Brescia, Italy
| | - Andrea Salvatori
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alberto Zucchelli
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Isabella Ceravolo
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Alice M Ornago
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Alberto Finazzi
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Stefania Arsuffi
- Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Bonfanti
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Infectious Diseases Unit, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, EA3920, University of Franche-Comté, Besançon, France
| | - Maria Grazia Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy - .,Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
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26
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Zhao J, Chhetri JK, Chang Y, Zheng Z, Ma L, Chan P. Intrinsic Capacity vs. Multimorbidity: A Function-Centered Construct Predicts Disability Better Than a Disease-Based Approach in a Community-Dwelling Older Population Cohort. Front Med (Lausanne) 2021; 8:753295. [PMID: 34651003 PMCID: PMC8505775 DOI: 10.3389/fmed.2021.753295] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to assess the status of intrinsic capacity (IC)—a novel function-centered construct proposed by the WHO and examine whether impairment in IC predicts subsequent 1-year activities of daily living (ADL) disability better than a disease-based approach, i. e., multimorbidity status. Methods: This study included data of community-dwelling older adults from the Beijing Longitudinal Study on Aging II aged 65 years or older who were followed up at 1 year. Multivariate logistic regressions were performed to estimate the odds of ADL disability at baseline and 1-year follow-up. Results: A total of 7,298 older participants aged 65 years or older were included in the current study. About 4,742 older adults were followed up at 1 year. At baseline, subjects with a higher impairment in IC domains showed higher odds of ADL disability [adj. odds ratio (OR) = 9.51 for impairment in ≥3 domains, area under the curve (AUC) = 0.751] compared to much lower odds of ADL disability in subjects with a higher number (≥3) of chronic diseases (adj. OR 3.92, AUC = 0.712). At 1-year follow-up, the overall incidence of ADL disability increased with the impairment in IC domains higher than the increase in multimorbidity status. A higher impairment in IC domains showed higher odds of incidence ADL disability for impairment in 2 or ≥3 IC domains (adj. OR 2.32 for impairment in ≥3 domains, adj. OR 1.43 for impairment in two domains, AUC = 0.685). Only subjects who had ≥3 chronic diseases had higher odds of 1-year incident ADL disability (adj. OR 1.73, AUC = 0.681) that was statistically significant. Conclusion: Our results imply that a function-centered construct could have higher predictability of disability compared to the multimorbidity status in community older people. Our results need to be confirmed by studies with longer follow-up.
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Affiliation(s)
- Jing Zhao
- Department of Geriatrics, Neurology and Neurobiology, National Clinical Research Center for Geriatric Disease, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jagadish K Chhetri
- Department of Geriatrics, Neurology and Neurobiology, National Clinical Research Center for Geriatric Disease, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yi Chang
- Department of Respiration, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Zheng Zheng
- Department of Geriatrics, Neurology and Neurobiology, National Clinical Research Center for Geriatric Disease, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Lina Ma
- Department of Geriatrics, Neurology and Neurobiology, National Clinical Research Center for Geriatric Disease, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Piu Chan
- Department of Geriatrics, Neurology and Neurobiology, National Clinical Research Center for Geriatric Disease, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Disease of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing, China.,Clinical Center for Parkinson's Disease, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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27
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Silva AMDM, Mambrini JVDM, Andrade JM, Andrade FBD, Lima-Costa MF. [Frailty in elderly individuals and perception of problems in indicators of attributes of primary healthcare: results of the ELSI-Brasil]. CAD SAUDE PUBLICA 2021; 37:e00255420. [PMID: 34586170 DOI: 10.1590/0102-311x00255420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
This study aimed to examine the association between frailty syndrome and the perception of problems in indicators of attributes in primary healthcare (PHC) among elderly Brazilians. This was a cross-sectional study with 5,432 participants 60 years or older in the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brasil), conducted in 2015 and 2016. Frailty, the independent variable, was defined according to the theoretical framework of the frailty phenotype, and the indicators of problems in PHC attributes, the dependent variables, were obtained from questions related to health services use. Access, longitudinal care, coordination, comprehensiveness, family orientation, and cultural adequacy were the target attributes. For the data analysis, logistic regression models were used, adjusted for predisposing, enabling, and need factors for use of health services. Among the participants, 55.1% were females, 57.9% were 60 to 69 years of age, and 51.8% reported multimorbidity. Frail and pre-frail elders accounted for 13.4% and 54.5% of the sample, respectively. Multivariate analyses showed that frail elders (compared to robust elders) showed higher odds of reporting problems with access (OR = 1.45; 95%CI: 1.08-1.93), longitudinal care (OR = 1.54; 95%CI: 1.19-2.00), and comprehensive care (OR = 1.45; 95%CI: 1.14-1.85), in addition to more problems with attributes of PHC (OR = 1.38; 95%CI: 1.05-1.82, for 5 or more). The study suggests the occurrence of inequities in the care provided by Brazilian PHC for frail elders, particularly in the attributes of access, longitudinal care, and comprehensiveness.
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Affiliation(s)
| | | | | | | | - Maria Fernanda Lima-Costa
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.,Programa de Pós-graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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28
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Bin-Jumah MN, Gilani SJ, Hosawi S, Al-Abbasi FA, Zeyadi M, Imam SS, Alshehri S, Ghoneim MM, Nadeem MS, Kazmi I. Pathobiological Relationship of Excessive Dietary Intake of Choline/L-Carnitine: A TMAO Precursor-Associated Aggravation in Heart Failure in Sarcopenic Patients. Nutrients 2021; 13:3453. [PMID: 34684454 PMCID: PMC8540684 DOI: 10.3390/nu13103453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 02/04/2023] Open
Abstract
The microecological environment of the gastrointestinal tract is altered if there is an imbalance between the gut microbiota phylases, resulting in a variety of diseases. Moreover, progressive age not only slows down physical activity but also reduces the fat metabolism pathway, which may lead to a reduction in the variety of bacterial strains and bacteroidetes' abundance, promoting firmicutes and proteobacteria growth. As a result, dysbiosis reduces physiological adaptability, boosts inflammatory markers, generates ROS, and induces the destruction of free radical macromolecules, leading to sarcopenia in older patients. Research conducted at various levels indicates that the microbiota of the gut is involved in pathogenesis and can be considered as the causative agent of several cardiovascular diseases. Local and systematic inflammatory reactions are caused in patients with heart failure, as ischemia and edema are caused by splanchnic hypoperfusion and enable both bacterial metabolites and bacteria translocation to enter from an intestinal barrier, which is already weakened, to the blood circulation. Multiple diseases, such as HF, include healthy microbe-derived metabolites. These key findings demonstrate that the gut microbiota modulates the host's metabolism, either specifically or indirectly, by generating multiple metabolites. Currently, the real procedures that are an analogy to the symptoms in cardiac pathologies, such as cardiac mass dysfunctions and modifications, are investigated at a minimum level in older patients. Thus, the purpose of this review is to summarize the existing knowledge about a particular diet, including trimethylamine, which usually seems to be effective for the improvement of cardiac and skeletal muscle, such as choline and L-carnitine, which may aggravate the HF process in sarcopenic patients.
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Affiliation(s)
- May Nasser Bin-Jumah
- Biology Department, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
- Environment and Biomaterial Unit, Health Sciences Research Center, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Sadaf Jamal Gilani
- Department of Basic Health Sciences, Preparatory Year, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Salman Hosawi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.H.); (F.A.A.-A.); (M.Z.); (M.S.N.)
| | - Fahad A. Al-Abbasi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.H.); (F.A.A.-A.); (M.Z.); (M.S.N.)
| | - Mustafa Zeyadi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.H.); (F.A.A.-A.); (M.Z.); (M.S.N.)
| | - Syed Sarim Imam
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.S.I.); (S.A.)
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.S.I.); (S.A.)
| | - Mohammed M Ghoneim
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Ad Diriyah 13713, Saudi Arabia;
| | - Muhammad Shahid Nadeem
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.H.); (F.A.A.-A.); (M.Z.); (M.S.N.)
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.H.); (F.A.A.-A.); (M.Z.); (M.S.N.)
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29
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Azzolino D, Spolidoro GCI, Saporiti E, Luchetti C, Agostoni C, Cesari M. Musculoskeletal Changes Across the Lifespan: Nutrition and the Life-Course Approach to Prevention. Front Med (Lausanne) 2021; 8:697954. [PMID: 34532328 PMCID: PMC8438318 DOI: 10.3389/fmed.2021.697954] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/22/2021] [Indexed: 12/12/2022] Open
Abstract
Aging is characterized by the progressive decline of muscle mass and function, the so-called sarcopenia. Also bone loss is widespread among older people. Sarcopenia and osteopenia/osteoporosis are associated with several adverse outcomes including falls, risk of fractures, functional decline, frailty, and mortality. Recently, the life-course approach to prevent or delay functional decline has become very popular. Regarding musculoskeletal health, there is suggestive evidence that acting during critical or sensitive periods of life in which each person build-up its biological reserves may influence the rate of functional decline in the later stages of life. A life-course approach to musculoskeletal health should take place during early life when plasticity allows more easily the attainment of the peak of the musculoskeletal system driven by environmental stimuli. The rate of the subsequent decline will depend on the peak previously reached. Nutrition and physical exercise are important environmental factors that can influence musculoskeletal development by favoring and maintaining peak bone and muscle mass and strength. Here we provide an overview of body composition changes occurring across the lifespan and strategies based on nutrition and physical exercise to support musculoskeletal health as well as minimizing losses during older life.
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Affiliation(s)
- Domenico Azzolino
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | | | - Edoardo Saporiti
- Specialization School in Geriatrics, University of Milan, Milan, Italy
| | - Costanza Luchetti
- Specialization School in Geriatrics, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Cesari
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
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Parodi JF, Runzer-Colmenares FM. [Impact of social support on limited mobility in older people in high Andean communities in PeruImpacto do apoio social na mobilidade reduzida em idosos de comunidades do altiplano andino no Peru]. Rev Panam Salud Publica 2021; 45:e88. [PMID: 34475884 PMCID: PMC8369112 DOI: 10.26633/rpsp.2021.88] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/16/2021] [Indexed: 12/25/2022] Open
Abstract
Objetivo. Determinar si existe relación entre la movilidad física y la falta de soporte social en personas mayores que viven en comunidades altoandinas de Perú. Métodos. Estudio observacional, analítico y retrospectivo a partir de la base de datos de una investigación previa de corte trasversal con información de 449 personas de 60 años o más participantes en el proyecto ANDES-FRAIL. La variable dependiente fue la movilidad, evaluada según el instrumento Short Physical Performance Battery; la variable independiente fue el soporte social, evaluado mediante un ítem del cuestionario de fragilidad de Edmonton. Como covariables se utilizaron parámetros sociodemográficos, comorbilidades, el número de fármacos de consumo habitual y los puntajes recibidos en varios instrumentos: el índice de Barthel para determinar la funcionalidad en personas mayores, el cuestionario de Yesavage para evaluar la depresión en ancianos, entre otros. Se calcularon las frecuencias y los porcentajes de las variables categóricas. Se elaboró un modelo ajustado con las variables que resultaron estadísticamente significativas en el análisis de regresión logística bifactorial. Resultados. La frecuencia de movilidad limitada en la población estudiada fue 58,6% (n = 263) y la de inadecuado soporte social fue 58,1% (n = 261). Los participantes con inadecuado soporte social tuvieron una frecuencia de movilidad limitada del 70,7% (n = 186). Según el modelo de regresión ajustado, el soporte social inadecuado incrementaría en 2,5 veces (IC95%: 1,3-4,5) las probabilidades de tener movilidad limitada, independientemente de las covariables confusoras. Conclusiones. La falta de apoyo social está asociada con la movilidad limitada de las personas mayores que habitan en comunidades altoandinas peruanas.
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Affiliation(s)
- José F Parodi
- Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martín de Porres Lima Perú Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martín de Porres, Lima, Perú
| | - Fernando M Runzer-Colmenares
- CHANGE Research Working Group, Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad Científica del Sur Lima Perú CHANGE Research Working Group, Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Perú
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Abstract
Delirium and frailty are prevalent geriatric syndromes and important public health issues among older adults. The prevalence of delirium among hospitalized older adults ranges from 15% to 75%, while that of frailty ranges from 12% to 24%. The exact pathophysiology of these two conditions has not been clearly identified, although several hypotheses have been proposed. However, these conditions are considered to be multifactorial in etiology and are associated with inflammation related to aging, alterations in vascular systems, genetics, and nutritional deficiency. Furthermore, clinically, they are significantly associated with frailty, which increases the risk of delirium by almost two- to three-fold among hospitalized older adults. With their multifactorial etiology and unknown pathophysiology, current evidence supports more practical multicomponent patient-centered approaches to prevent and manage delirium with frailty among hospitalized older adults. These comprehensive and organized bundled approaches can identify high-risk patients with frailty and more effectively manage their delirium.
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Affiliation(s)
- Min Ji Kwak
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Corresponding author: Min Ji Kwak, MD, MS, DrPH Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St MSB 5.126, Houston, TX 77030, USA E-mail:
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Kotsani M, Kravvariti E, Avgerinou C, Panagiotakis S, Bograkou Tzanetakou K, Antoniadou E, Karamanof G, Karampeazis A, Koutsouri A, Panagiotopoulou K, Soulis G, Stolakis K, Georgiopoulos I, Benetos A. The Relevance and Added Value of Geriatric Medicine (GM): Introducing GM to Non-Geriatricians. J Clin Med 2021; 10:3018. [PMID: 34300184 PMCID: PMC8304813 DOI: 10.3390/jcm10143018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Geriatric Medicine (GM) holds a crucial role in promoting health and managing the complex medical, cognitive, social, and psychological issues of older people. However, basic principles of GM, essential for optimizing the care of older people, are commonly unknown or undermined, especially in countries where GM is still under development. This narrative review aims at providing insights into the role of GM to non-geriatrician readers and summarizing the main aspects of the added value of a geriatric approach across the spectrum of healthcare. Health practitioners of all specialties are frequently encountered with clinical conditions, common in older patients (such as cancer, hypertension, delirium, major neurocognitive and mental health disorders, malnutrition, and peri-operative complications), which could be more appropriately managed under the light of the approach of GM. The role of allied health professionals with specialized knowledge and skills in dealing with older people's issues is essential, and a multidisciplinary team is required for the delivery of optimal care in response to the needs and aspirations of older people. Thus, countries should assure the educational background of all health care providers and the specialized health and social care services required to meet the demands of a rapidly aging society.
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Affiliation(s)
- Marina Kotsani
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
| | - Evrydiki Kravvariti
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- 1st Department of Propaedeutic Internal Medicine, Laiko General Hospital, 11527 Athens, Greece
- Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christina Avgerinou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Symeon Panagiotakis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Internal Medicine, Heraklion University Hospital, 71003 Heraklion, Greece
| | - Katerina Bograkou Tzanetakou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Medical Psychology Unit, School of Medicine, European University Cyprus, 1516 Nicosia, Cyprus
| | - Eleftheria Antoniadou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Rehabilitation Unit, Patras University Hospital, 26504 Rio, Greece
| | - Georgios Karamanof
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Geriatric Clinic, Vrinnevi Hospital, 60379 Norrköping, Sweden
| | - Athanasios Karampeazis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Medical Oncology Unit, NIMTS Veterans Hospital, 11521 Athens, Greece
| | - Anastasia Koutsouri
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Henry Dunant Hospital Center, Outpatient Geriatric Assessment Unit, 11526 Athens, Greece
| | - Kyriaki Panagiotopoulou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Geriatric Ward, Hôpital “Sainte Thérèse”, VIVALIA-IFAC, 6600 Bastogne, Belgium
| | - George Soulis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Henry Dunant Hospital Center, Outpatient Geriatric Assessment Unit, 11526 Athens, Greece
- School of Social Sciences, Hellenic Open University, 26335 Patras, Greece
| | - Konstantinos Stolakis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- School of Medicine, Patras University, 26504 Rio, Greece
| | - Ioannis Georgiopoulos
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
| | - Athanase Benetos
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
- INSERM DCAC, 54505 Vandœuvre-lès-Nancy, France
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Cheng YC, Kuo YC, Chang PC, Li YC, Huang WT, Chen W, Chou CY. Geriatric Functional Impairment Using the Integrated Care for Older People (ICOPE) Approach in Community-Dwelling Elderly and Its Association with Dyslipidemia. Vasc Health Risk Manag 2021; 17:389-394. [PMID: 34262283 PMCID: PMC8274513 DOI: 10.2147/vhrm.s305490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/18/2021] [Indexed: 12/19/2022] Open
Abstract
Background The World Health Organization (WHO) proposed the integrated care for older people (ICOPE) screening tool to identify functional impairment. We explore the association of geriatric functional impairment and hypertension, diabetes, dyslipidemia in the community-dwelling elderly. Methods We enrolled individuals aged at least 65 with hypertension, diabetes, or dyslipidemia; or those aged at least 75 from May to July 2019. We applied ICOPE tools to evaluate six function assessments: cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss, and depressive symptoms. Factors were analyzed using stepwise multivariable linear regression for ICOPE scores and logistic regression for geriatric functional impairment. All analyses were adjusted for age and glomerular filtration rate. Results We enrolled 457 participants including 303 (66.3%) participants with hypertension, 296 (64.8%) diabetes, and 221 (48.4%) dyslipidemia. Seventy-eight (17.1%) participants have at least one geriatric functional impairment, including 41 (25.9%) participants aged ≥ 75 and 37 (12.4%) aged 65–74. The ICOPE score (0.4 ± 0.6) of participants aged at least 75 was higher than that (0.1 ± 0.4) of the participants aged 65–74 (p < 0.001). Dyslipidemia (p = 0.002) was positively associated with ICOPE score. Dyslipidemia (odds ratio: 2.15, 95% confidence interval: 1.27–3.70, p = 0.005), not hypertension (p = 0.3) and diabetes (p = 0.9), was associated with geriatric functional impairment. Visual impairment was the most common function impairment. Female was linked to limited mobility, renal function was associated with mobility (p < 0.001) and nutrition (p = 0.02). Conclusion Dyslipidemia but not hypertension, diabetes is linked to geriatric functional impairment in community-dwelling elderly. Lower renal function is associated with decreased mobility and nutrition. More studies are needed to determine if treatment of dyslipidemia reduces geriatric functional impairment.
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Affiliation(s)
- Ya-Chi Cheng
- Division of Family Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Yi-Chun Kuo
- Community Nursing Room, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Pei-Chi Chang
- Community Nursing Room, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Ya-Ching Li
- Community Nursing Room, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Wan-Ting Huang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Wei Chen
- Division of Pulmonary and Critical Care Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Che-Yi Chou
- Division of Nephrology, Asia University Hospital, Wufeng, Taichung, Taiwan.,Department of Post-baccalaureate Veterinary Medicine, Asia University, Wufeng, Taichung, Taiwan.,Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
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Crosignani S, Fantinati J, Cesari M. Frailty and Geriatric Medicine During the Pandemic. Front Med (Lausanne) 2021; 8:673814. [PMID: 34164415 PMCID: PMC8215135 DOI: 10.3389/fmed.2021.673814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
The term frailty in the era of coronavirus disease 2019 (COVID-19) has a manifold implication. The vast majority of the countries worldwide being hit by the pandemic have shown the frailty of their health and social care systems. Although the surprise factor could somehow justify the unpreparedness experienced during the first wave, the second wave still led to significant difficulties almost everywhere. Looking at Italy's situation, it is evident how the stress test applied by COVID-19 on the system has threatened its stability, getting it closer to collapsing many times. It is true that Italy, in particular the Northern regions, has been the epicenter of COVID-19 in Europe in a time when information about the severe acute respiratory syndrome coronavirus 2 was still lacking and confusing. Nevertheless, what happened has demonstrated significant issues in the structure, priorities, and organization of the system. It has exemplified the obsolete approach adopted in clinical practice, particularly when applied to frail older persons. The COVID-19 pandemic has made emerging the need for a substantial reshaping of our healthcare system. The hospital-centered model has dramatically failed. To adequately face the new challenges brought by the increasing complexity of our aging society, it is critical to move the barycenter of action toward the community/primary care, promoting the integration of services and centralization of clinical/administrative data. It is vital to train healthcare professionals in the identification and basic principles of geriatric conditions, clarifying the role that geriatricians play. In the present article, some cornerstone concepts of geriatric medicine (i.e., definition of geriatrics, multidisciplinarity, integrated care, and development of clinical databases for filling the evidence-based medicine gaps) are presented, explaining the challenges they have faced during the COVID-19 pandemic and possible solutions for implementing improvements in the future.
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Affiliation(s)
- Silvia Crosignani
- Fellowship in Geriatrics and Gerontology, University of Milan, Milan, Italy
| | - Jacopo Fantinati
- Fellowship in Geriatrics and Gerontology, University of Milan, Milan, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Istituti di Ricovero e Cura a Carattere Scientifico Istituti Clinici Scientifici Maugeri, University of Milan, Milan, Italy
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Renom-Guiteras A. Potentially inappropriate medication among people with dementia: towards individualized decision-making. Eur Geriatr Med 2021; 12:569-575. [PMID: 34003481 DOI: 10.1007/s41999-021-00502-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/15/2021] [Indexed: 12/18/2022]
Abstract
AIM The aims of this manuscript are to report on several aspects that may deserve special consideration when individualizing decisions on the prescription appropriateness among people with dementia, and to discuss current research needs in relation to these aspects. METHODS Review article based on selective literature. RESULTS The aspects that may deserve special consideration are: the prescription of pychotropic medications, for being commonly inappropriately prescribed; the presence of advanced stage of dementia, comorbidities or multi-morbidity and/or frailty, as they can determine the prognosis and goals of care; the values and wishes of the person with dementia, as they may prioritize different goals of care; and medication adherence, as it may be poorer compared with persons without dementia. Further research on these aspects including representative participants is necessary as evidence base to guide clinical practice. CONCLUSION Individualised decisions on prescription appropriateness among people with dementia may require a comprehensive evaluation of the person in order to establish a shared care plan. Further research will probably support this process.
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Affiliation(s)
- Anna Renom-Guiteras
- Department of Geriatric Medicine. Parc de Salut Mar, Barcelona, Spain. .,Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.
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Reliability, Validity, and Feasibility of the Frail-VIG Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105187. [PMID: 34068227 PMCID: PMC8153117 DOI: 10.3390/ijerph18105187] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 12/20/2022]
Abstract
The study aimed to assess the reliability of the scores, evidence of validity, and feasibility of the Frail-VIG index. A validation study mixing hospitalized and community-dwelling older people was designed. Intraclass correlation coefficient (ICC) was used to assess the inter-rater agreement and the reliability. The construct validity of the Frail-VIG index with respect to the Frailty Phenotype (FP) was evaluated by calculating the area under the receiver operating characteristic curve (AUC-ROC). Convergent validity with the Clinical Frailty Scale (CFS) was assessed using Pearson's correlation coefficients. The feasibility was evaluated by calculating the average time required to administer the Frail-VIG index and the percentage of unanswered responses. A sample of 527 older people (mean age of 81.61, 56.2% female) was included. The inter-rater agreement and test-retest reliability were very strong: 0.941 (95% CI, 0.890 to 0.969) and 0.976 (95% CI, 0.958 to 0.986), respectively. Results indicated adequate convergent validity of the Frail-VIG index with respect to the FP, AUC-ROC 0.704 (95% CI, 0.622 to 0.786), and a moderate to strong positive correlation between the Frail-VIG index and CFS (r = 0.635, 95% CI, 0.54 to 0.71). The Frail-VIG index administration required an average of 5.01 min, with only 0.34% of unanswered responses. The Frail-VIG index is a reliable, feasible, and valid instrument to assess the degree of frailty in hospitalized and community-dwelling older people.
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Blasimme A. The plasticity of ageing and the rediscovery of ground-state prevention. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2021; 43:67. [PMID: 33948779 PMCID: PMC8096726 DOI: 10.1007/s40656-021-00414-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/07/2021] [Indexed: 05/05/2023]
Abstract
In this paper, I present an emerging explanatory framework about ageing and care. In particular, I focus on how, in contrast to most classical accounts of ageing, biomedicine today construes the ageing process as a modifiable trajectory. This framing turns ageing from a stage of inexorable decline into the focus of preventive strategies, harnessing the functional plasticity of the ageing organism. I illustrate this shift by focusing on studies of the demographic dynamics in human population, observations of ageing as an intraspecifically heterogenous phenotype, and the experimental manipulation of longevity, in both model organisms and humans. I suggest that such an explanatory framework about ageing creates the epistemological conditions for the rise of a peculiar form of prevention that does not aim to address a specific condition. Rather it seeks to stall the age-related accumulation of molecular damage and functional deficits, boosting individual resilience against age-related decline. I call this preventive paradigm "ground-state prevention." While new, ground-state prevention bears conceptual resemblance to forms of medical wisdom prominent in classic Galenic medicine, as well as in the Renaissance period.
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Affiliation(s)
- Alessandro Blasimme
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH Zurich), Zurich, Switzerland.
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Kotsani M, Avgerinou C, Haidich AB, Smyrnakis E, Soulis G, Papageorgiou DI, Andreou M, Zeimbekis D, Kokkali S, Gavana M. Feasibility and impact of a short training course on frailty destined for primary health care professionals. Eur Geriatr Med 2021; 12:333-346. [PMID: 33646537 DOI: 10.1007/s41999-021-00467-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/04/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is an unmet need for training primary health care professionals on frailty, especially in countries where geriatrics is still emerging. PURPOSE We aimed to evaluate the feasibility and efficacy of a training course for primary health care professionals on the detection, assessment, and management of frailty. METHODS A single-day training course, developed and facilitated by three physicians trained in geriatrics abroad, was organized by the Aristotle University of Thessaloniki Primary Hearth Care Research Network. Primary health care professionals' attitudes, knowledge, and everyday practices regarding frailty were assessed by self-administered anonymous questionnaires (using Likert-type scales) at three time-points (before, upon completion of the training course, and 3 months afterward). RESULTS Out of 31 participants (17 physicians, 12 nurses, 2 health visitors; 87.1% women; mean age 46.4 years), 31(100%) filled in the first, 30(97%) the second, and 25(81%) the third questionnaire. Improvements were reported in familiarization with the frailty syndrome (p = 0.041) and in self-perception of knowledge and skills to detect (p < 0.001) and manage (p < 0.001) frailty, that were also sustained 3 months afterward (p = 0.001 and p = 0.003 respectively). Improvement was also observed in the attitude that frailty is an inevitable consequence of aging (p = 0.007) and in the frequency of application of screening (but not management) strategies, 3 months following the workshop compared to baseline (p = 0.014). Participants reported less disagreement with the statement that systematic screening for frailty was unfeasible in their daily practice at 3 months compared to baseline (p = 0.006), mainly due to time restrictions. CONCLUSION A short skill-oriented training course can significantly and sustainably improve primary health care professionals' attitudes and practices regarding frailty.
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Affiliation(s)
- Marina Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle «Maladies du Vieillissement, Gérontologie et Soins Palliatifs», 54000, Nancy, France.
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Dimitra Iosifina Papageorgiou
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Stamatia Kokkali
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Magda Gavana
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Hu D, Yan W, Zhu J, Zhu Y, Chen J. Age-Related Disease Burden in China, 1997-2017: Findings From the Global Burden of Disease Study. Front Public Health 2021; 9:638704. [PMID: 33732678 PMCID: PMC7959714 DOI: 10.3389/fpubh.2021.638704] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/20/2021] [Indexed: 12/11/2022] Open
Abstract
Background: The population is aging much faster in China than other low- and middle-income countries. With the accelerated aging of the population, incidence and disease burden of age-related diseases have also continued to increase. Exploring the burden of age-related diseases is crucial for early disease prevention, assessing the extent of population aging, and achieving the goal of healthy aging. Methods: We used the dataset from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), and selected data on incidence, prevalence, and disease burden in China, in 1997, 2007, and 2017. We classified age-related diseases, which were defined as diseases in which the incidence rate increased quadratically with age in the adult population. Additionally, we described the changes in age-related diseases during the study period by different GBD categories. It also measured changes in the age-related disease burden in our study period, including disability-adjusted life years (DALY), years of life lost (YLL), and years lived with disability (YLD). Finally, we compared the differences in the age-related disease burdens for men and women. Results: Among the 293 diseases listed in the GBD study, 69 in 2017, 78 in 1997 and 72 in 2007 were identified as age-related diseases. More than half of the age-related diseases belonged to non-communicable diseases (NCDs) in our study period. The rate of age-standardized age-related disease burden decreased between 1997 and 2017. DALYs decreased by 24.89% for non-age-related diseases and by 50.15% in age-related diseases from 1997 to 2017. The age-related disease burden of men was higher than that of women; we found a decreasing trend, with −46.23% in men and −54.90% in women. Conclusions: Comparing characteristics of the aging population in China and the world, we found that China does not have the typical disease characteristics of aging society. Currently, China faces the dual threat of NCDs and communicable diseases, and NCDs account for the vast majority of the age-related disease burden. Our health systems should focus on disease prevention and early detection among the entire population, instead of treatment. Further studies should focus on reducing the duration and severity of morbidity in later life.
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Affiliation(s)
- Dan Hu
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China.,Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, China.,Creative Health Policy Research Group, Nanjing Medical University, Nanjing, China
| | - Wu Yan
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jing Zhu
- Division of Medical Affairs, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Zhu
- Respiratory and Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Jiaying Chen
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China.,Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, China
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Adja KYC, Lenzi J, Sezgin D, O'Caoimh R, Morini M, Damiani G, Buja A, Fantini MP. The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective. Front Public Health 2020; 8:599170. [PMID: 33282818 PMCID: PMC7689262 DOI: 10.3389/fpubh.2020.599170] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Across the world, life expectancy is increasing. However, the years of life gained do not always correspond to healthy life years, potentially leading to an increase in frailty. Given the extent of population aging, the association between frailty and age and the impact of frailty on adverse outcomes for older people, frailty is increasingly being recognized to be a significant public health concern. Early identification of the condition is important to help older adults regain function and to prevent the negative outcomes associated with the syndrome. Despite the importance of diagnosing frailty, there is no definitive evidence or consensus of whether screening should be routinely implemented. A broad range of screening and assessment instruments have been developed taking a biopsychosocial approach, characterizing frailty as a dynamic state resulting from deficits in any of the physical, psychological and social domains, which contribute to health. All these aspects of frailty should be identified and addressed using an integrated and holistic approach to care. To achieve this goal, public health and primary health care (PHC) need to become the fulcrum through which care is offered, not only to older people and those that are frail, but to all individuals, favoring a life-course and patient-centered approach centered around integrated, community-based care. Public health personnel should be trained to address frailty not merely from a clinical perspective, but also in a societal context. Interventions should be delivered in the individuals' environment and within their social networks. Furthermore, public health professionals should contribute to education and training on frailty at a community level, fostering community-based interventions to support older adults and their caregivers to prevent and manage frailty. The purpose of this paper is to offer an overview of the concept of frailty for a public health audience in order to raise awareness of the multidimensional aspects of frailty and on how these should be addressed using an integrated and holistic approach to care.
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Affiliation(s)
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Duygu Sezgin
- School of Nursing and Midwifery, College of Medicine Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Rónán O'Caoimh
- Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Research Facility Cork, University College Cork, Cork, Ireland
| | - Mara Morini
- Italian Scientific Society of Hygiene and Preventive Medicine - Primary Care Group, Bologna, Italy
| | - Gianfranco Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Buja
- Laboratory of Health Care Services and Health Promotion, Evaluation Unit of Hygiene and Public Health Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Assessing the strengths and weaknesses of the Clinical Frailty Scale through correlation with a frailty index. Aging Clin Exp Res 2020; 32:2225-2232. [PMID: 31898172 DOI: 10.1007/s40520-019-01450-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Care for the elderly patient is a challenge that geriatricians now share with other medical specialties. Frailty has emerged as a key concept. Due to its simplicity and applicability, the Clinical Frailty Scale (CFS) is gaining increasing acceptance. AIM Compare the CFS with the Frail-VIG index (IF-VIG), an index based on the accumulation of deficits and developed on the basis of comprehensive geriatric assessment. METHODS Cross-sectional and single-center study carried out at the Acute Geriatric Unit of a University Hospital. Patients consecutively recruited on admission over a 6-month period (n = 184). The concurrent validity of the CFS was measured by assessing the concordance between the two measurement methods. The degree of association was determined by applying a linear regression model, calculating the Pearson correlation coefficient (r). RESULTS The prevalence of frailty was 91.8%. A mean IF-VIG score of 0.41 (SD ± 0.14) was found. The two most frequently recorded CFS categories were 6 and 7. An effective correlation was established (r = 0.706, p < 0.001). In the cohort with severe dementia, the association fell (r = 0.442). In the whole population, it rose adding Charlson index score (r = 0.747). CONCLUSIONS The strong correlation of the CFS with a frailty index supports its use. Incorporating comorbidity into the physical function domains of the CFS improved the correlation. However, the CFS was unsuitable in patients with dementia. To infer prognosis, in categories 6 and 7, the situational diagnosis should be extended with more discriminative tools.
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Improving the care of older patients during the COVID-19 pandemic. Aging Clin Exp Res 2020; 32:1883-1888. [PMID: 32654005 PMCID: PMC7352085 DOI: 10.1007/s40520-020-01641-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/22/2020] [Indexed: 01/05/2023]
Abstract
The SARS-CoV-2 pandemic has led to a dramatic crisis of Health Care Systems worldwide, and older people have been among the most disadvantaged. Specific recommendations and reports have been released both at International and National level, regarding the diagnosis and management of COVID-19 in the elderly. However, little has been proposed for an appropriate response to older, frail and multimorbid patients in different settings of care (acute care units, long term care facilities, nursing homes and primary care) and for the management of geriatric syndromes (i.e. delirium, sarcopenia, falls). We presume that the current pandemic of will leads to substantial changes in health care systems, and we suggest some key guide principles that could inspire the provision of healthcare services to older people and their families. These principles are primarily directed to physicians and nurses working in the geriatric field but could also be useful for other specialists.
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Abstract
Although current literature about the “cure versus care” issue tends to promote a patient-centered approach, the disease-centered approach remains the prevailing model in practice. The perceived dichotomy between the two approaches has created a barrier that could make it difficult for medical students and physicians to integrate psychosocial aspects of patient care into the prevailing disease-based model. This article examines the influence of the formal and hidden curricula on the perception of these two approaches and finds that the hidden curriculum perpetuates the notion that “cure” and “care” based approaches are dichotomous despite significant changes in formal curricula that promote a more integrated approach. The authors argue that it is detrimental for clinicians to view the two approaches as oppositional rather than complementary and attempt to give recommendations on how the influence of the hidden curriculum can be reduced to get a both-cure-and-care-approach, rather than an either-cure-or-care-approach.
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Affiliation(s)
| | - Nico Nortjé
- Department of Critical Care, Division of Anesthesiology and Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Dietetics and Nutrition, University of the Western Cape, Bellville, South Africa. .,Centre for Health Care Ethics, Lakehead University, Thunder Bay, Ontario, Canada.
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Donoghue OA, O'Shea M, McGarrigle CA, Lang D, Hoey C, Whitty H, O'Shea D, Kenny RA. Translating Frailty Assessment Methodologies and Research-based Evidence to Clinical Education and Practice. J Aging Soc Policy 2020; 34:537-551. [PMID: 32634336 DOI: 10.1080/08959420.2020.1777825] [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: 10/23/2022]
Abstract
Frailty is a common clinical syndrome that predisposes older adults to an increased risk of adverse health outcomes. With population aging, this will become an increasing challenge for the healthcare services; therefore, different models of healthcare training and provision are required to address these increasing demands. In Ireland, the National Clinical Programme for Older People (NCPOP) has partnered with The Irish Longitudinal Study on Ageing (TILDA) to deliver the National Frailty Education Programme. This demonstrates an innovative way in which evidence-based longitudinal research can be translated into clinical education and practice to improve patient care, following a Knowledge to Action (KTA) process. To the authors' knowledge, it is the first time that a longitudinal research study such as TILDA has employed such methods of translation and therefore, this collaboration could serve as an international model of translation and implementation for frailty and other areas of clinical priority.
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Affiliation(s)
- Orna A Donoghue
- Project Manager, The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
| | - Mary O'Shea
- Research Nurse Manager, The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
| | - Christine A McGarrigle
- Senior Research Fellow, The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
| | - Deirdre Lang
- Director of Nursing, National Clinical Programme for Older People, Health Service Executive, Dublin, Ireland
| | - Carmel Hoey
- HSE Service Planner, National Clinical Programme for Older People, Health Service Executive, Dublin, Ireland
| | - Helen Whitty
- Programme Manager, National Clinical Programme for Older People, Health Service Executive, Dublin, Ireland.,Programme Manager, National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Diarmuid O'Shea
- Clinical Lead, National Clinical Programme for Older People, Health Service Executive, Dublin, Ireland.,Consultant Geriatrician, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Rose Anne Kenny
- Principal Investigator, The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland.,Director, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
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Stolz E, Rásky É, Jagsch C. Frailty index predicts geriatric psychiatry inpatient mortality: a case-control study. Psychogeriatrics 2020; 20:469-472. [PMID: 32092779 PMCID: PMC7496584 DOI: 10.1111/psyg.12535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many geriatric psychiatry patients suffer from complex psychiatric and medical problems and a minority of patients dies in-hospital. We assess whether a frailty index (FI) predicts inpatient mortality. METHODS Electronic health records from 276 patients of a geriatric psychiatry department over 3 years (2015-2017) in Austria were analysed using logistic regression analysis. RESULTS Mortality rate was 4.2%. The adjusted effect of frailty (per 0.1 FI) on mortality was odds ratio = 3.25 (95% CI = 2.29-4.79). The area under the curve of 0.81 (95% CI = 0.76-0.86) suggested acceptable predictive accuracy. CONCLUSIONS We found that a non-negligible minority of geronto-psychiatric patients died in-hospital, which can be usefully predicted by the FI derived from routine electronic patient records.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Éva Rásky
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Christian Jagsch
- Department of Geriatric Psychiatry and Geriatric Psychotherapy, State Hospital Graz II, Graz, Austria
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Liu Y, Meng H, Tu N, Liu D. The Relationship Between Health Literacy, Social Support, Depression, and Frailty Among Community-Dwelling Older Patients With Hypertension and Diabetes in China. Front Public Health 2020; 8:280. [PMID: 32714893 PMCID: PMC7344226 DOI: 10.3389/fpubh.2020.00280] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/28/2020] [Indexed: 01/23/2023] Open
Abstract
Population aging is one of the major challenges facing modern society and has attracted global attention. With population aging becoming a global phenomenon, the impact of age-related diseases on health is increasing rapidly. Frailty is one of the most pressing issues facing older adults. The purpose of this study was to explore the interrelationship between health literacy, social support, depression, and frailty among older patients with hypertension and diabetes in China. No studies have investigated the mediating effects of social support and depression between health literacy and frailty. The findings of this study can be applied to help ameliorate frailty in older hypertensive and diabetic patients. Data were collected from 637 older hypertensive and diabetic patients aged 65 years and older in Sichuan Province, China. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. The results showed that 42.4% of the participants suffered from frailty. The mean scores for health literacy, social support, depression, and frailty were 13.6 ± 5.7, 35.7 ± 6.5, 4.0 ± 3.4, and 3.5 ± 2.1, respectively. Social support had a direct negative association with frailty (β = −0.128, 95%CI: [−0.198, −0.056]), and depression had a direct positive association with frailty (β = 0.326, 95%CI: [0.229, 0.411]), while social support had no direct association with depression. Health literacy had a direct positive association with social support (β = 0.151, 95%CI: [0.077, 0.224]) and a direct negative association with depression (β = −0.173, 95%CI: [−0.246, −0.1]), while health literacy had an indirect negative association with frailty through the mediating effect of social support and depression. To mitigate frailty in older patients with hypertension and diabetes, measures that provide social support, and enhance health literacy, while alleviating depression, should be considered, along with greater attention to patients who are divorced, widowed, or unmarried, those with comorbidities, and those with lower socioeconomic status.
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Affiliation(s)
- Yan Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
| | - Naidan Tu
- Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, United States
| | - Danping Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Chengdu, China
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Kehler DS. Age-related disease burden as a measure of population ageing. LANCET PUBLIC HEALTH 2020; 4:e123-e124. [PMID: 30851865 DOI: 10.1016/s2468-2667(19)30026-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Affiliation(s)
- D Scott Kehler
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS B3H 2E1, Canada.
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Giannotti C, Massobrio A, Cannata D, Nencioni A, Monacelli F, Aprile A, Soriero D, Scabini S, Pertile D. A two-step surgery and a multidisciplinary approach in a centenarian patient with an acute presentation of right colon cancer. BMC Surg 2020; 20:52. [PMID: 32188448 PMCID: PMC7079362 DOI: 10.1186/s12893-020-00708-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/02/2020] [Indexed: 01/22/2023] Open
Abstract
Background As surgery remains the cornerstone of colorectal cancer (CRC) treatment, the number of older patients presented for colorectal resection is rapidly increasing. Nevertheless, the choice to operate an oldest-old patient still remain challenging and requires a careful assessment of risk to benefit ratio in order to guarantee appropriate surgical strategies and perioperative management. Case presentation A centenarian patient, acutely admitted to the emergency department, was diagnosed with an ileus caused by stenosing ascending colon cancer with abnormal distension of the right colon at high risk of perforation. Facing with this complex clinical scenario, a lateral decompressive cecostomy as alternative surgical procedure, was performed in local anesthesia in order to avoid the stressful event of an emergency surgery. Thereafter, the patient was admitted to the surgical ward and followed by a geriatrician who performed a comprehensive geriatric assessment (CGA) and daily clinical evaluations. This integrated plan of care was mainly focused on rehabilitation, nutritional interventions and therapeutic reconciliation, maximizing patient’s clinical conditions and performance status. Then, the second surgical step, the radical colon surgery with curative intent and bowel continuity reestablishment was performed, demonstrating to be feasible and safety also in a very advanced age patient in term of prolonged survival and preservation of an adequate quality of life. Conclusions This is the first case-report that illustrates a successful two step surgery for CRC in a centenarian patient thanks to a multidisciplinary based approach, overwhelming the mere concept of chronological age.
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Affiliation(s)
- Chiara Giannotti
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132, Genoa, Italy
| | - Andrea Massobrio
- Oncological Surgery, San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy. .,San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy.
| | - Daniela Cannata
- San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy.,Department of Anesthesia and Resuscitation, San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy
| | - Alessio Nencioni
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132, Genoa, Italy.,San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy
| | - Fiammetta Monacelli
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132, Genoa, Italy.,San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy
| | - Alessandra Aprile
- Oncological Surgery, San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy
| | - Domenico Soriero
- Oncological Surgery, San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy
| | - Stefano Scabini
- Oncological Surgery, San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy.,San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy
| | - Davide Pertile
- Oncological Surgery, San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy.,San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy
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50
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Hoogendijk EO, Stenholm S, Ferrucci L, Bandinelli S, Inzitari M, Cesari M. Operationalization of a frailty index among older adults in the InCHIANTI study: predictive ability for all-cause and cardiovascular disease mortality. Aging Clin Exp Res 2020; 32:1025-1034. [PMID: 32006385 PMCID: PMC7260260 DOI: 10.1007/s40520-020-01478-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/10/2020] [Indexed: 12/31/2022]
Abstract
Background The frailty index (FI) is a sensitive instrument to measure the degree of frailty in older adults, and is increasingly used in cohort studies on aging. Aims To operationalize an FI among older adults in the “Invecchiare in Chianti” (InCHIANTI) study, and to validate its predictive capacity for mortality. Methods Longitudinal data were used from 1129 InCHIANTI participants aged ≥ 65 years. A 42-item FI was operationalized following a standard procedure using baseline data (1998/2000). Associations of the FI with 3- and 6-year all-cause and cardiovascular disease (CVD) mortality were studied using Cox regression. Predictive accuracy was estimated by the area under the ROC curve (AUC), for a continuous FI score and for different cut-points. Results The median FI was 0.13 (IQR 0.08–0.21). Scores were higher in women, and at advanced age. The FI was associated with 3- and 6-year all-cause and CVD mortality (HR range per 0.01 FI increase = 1.03–1.07, all p < 0.001). The continuous FI score predicted the mortality outcomes with moderate-to-good accuracy (AUC range 0.72–0.83). When applying FI cut-offs between 0.15 and 0.35, the accuracy of this FI for predicting mortality was moderate (AUC range 0.61–0.76). Overall, the predictive accuracy of the FI was higher in women than in men. Conclusions The FI operationalized in the InCHIANTI study is a good instrument to grade the risk of all-cause mortality and CVD mortality. More measurement properties, such as the responsiveness of this FI when used as outcome measure, should be investigated in future research. Electronic supplementary material The online version of this article (10.1007/s40520-020-01478-3) contains supplementary material, which is available to authorized users.
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