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Mone P, Gambardella J, Lombardi A, Pansini A, De Gennaro S, Leo AL, Famiglietti M, Marro A, Morgante M, Frullone S, De Luca A, Santulli G. Correlation of physical and cognitive impairment in diabetic and hypertensive frail older adults. Cardiovasc Diabetol 2022; 21:10. [PMID: 35045834 PMCID: PMC8772197 DOI: 10.1186/s12933-021-01442-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/30/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Diabetes and hypertension are common in older adults and represent established risk factors for frailty. Frailty is a multidimensional condition due to reserve loss and susceptibility to stressors with a high risk of death, hospitalizations, functional and cognitive impairment. Comorbidities such as diabetes and hypertension play a key role in increasing the risk of mortality, hospitalization, and disability. Moreover, frail patients with diabetes and hypertension are known to have an increased risk of cognitive and physical impairment. Nevertheless, no study assessed the correlation between physical and cognitive impairment in frail older adults with diabetes and hypertension. METHODS We evaluated consecutive frail older patients with diabetes and hypertension who presented at ASL (local health unit of the Italian Ministry of Health) Avellino, Italy, from March 2021 to October 2021. The inclusion criteria were: a previous diagnosis of diabetes and hypertension with no evidence of secondary causes; age > 65 years; a frailty status; Montreal Cognitive Assessment (MoCA) score < 26. RESULTS 179 patients successfully completed the study. We found a strong and significant correlation between MoCA score and 5-m gait speed test (r: 0.877; p < 0.001). To further verify our results, we performed a linear multivariate analysis adjusting for potential confounding factors, with MoCA score as dependent variable, which confirmed the significant association with glycemia (p < 0.001). CONCLUSIONS This is the first study showing a significant correlation between 5-m gait speed test and MoCA score in frail diabetic and hypertensive older adults.
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Affiliation(s)
- Pasquale Mone
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.9841.40000 0001 2200 8888Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy ,Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Jessica Gambardella
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.4691.a0000 0001 0790 385XInternational Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Angela Lombardi
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA
| | - Antonella Pansini
- Elderly Assistance and Home Care, ASL (Local Health Unit), Avellino, Italy
| | - Stefano De Gennaro
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Anna Luisa Leo
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Michele Famiglietti
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Anna Marro
- Elderly Assistance and Home Care, ASL (Local Health Unit), Avellino, Italy
| | - Maria Morgante
- Elderly Assistance and Home Care, ASL (Local Health Unit), Avellino, Italy
| | - Salvatore Frullone
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Antonio De Luca
- grid.9841.40000 0001 2200 8888Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gaetano Santulli
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.4691.a0000 0001 0790 385XInternational Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy ,grid.251993.50000000121791997Department of Molecular Pharmacology, Institute for Neuroimmunology and Inflammation (INI), Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, NY USA
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Multidimensional Prognostic Index and Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Implantation: Survival of the Fittest. J Clin Med 2021; 10:jcm10163529. [PMID: 34441825 PMCID: PMC8397063 DOI: 10.3390/jcm10163529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 01/22/2023] Open
Abstract
Selecting patients with a high chance of endured benefit from transcatheter aortic valve implantation (TAVI) is becoming relevant with changing indications and increasing number of TAVI being performed. The aim of our study was to investigate the association of the multidimensional prognostic index (MPI) based on a comprehensive geriatric assessment (CGA) on survival. The TAVI Care & Cure program is a prospective, observational registry of patients referred for TAVI at the Erasmus MC University Medical Center. Consecutive patients who underwent a complete CGA and TAVI were included. CGA components were used to calculate the MPI score. The impact of the MPI score on survival was evaluated using Cox regression. Furthermore, 376 patients were included, 143 (38.0%) patients belonged to the MPI-1 group and 233 (61.9%) patients to the MPI-2–3 group. After 3 years, 14.9% of the patients in the MPI-1 group and 30.5% of the patients in the MPI-2–3 group died (p = 0.001). Patients in MPI-1 had increased chances of overall survival in comparison with patients in MPI group 2–3 Hazard Ratio (HR) 0.57, (95% Confidence Interval (CI) 0.33–0.98)). In this study we found that the MPI tool could be useful to assess frailty and to predict which patient will have a higher chance of enduring benefit from a TAVI procedure.
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Lilamand M, Saintout M, Vigan M, Bichon A, Tourame L, Diet AB, Iung B, Himbert D, Laouenan C, Raynaud-Simon A. Quality of life, physical performance and nutritional status in older patients hospitalized in a cardiology department. J Geriatr Cardiol 2020; 17:410-416. [PMID: 32863823 PMCID: PMC7416066 DOI: 10.11909/j.issn.1671-5411.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES Quality of life (QoL) is a priority outcome in older adults suffering from cardiovascular diseases. Frailty and poor nutritional status may affect the QoL through mobility disorders and exhaustion. The objective of this study was to determine if physical frailty and nutritional status were associated with QoL, in older cardiology patients. METHODS Cross sectional, observational study conducted in a cardiology department from a university hospital. Participants (n = 100) were aged 70 and older. Collected data included age, sex, cardiac diseases, New York Heart Association (NYHA) classification, comorbidities (Charlson Index) and disability. A Short Physical Performance Battery (SPPB), including walking speed assessment was performed; handgrip strength were measured as well as Fried's frailty phenotype. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and Body Mass Index (BMI), inflammation by C-reactive protein (CRP). QoL was assessed using the EORTC-QLQ questionnaire. Univariate and multivariate analyses were performed to study the associations between all recorded parameters and QoL. RESULTS In participants (mean age: 79.3 ± 6.7 years; male: 59%), Charlson index, arrhythmia, heart failure, NYHA classⅢ-Ⅳ, MNA, disability, walking speed, SPPB score, frailty and CRP were significantly associated with QoL in univariate analysis. Multivariate analysis showed that NYHA classⅢ-Ⅳ (P < 0.001), lower MNA score (P = 0.03), frailty (P < 0.0001), and higher CRP (P < 0.001) were independently associated with decreased QoL. CONCLUSIONS Frailty, nutritional status and inflammation were independently associated with poor QoL. Further studies are needed to assess the efficacy of nutritional and physical interventions on QoL in this population.
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Affiliation(s)
- Matthieu Lilamand
- Assistance Publique Hôpitaux de Paris Nord, Department of Geriatrics, Bichat University Hospital, France
- University of Paris, France
- Matthieu Lilamand, MD, PhD, Department of Geriatrics, Assistance Publique Hôpitaux de Paris Nord, Bichat Hospital, 46 rue Henri Huchard, 75877 Paris cedex 18, France. E-mail:
| | - Mariannick Saintout
- Assistance Publique Hôpitaux de Paris Nord, Department of Geriatrics, Bichat University Hospital, France
| | - Marie Vigan
- Assistance Publique Hôpitaux de Paris Nord, Department of Epidemiology, Biostatistics and Clinical Research, Bichat University Hospital, France
| | - Astrid Bichon
- Assistance Publique Hôpitaux de Paris Nord, Department of Geriatrics, Bichat University Hospital, France
| | - Laure Tourame
- Assistance Publique Hôpitaux de Paris Nord, Department of Geriatrics, Bichat University Hospital, France
| | - Aurélie Brembilla Diet
- Assistance Publique Hôpitaux de Paris Nord, Department of Geriatrics, Bichat University Hospital, France
| | - Bernard Iung
- University of Paris, France
- Assistance Publique Hôpitaux de Paris Nord, Department of Cardiology, Bichat University Hospital, France
| | - Dominique Himbert
- University of Paris, France
- Assistance Publique Hôpitaux de Paris Nord, Department of Cardiology, Bichat University Hospital, France
| | - Cédric Laouenan
- University of Paris, France
- Assistance Publique Hôpitaux de Paris Nord, Department of Epidemiology, Biostatistics and Clinical Research, Bichat University Hospital, France
| | - Agathe Raynaud-Simon
- Assistance Publique Hôpitaux de Paris Nord, Department of Geriatrics, Bichat University Hospital, France
- University of Paris, France
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The "Heart Valve Clinic" Pathway for the Management of Frail Patients With Valvular Heart Disease: From "One for All" to "All for One". Crit Pathw Cardiol 2020; 18:61-65. [PMID: 31094730 DOI: 10.1097/hpc.0000000000000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Valvular heart disease (VHD) is frequently diagnosed in old patients with clinical evidence of heart failure. This elderly population typically presents a high prevalence of frailty and comorbidities, which are associated with increased operative risk for surgical and percutaneous procedures. Recently, the Euro Heart Survey reported a clear gap between treatment guidelines and their application in the "real world". A more realistic approach to the treatment of older VHD patients treatment, mostly if associated with heart failure, is advocated. A multidisciplinary approach, as obtained with the Heart Valve Clinic methodology (intended to put the patient in the "center" of the scene and the specialists "around him"), has been applied in a group of 79 patients, aged >70 years, with symptomatic VHD, divided in 2 groups according to their frailty status (58 robust and 21 frail). No in-hospital mortality and no difference in late mortality and complications were observed. Infections were more frequent (14.3 vs. 1.7 %; P = 0.02) in frail patients. In patients with postoperative complications, serum levels of interleukin 6 (67.6 vs. 49.6; P = 0.01) and of CAF (C-terminal agrin fragment) as sarcopenia marker (67.9 vs. 62.0; P = 0.04) were higher than that in uncomplicated patients. This study was designed to determine the outcomes of the multidimensional geriatric assessment in the management of older patients with heart failure eligible for heart valve surgery. Geriatric assessment and measurement of inflammatory and sarcopenia markers may represent valid tools for a more realistic evaluation of elderly patients with VHD.
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Role of comprehensive geriatric assessment in low surgical risk older patients with aortic stenosis. Aging Clin Exp Res 2020; 32:381-388. [PMID: 31148097 DOI: 10.1007/s40520-019-01228-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Among elderly with severe aortic stenosis (AS), Comprehensive Geriatric Assessment (CGA) originally contributed to address to transcatheter aortic valve implantation (TAVI) patients not suitable to surgical aortic valve replacement(SAVR). Nevertheless, TAVI has recently been proposed also in lower surgical risk patients. AIMS To evaluate predictors of TAVI procedure and clinical outcomes among these patients. METHODS For each patient ≥ 65 years with severe AS referring to our Cardiac Surgery Division, CGA was performed, including functional and cognitive status, comorbidity burden, frailty, nutritional status, gait speed, hand-grip strength and number of medications. Surgical risk was evaluated according to the Society of Thoracic Surgeons (STS) score (low-risk < 4%). Post-procedural outcomes (30-day survival and post-procedural complications) were obtained by medical records and a one-year follow-up assessed survival, and functional and cognitive performance. RESULTS Among 154 subjects (mean age 82.9 years), 52 were at low-risk according to STS score. 32 patients were addressed to TAVI, 20 to SAVR. Variables significantly associated with TAVI-approach were lower gait speed (p 0.030) and higher number of medications (p 0.015). Short and long-term outcomes did not differ between groups. DISCUSSION Among CGA variables, gait speed and number of medications were associated with the decision to perform TAVI instead of SAVR, even in patients at low surgical risk. 30-day and one-year survival and one-year functional and cognitive decline were similar between groups, despite a relevant prevalence of frailty in the TAVI group. CONCLUSIONS We suggest that gait speed and number of medications should be considered in selecting appropriate candidates to TAVI among low surgical risk patients.
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Afilalo J, Sharma A, Zhang S, Brennan JM, Edwards FH, Mack MJ, McClurken JB, Cleveland JC, Smith PK, Shahian DM, Peterson ED, Alexander KP. Gait Speed and 1-Year Mortality Following Cardiac Surgery: A Landmark Analysis From the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Am Heart Assoc 2019; 7:e010139. [PMID: 30571598 PMCID: PMC6405557 DOI: 10.1161/jaha.118.010139] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background In older adults undergoing cardiac surgery, prediction of downstream risk is critical. Our objective was to determine the association of 5‐m gait speed with 1‐year mortality and repeat hospitalization following cardiac surgery. Methods and Results In this prospective cohort of patients undergoing cardiac surgery at centers participating in the Society of Thoracic Surgeons Database with gait speed recorded, we examined all‐cause mortality using a landmark analysis at 0 to 30, 30 to 365, and >365 days, as well as repeat hospitalization. The cohort consisted of 8287 patients (median age, 74 years; 32% females). At 1 year, survival was 90% in the slow (<0.83 m/s), 95% in the middle (0.83–1.00 m/s), and 97% in the fast (>1.00 m/s) gait speed tertiles, and risk of hospitalization was 45%, 33%, and 27%, respectively (both P<0.0001). After adjustment, gait speed remained predictive of mortality (hazard ratio, 2.16 per 0.1‐m/s decrease in gait speed; 95% confidence interval, 1.59–2.93) and rehospitalization (hazard ratio, 1.71 per 0.1‐m/s decrease in gait speed; 95% confidence interval, 1.45–2.0). In a landmark analysis, the effect of slow gait speed on mortality was most marked from 30 to 365 days after surgery, where each decline in 0.1 m/s of gait speed conferred a 2‐fold increased risk of mortality. Conclusions Gait speed is a simple tool to screen for frailty and identify older adults at risk for adverse events in the early and midterm postoperative periods.
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Affiliation(s)
- Jonathan Afilalo
- 1 Division of Cardiology & Centre for Clinical Epidemiology Jewish General Hospital McGill University Montreal Quebec Canada
| | - Abhinav Sharma
- 2 Duke Centre for Clinical Research Institute Durham NC.,3 Divisions of Cardiology Duke University Medical Center Durham NC
| | - Shuaiqi Zhang
- 2 Duke Centre for Clinical Research Institute Durham NC
| | - J Matthew Brennan
- 2 Duke Centre for Clinical Research Institute Durham NC.,3 Divisions of Cardiology Duke University Medical Center Durham NC
| | - Fred H Edwards
- 5 Division of Cardiac Surgery University of Florida Jacksonville FL
| | - Michael J Mack
- 6 Division of Cardiac Surgery The Heart Hospital Baylor Plano Plano TX
| | - James B McClurken
- 7 Cardiothoracic Surgery Reif Cardiovascular Institute, Doylestown Hospital Doylestown PA
| | | | - Peter K Smith
- 4 Divisions of Cardiac Surgery Duke University Medical Center Durham NC
| | - David M Shahian
- 9 Department of Surgery Massachusetts General Hospital Boston MA
| | - Eric D Peterson
- 2 Duke Centre for Clinical Research Institute Durham NC.,3 Divisions of Cardiology Duke University Medical Center Durham NC
| | - Karen P Alexander
- 2 Duke Centre for Clinical Research Institute Durham NC.,3 Divisions of Cardiology Duke University Medical Center Durham NC
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7
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Shi S, Afilalo J, Lipsitz LA, Popma JJ, Khabbaz KR, Laham RJ, Guibone K, Grodstein F, Lux E, Kim DH. Frailty Phenotype and Deficit Accumulation Frailty Index in Predicting Recovery After Transcatheter and Surgical Aortic Valve Replacement. J Gerontol A Biol Sci Med Sci 2019; 74:1249-1256. [PMID: 30165422 PMCID: PMC6625585 DOI: 10.1093/gerona/gly196] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Frailty phenotype and deficit-accumulation frailty index (FI) are widely used measures of frailty. Their performance in predicting recovery after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) has not been compared. METHODS Patients undergoing SAVR (n = 91) or TAVR (n = 137) at an academic medical center were prospectively assessed for frailty phenotype and FI. Outcomes were death or poor recovery, defined as a decline in ability to perform 22 daily activities and New York Heart Association class 3 or 4 at 6 months after surgery. The predictive ability of frailty phenotype versus FI and their additive value to a traditional surgical risk model were evaluated using C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement. RESULTS TAVR patients had higher prevalence of phenotypic frailty (85% vs 38%, p < .001) and greater mean FI (0.37 vs 0.24, p < .001) than SAVR patients. In the overall cohort, FI had a higher C-statistic than frailty phenotype (0.74 vs 0.63, p = .01) for predicting death or poor recovery. Adding FI to the traditional model improved prediction (NRI, 26.4%, p = .02; integrated discrimination improvement, 7.7%, p < .001), while adding phenotypic frailty did not (NRI, 4.0%, p = .70; integrated discrimination improvement, 1.6%, p = .08). The additive value of FI was evident in TAVR patients (NRI, 42.8%, p < .01) but not in SAVR patients (NRI, 25.0%, p = .29). Phenotypic frailty did not add significantly in either TAVR (NRI, 6.8%, p = .26) or SAVR patients (NRI, 25.0%, p = .29). CONCLUSIONS Deficit-accumulation FI provides better prediction of death or poor recovery than frailty phenotype in older patients undergoing SAVR and TAVR.
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Affiliation(s)
- Sandra Shi
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Afilalo
- Division of Cardiology and Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lewis A Lipsitz
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey J Popma
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kamal R Khabbaz
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Roger J Laham
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kim Guibone
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Francine Grodstein
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eliah Lux
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Dae Hyun Kim
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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8
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Hosler QP, Maltagliati AJ, Shi SM, Afilalo J, Popma JJ, Khabbaz KR, Laham RJ, Guibone K, Kim DH. A Practical Two-Stage Frailty Assessment for Older Adults Undergoing Aortic Valve Replacement. J Am Geriatr Soc 2019; 67:2031-2037. [PMID: 31211413 DOI: 10.1111/jgs.16036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/28/2019] [Accepted: 05/21/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Despite evidence, frailty is not routinely assessed before cardiac surgery. We compared five brief frailty tests for predicting poor outcomes after aortic valve replacement and evaluated a strategy of performing comprehensive geriatric assessment (CGA) in screen-positive patients. DESIGN Prospective cohort study. SETTING A single academic center. PARTICIPANTS Patients undergoing surgical aortic valve replacement (SAVR) (n = 91; mean age = 77.8 y) or transcatheter aortic valve replacement (TAVR) (n = 137; mean age = 84.5 y) from February 2014 to June 2017. MEASUREMENTS Brief frailty tests (Fatigue, Resistance, Ambulation, Illness, and Loss of weight [FRAIL] scale; Clinical Frailty Scale; grip strength; gait speed; and chair rise) and a deficit-accumulation frailty index based on CGA (CGA-FI) were measured at baseline. A composite of death or functional decline and severe symptoms at 6 months was assessed. RESULTS The outcome occurred in 8.8% (n = 8) after SAVR and 24.8% (n = 34) after TAVR. The chair rise test showed the highest discrimination in the SAVR (C statistic = .76) and TAVR cohorts (C statistic = .63). When the chair rise test was chosen as a screening test (≥17 s for SAVR and ≥23 s for TAVR), the incidence of outcome for screen-negative patients, screen-positive patients with CGA-FI of .34 or lower, and screen-positive patients with CGA-FI higher than .34 were 1.9% (n = 1/54), 5.3% (n = 1/19), and 33.3% (n = 6/18) after SAVR, respectively, and 15.0% (n = 9/60), 14.3% (n = 3/21), and 38.3% (n = 22/56) after TAVR, respectively. Compared with routinely performing CGA, targeting CGA to screen-positive patients would result in 54 fewer CGAs, without compromising sensitivity (routine vs targeted: .75 vs .75; P = 1.00) and specificity (.84 vs .86; P = 1.00) in the SAVR cohort; and 60 fewer CGAs with lower sensitivity (.82 vs.65; P = .03) and higher specificity (.50 vs .67; P < .01) in the TAVR cohort. CONCLUSIONS The chair rise test with targeted CGA may be a practical strategy to identify older patients at high risk for mortality and poor recovery after SAVR and TAVR in whom individualized care management should be considered. J Am Geriatr Soc 67:2031-2037, 2019.
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Affiliation(s)
- Quinn P Hosler
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Sandra M Shi
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jonathan Afilalo
- Division of Cardiology and Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jeffrey J Popma
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kamal R Khabbaz
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Roger J Laham
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kimberly Guibone
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Dae Hyun Kim
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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Skaar E, Eide LSP, Norekvål TM, Ranhoff AH, Nordrehaug JE, Forman DE, Schoenenberger AW, Hufthammer KO, Kuiper KKJ, Bleie Ø, Packer EJS, Langørgen J, Haaverstad R, Schaufel MA. A novel geriatric assessment frailty score predicts 2-year mortality after transcatheter aortic valve implantation. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:153-160. [PMID: 30256921 PMCID: PMC6440438 DOI: 10.1093/ehjqcco/qcy044] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/13/2018] [Accepted: 09/20/2018] [Indexed: 12/12/2022]
Abstract
Aims Established surgical scores have limitations in delineating risk among candidates for transcatheter aortic valve implantation (TAVI). Assessment of frailty might help to estimate the mortality risk and identify patients likely to benefit from treatment. The aim of the study was to develop a frailty score to guide the decision for TAVI. Methods and results We conducted a prospective observational study in patients ≥70 years referred for TAVI during 2011–15. A Heart Team had declined the patients for open heart surgery due to high risk but accepted them for TAVI. Prior to the procedure, a geriatric assessment (GA) was performed. Based on this, an 8-element frailty score with a 0–9 (least frail–most frail) scale was developed. A total of 142 patients, 54% women, mean age 83 (standard deviation 4) years, with severe and symptomatic aortic stenosis were assessed. All-cause 2 year mortality was 11%. The novel GA frailty score predicted 2-year mortality in Cox analyses, also when adjusted for age, gender, and logistic EuroSCORE [hazard ratio (HR) 1.75, 95% confidence interval (CI): 1.28–2.42, P < 0.001]. A receiver operating characteristic (ROC) curve analysis indicated that a GA frailty score cut-off at ≥4 predicted 2-year mortality with a specificity of 80% (95% CI: 73–86%) and a sensitivity of 60% (95% CI: 36–80%). The area under the curve was 0.81 (95% CI 0.71–0.90). Conclusion A novel 8-element GA frailty score identified gradations in survival in patients declined for open heart surgery. Patients with higher GA frailty scores had significantly higher 2-year mortality after TAVI.
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Affiliation(s)
- Elisabeth Skaar
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Norway.,Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Leslie Sofia Pareja Eide
- Institute of Health and Social Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Norway
| | - Anette Hylen Ranhoff
- Department of Clinical Science, University of Bergen, Norway.,Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | - Daniel Edward Forman
- Department of Medicine, Section of Geriatric Cardiology, Divisions of Geriatrics and the Heart and vascular Institute, University of Pittsburgh, Pittsburg, Pennsylvania, USA.,Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Andreas W Schoenenberger
- Department of Geriatrics, Inselspital, Bern University Hospital, Bern, Switzerland.,University of Bern, Bern, Switzerland
| | | | | | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Jørund Langørgen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Norway
| | - Margrethe Aase Schaufel
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Research Unit for General Practice, Uni Research Health, Bergen, Norway
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Ungar A, Mannarino G, van der Velde N, Baan J, Thibodeau MP, Masson JB, Santoro G, van Mourik M, Jansen S, Deutsch C, Bramlage P, Kurucova J, Thoenes M, Maggi S, Schoenenberger AW. Comprehensive geriatric assessment in patients undergoing transcatheter aortic valve implantation - results from the CGA-TAVI multicentre registry. BMC Cardiovasc Disord 2018; 18:1. [PMID: 29301486 PMCID: PMC5755352 DOI: 10.1186/s12872-017-0740-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/14/2017] [Indexed: 01/06/2023] Open
Abstract
Background In older patients with aortic stenosis (AS) undergoing TAVI, the potential role of prior CGA is not well established. To explore the value of comprehensive geriatric assessment (CGA) for predicting mortality and/or hospitalisation within the first 3 months after transcatheter aortic valve implantation (TAVI). Methods An international, multi-centre, prospective registry (CGA-TAVI) was established to gather data on CGA results and medium-term outcomes in geriatric patients undergoing TAVI. Logistic regression was used to evaluate the predictive value of a multidimensional prognostic index (MPI); a short physical performance battery (SPPB); and the Silver Code, which was based on administrative data, for predicting death and/or hospitalisation in the first 3 months after TAVI (primary endpoint). Results A total of 71 TAVI patients (mean age 85.4 years; mean log EuroSCORE I 22.5%) were enrolled. Device success according to VARC criteria was 100%. After adjustment for selected baseline characteristics, a higher (poorer) MPI score (OR: 3.34; 95% CI: 1.39–8.02; p = 0.0068) and a lower (poorer) SPPB score (OR: 1.15; 95% CI: 1.01–1.54; p = 0.0380) were found to be associated with an increased likelihood of the primary endpoint. The Silver Code did not show any predictive ability in this population. Conclusions Several aspects of the CGA have shown promise for being of use to physicians when predicting TAVI outcomes. While the MPI may be useful in clinical practice, the SPPB may be of particular value, being simple and quick to perform. Validation of these findings in a larger sample is warranted. Trial registration The trial was registered in ClinicalTrials.gov on November 7, 2013 (NCT01991444).
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Affiliation(s)
- Andrea Ungar
- Geriatric Intensive Care Unit, Department of Geriatrics and Medicine, Careggi Hospital and University of Florence, Florence, Italy.
| | - Giulio Mannarino
- Geriatric Intensive Care Unit, Department of Geriatrics and Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Nathalie van der Velde
- Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Jan Baan
- Cardiology, Academic Medical Center, Amsterdam, Netherlands
| | | | | | - Gennaro Santoro
- Geriatric Intensive Care Unit, Department of Geriatrics and Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Sofie Jansen
- Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Cornelia Deutsch
- Institute for Pharmacology und Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology und Preventive Medicine, Cloppenburg, Germany
| | | | | | - Stefania Maggi
- CNR-Institute of Neuroscience, Aging Branch, Padua, Italy
| | - Andreas W Schoenenberger
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Using a multidimensional prognostic index (MPI) based on comprehensive geriatric assessment (CGA) to predict mortality in elderly undergoing transcatheter aortic valve implantation. Int J Cardiol 2017; 236:381-386. [DOI: 10.1016/j.ijcard.2017.02.048] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/11/2017] [Accepted: 02/13/2017] [Indexed: 11/20/2022]
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Pulignano G, Gulizia MM, Baldasseroni S, Bedogni F, Cioffi G, Indolfi C, Romeo F, Murrone A, Musumeci F, Parolari A, Patanè L, Pino PG, Mongiardo A, Spaccarotella C, Di Bartolomeo R, Musumeci G. ANMCO/SIC/SICI-GISE/SICCH Executive Summary of Consensus Document on Risk Stratification in elderly patients with aortic stenosis before surgery or transcatheter aortic valve replacement. Eur Heart J Suppl 2017; 19:D354-D369. [PMID: 28751850 PMCID: PMC5520760 DOI: 10.1093/eurheartj/sux012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aortic stenosis is one of the most frequent valvular diseases in developed countries, and its impact on public health resources and assistance is increasing. A substantial proportion of elderly people with severe aortic stenosis is not eligible to surgery because of the advanced age, frailty, and multiple co-morbidities. Transcatheter aortic valve implantation (TAVI) enables the treatment of very elderly patients at high or prohibitive surgical risk considered ineligible for surgery and with an acceptable life expectancy. However, a significant percentage of patients die or show no improvement in quality of life (QOL) in the follow-up. In the decision-making process, it is important to determine: (i) whether and how much frailty of the patient influences the risk of procedures; (ii) how the QOL and the individual patient's survival are influenced by aortic valve disease or from other associated conditions; and (iii) whether a geriatric specialist intervention to evaluate and correct frailty or other diseases with their potential or already manifest disabilities can improve the outcome of surgery or TAVI. Consequently, in addition to risk stratification with conventional tools, a number of factors including multi-morbidity, disability, frailty, and cognitive function should be considered, in order to assess the expected benefit of both surgery and TAVI. The pre-operative optimization through a multidisciplinary approach with a Heart Team can counteract the multiple damage (cardiac, neurological, muscular, respiratory, and kidney) that can potentially aggravate the reduced physiological reserves characteristic of frailty. The systematic application in clinical practice of multidimensional assessment instruments of frailty and cognitive function in the screening and the adoption of specific care pathways should facilitate this task.
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Affiliation(s)
- Giovanni Pulignano
- Cardiology Department 1, Ospedale San Camillo-Forlanini, Via O. Regnoli, 8 00152 Rome, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi" Catania, Italy
| | | | - Francesco Bedogni
- CCU-Cardiology Unit, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
| | - Giovanni Cioffi
- Cardiology and Medicine Unit, Casa di Cura Villa Bianca, Trento, Italy
| | - Ciro Indolfi
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
| | - Francesco Romeo
- Cardiology and Interventional Cardiology Department, Policlinico "Tor Vergata", Rome, Italy
| | - Adriano Murrone
- Cardiology and Cardiovascular Pathophysiology Department, Azienda Ospedaliera di Perugia, Perugia, Italy
| | | | - Alessandro Parolari
- Heart Surgery Unit, Centro Cardiologico Monzino IRCCS, Università degli Studi, Milano, Italy
| | - Leonardo Patanè
- Cardiology Cardiac Surgery Department (Centro Cuore), Centro Clinico Diagnostico G.B. Morgagni, Pedara (Catania), Italy
| | | | - Annalisa Mongiardo
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
| | - Carmen Spaccarotella
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
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Cesari M, Marzetti E, Calvani R, Vellas B, Bernabei R, Bordes P, Roubenoff R, Landi F, Cherubini A. The need of operational paradigms for frailty in older persons: the SPRINTT project. Aging Clin Exp Res 2017; 29:3-10. [PMID: 28155179 DOI: 10.1007/s40520-016-0712-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 10/10/2016] [Indexed: 12/25/2022]
Abstract
The exploration of frailty as a pre-disability geriatric condition represents one of the most promising research arenas of modern medicine. Frailty is today indicated as a paradigmatic condition around which the traditional healthcare systems might be re-shaped and optimized in order to address the complexities and peculiarities of elders. Unfortunately, the lack of consensus around a single operational definition has limited the clinical implementation of frailty in clinical practice. In these last years, growing attention (even beyond the traditional boundaries of geriatric medicine) has been given to physical performance measures. These instruments have shown to be predictive of negative health-related events and able to support an accurate estimation of the "biological age" in late life. The strong construct of physical performance measures also makes them particularly suitable for the assessment of the frailty status. Furthermore, the adoption of physical performance measures may help render the frailty condition more organ-specific (i.e., centred on the skeletal muscle quality) and less heterogeneous than currently perceived. The translation of the frailty concept by means of physical performance measures implicitly represents an attempt to go beyond traditional paradigms. In this context, the recently funded "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) project (largely based on such a novel approach) may indeed fill an important gap in the field and provide key insights for counteracting the disabling cascade in the elderly.
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Rodríguez-Pascual C, Paredes-Galán E, Ferrero-Martínez AI, Baz-Alonso JA, Durán-Muñoz D, González-Babarro E, Sanmartín M, Parajes T, Torres-Torres I, Piñón-Esteban M, Calvo-Iglesias F, Olcoz-Chiva MT, Rodríguez-Artalejo F. The frailty syndrome and mortality among very old patients with symptomatic severe aortic stenosis under different treatments. Int J Cardiol 2016; 224:125-131. [DOI: 10.1016/j.ijcard.2016.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/20/2016] [Accepted: 09/12/2016] [Indexed: 12/28/2022]
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Measurement of gait speed in older adults to identify complications associated with frailty: A systematic review. J Geriatr Oncol 2015; 6:484-96. [PMID: 26362356 DOI: 10.1016/j.jgo.2015.08.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/24/2015] [Accepted: 08/17/2015] [Indexed: 11/22/2022]
Abstract
Several frailty screening tests in older cancer patients were developed but their statistical performance is low. We aimed to assess whether measurement of usual gait speed (GS) alone could be used as a frailty screening test in older cancer patients. This systematic review was conducted on "pub med" between 1984 and 2014 and included reviews and original studies. Eligibility criteria were: GS over a short distance, alone or included in composite walking tests (Timed Get Up and Go test: TGUG, Short Physical Performance Battery: SPPB) in older people (aged 65 and over) living in a community setting and predictive value of GS on medical complications associated with frailty. 46 articles were finally selected. GS alone is consensual and recommended for screening sarcopenia in elderly. A slow GS is predictive of early death, disability, falls and hospitalization/institutionalization in older people living in a community setting. GS alone is comparable to composite walking tests that do not provide additional information on the medical complications associated with frailty. Despite few studies in geriatric oncology, GS seems to predict overall survival and disability. We suggest GS over 4m (at a threshold of 1m/s) as a new frailty screening test in older cancer patients (65 and over) to guide the implementation of a comprehensive geriatric assessment during the initial management phase or during follow-up. Prospective cohort studies are needed to validate this algorithm and compare it with other screening tool.
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Lana A, Rodriguez-Artalejo F, Lopez-Garcia E. Dairy Consumption and Risk of Frailty in Older Adults: A Prospective Cohort Study. J Am Geriatr Soc 2015; 63:1852-60. [DOI: 10.1111/jgs.13626] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Alberto Lana
- Department of Medicine; Preventive Medicine and Public Health Area; School of Medicine and Health Sciences; University of Oviedo; Oviedo Spain
- Department of Preventive Medicine and Public Health; School of Medicine; Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz); and CIBERESP (CIBER of Epidemiology and Public Health); Madrid Spain
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health; School of Medicine; Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz); and CIBERESP (CIBER of Epidemiology and Public Health); Madrid Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health; School of Medicine; Universidad Autónoma de Madrid; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz); and CIBERESP (CIBER of Epidemiology and Public Health); Madrid Spain
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Justice JN, Cesari M, Seals DR, Shively CA, Carter CS. Comparative Approaches to Understanding the Relation Between Aging and Physical Function. J Gerontol A Biol Sci Med Sci 2015; 71:1243-53. [PMID: 25910845 DOI: 10.1093/gerona/glv035] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/07/2015] [Indexed: 01/09/2023] Open
Abstract
Despite dedicated efforts to identify interventions to delay aging, most promising interventions yielding dramatic life-span extension in animal models of aging are often ineffective when translated to clinical trials. This may be due to differences in primary outcomes between species and difficulties in determining the optimal clinical trial paradigms for translation. Measures of physical function, including brief standardized testing batteries, are currently being proposed as biomarkers of aging in humans, are predictive of adverse health events, disability, and mortality, and are commonly used as functional outcomes for clinical trials. Motor outcomes are now being incorporated into preclinical testing, a positive step toward enhancing our ability to translate aging interventions to clinical trials. To further these efforts, we begin a discussion of physical function and disability assessment across species, with special emphasis on mice, rats, monkeys, and man. By understanding how physical function is assessed in humans, we can tailor measurements in animals to better model those outcomes to establish effective, standardized translational functional assessments with aging.
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Affiliation(s)
- Jamie N Justice
- Department of Integrative Physiology, University of Colorado Boulder.
| | - Matteo Cesari
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France. INSERM UMR1207, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder
| | - Carol A Shively
- Departments of Pathology Section on Comparative Medicine, Public Health Sciences and Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christy S Carter
- Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville
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