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Nakashima H, Watanabe K, Komiya H, Fujisawa C, Yamada Y, Sakai T, Tajima T, Umegaki H. Frailty Index Based on Common Laboratory Tests for Patients Starting Home-Based Medical Care. J Am Med Dir Assoc 2024; 25:105114. [PMID: 38950586 DOI: 10.1016/j.jamda.2024.105114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES To determine whether a Frailty Index based on laboratory tests (FI-lab) is associated with clinical outcomes independently of a standard nonlaboratory Frailty Index (FI-clinical) in older patients starting home-based medical care. DESIGN Secondary analysis of data from a multicenter prospective cohort study. SETTING AND PARTICIPANTS Patients aged ≥65 years who were starting home-based medical care services provided by doctors and nurses at Nagoya, Japan. METHODS We calculated FI-lab (proportion of abnormal results out of 25 commonly tested laboratory parameters) and FI-clinical using 42 items based on data obtained at enrollment. The primary outcome was mortality within 2 years after starting home-based medical care. A sensitivity analysis was also conducted with 1-year mortality as the outcome. Other outcomes included hospitalization and nursing home admission within 2 years. RESULTS In total, 188 patients (mean age 79.9 ± 10.2 years, 57.5% male) were included. The median FI-lab was 0.40 [interquartile range (IQR) 0.29-0.50] and the median FI-clinical was 0.32 (IQR 0.24-0.43). Sixty-nine patients (36.7%) died within 2 years of starting home-based medical care. A Cox proportional hazards regression analysis including age, sex, FI-lab, and FI-clinical as independent variables revealed that FI-lab was associated with 2-year mortality independently of FI-clinical [FI-lab per 0.1 unit, odds ratio (OR) 1.49, 95% CI 1.25-1.77; FI-clinical per 0.1 unit, OR 1.13, 95% CI 0.90-1.41]. The sensitivity analysis showed similar results for 1-year mortality. Neither FI-lab nor FI-clinical was associated with hospitalization or nursing home admission within 2 years. CONCLUSIONS AND IMPLICATIONS FI-lab was associated with 2-year mortality in patients starting home-based medical care, independently of FI-clinical, and may be useful for risk assessment in this population. Studies with larger sample sizes are needed.
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Affiliation(s)
| | | | - Hitoshi Komiya
- Department of Geriatrics, Nagoya University Hospital, Nagoya, Japan
| | - Chisato Fujisawa
- Department of Geriatrics, Nagoya University Hospital, Nagoya, Japan
| | - Yosuke Yamada
- Department of Geriatrics, Nagoya University Hospital, Nagoya, Japan
| | - Tomomichi Sakai
- Department of Geriatrics, Nagoya University Hospital, Nagoya, Japan
| | - Tomihiko Tajima
- Department of Geriatrics, Nagoya University Hospital, Nagoya, Japan
| | - Hiroyuki Umegaki
- Department of Geriatrics, Nagoya University Hospital, Nagoya, Japan; Institute of Innovation for Future Society, Nagoya University, Nagoya, Japan
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Stubbs BJ, Alvarez-Azanedo G, Peralta S, Roa-Diaz S, Gray W, Alexander L, Silverman-Martin W, Garcia T, Blonquist TM, Upadhyay V, Turnbaugh PJ, Johnson JB, Newman JC. Rationale and protocol for a safety, tolerability and feasibility randomized, parallel group, double-blind, placebo-controlled, pilot study of a novel ketone ester targeting frailty via immunometabolic geroscience mechanisms. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.25.23297571. [PMID: 37961234 PMCID: PMC10635199 DOI: 10.1101/2023.10.25.23297571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Frailty is a geriatric syndrome characterized by chronic inflammation and metabolic insufficiency that creates vulnerability to poor outcomes with aging. We hypothesize that geroscience interventions, which target mechanisms of aging, could ameliorate frailty. Metabolites such as ketone bodies are candidate geroscience interventions, having pleiotropic effects on inflammo-metabolic aging mechanisms. Ketone esters (KEs) induce ketosis without dietary changes, but KEs have not been studied in an older adult population. Our long-term goal is to examine if KEs modulate geroscience mechanisms and clinical outcomes relevant to frailty in older adults. Objectives The primary objective of this randomized, placebo-controlled, double-blinded, parallel-group, pilot trial is to determine tolerability of 12-weeks of KE ingestion in a generalizable population of older adults (≥ 65 years). Secondary outcomes include safety and acute blood ketone kinetics. Exploratory outcomes include physical function, cognitive function, quality of life, aging biomarkers and inflammatory measures. Methods Community-dwelling adults who are independent in activities of daily living, with no unstable acute medical conditions (n=30) will be recruited. The study intervention is a KE or a taste, appearance, and calorie matched placebo beverage. Initially, acute 4-hour ketone kinetics after 12.5g or 25g of KE consumption will be assessed. After collection of baseline safety, functional, and biological measurements, subjects will randomly be allocated to consume KE 25g or placebo once daily for 12-weeks. Questionnaires will assess tolerability daily for 2-weeks, and then via phone interview at bi-monthly intervals. Safety assessments will be repeated at week 4. All measures will be repeated at week 12. Conclusion This study will evaluate feasibility, tolerability, and safety of KE consumption in older adults and provide exploratory data across a range of geroscience-related endpoints. This data will inform design of larger trials to rigorously test KE effects on geroscience mechanisms and clinical outcomes relevant to frailty.
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Affiliation(s)
| | | | | | | | - Wyatt Gray
- Buck Institute for Research on Aging, Novato, CA, USA
| | | | | | - Thelma Garcia
- Buck Institute for Research on Aging, Novato, CA, USA
| | | | - Vaibhav Upadhyay
- Department of Microbiology & Immunology, UCSF, San Francisco, CA, USA 94143
- Department of Medicine, UCSF, San Francisco California, USA
| | - Peter J. Turnbaugh
- Department of Microbiology & Immunology, UCSF, San Francisco, CA, USA 94143
- Chan Zuckerberg Biohub-San Francisco, San Francisco, CA, USA 94158
| | | | - John C. Newman
- Buck Institute for Research on Aging, Novato, CA, USA
- Division of Geriatrics, UCSF, San Francisco, California, USA
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Hamiduzzaman A, Wu R, Murray V, Kalantar-Zadeh K, Streja E, Sy J. Comparing the Fried frailty phenotype versus the Veterans Affairs frailty index among dialysis dependent patients. Hemodial Int 2023; 27:444-453. [PMID: 37318050 DOI: 10.1111/hdi.13101] [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: 03/01/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Frailty in dialysis patients is a modifiable disease state which can increase mortality if left untreated but remains underdiagnosed as frailty evaluations can be arduous or time consuming. We evaluate the agreement between a clinical frailty construct (Fried frailty phenotype, FFP) against and an electronic health record-based Veterans Affairs Frailty Index (VAFI) and their association with mortality. METHODS A retrospective cohort analysis of 764 participants from the ACTIVE/ADIPOSE study was performed. Frailty as measured by VAFI and FFP was obtained and Kappa statistic estimating concordance between the two scores were calculated. Differences in mortality risk were analyzed according to presence or absence of frailty. FINDINGS When assessing agreement between the VAFI and FFP, the kappa statistic was 0.09 (95% confidence interval [CI] 0.02-0.16) suggesting a low level of agreement. Frailty was independently associated with higher mortality risk (hazards ratio [HR] 1.40-1.42 in fully adjusted models depending upon frailty construct). Discordantly frail patients by construct had a higher risk of mortality though this was not statistically significant after adjustment. However, concordantly frail patients had much higher mortality risk compared to concordantly nonfrail (adjusted HR 2.08, 95% CI 1.44-3.01). DISCUSSION Poor agreement between constructs is likely reflective of the multifactorial definition of frailty. While further longitudinal studies are needed to determine if the VAFI would be beneficial in the reassessment of frailty, it may be beneficial as a cue for further frailty testing (e.g., with FFP) with the combination of multiple frail constructs providing improved prognostic information.
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Affiliation(s)
- Anum Hamiduzzaman
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
- Veterans Affairs Long Beach Healthcare System, Division of Nephrology, Long Beach, California, USA
| | - Ruoxue Wu
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
| | - Victoria Murray
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
- Veterans Affairs Long Beach Healthcare System, Division of Nephrology, Long Beach, California, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
- Veterans Affairs Long Beach Healthcare System, Division of Nephrology, Long Beach, California, USA
| | - John Sy
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
- Veterans Affairs Long Beach Healthcare System, Division of Nephrology, Long Beach, California, USA
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Nakashima H, Nagae M, Komiya H, Fujisawa C, Watanabe K, Yamada Y, Tajima T, Miyahara S, Sakai T, Umegaki H. Combined use of the Clinical Frailty Scale and laboratory tests in acutely hospitalized older patients. Aging Clin Exp Res 2023; 35:1927-1935. [PMID: 37378813 DOI: 10.1007/s40520-023-02477-w] [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: 03/21/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
AIMS To evaluate the Clinical Frailty Scale (CFS) and a Frailty Index based on laboratory tests (FI-lab) in terms of what each assesses about frailty and to determine the appropriateness of combined use of these two frailty scales. METHODS This was a prospective observational cohort study in an acute geriatric ward of a university hospital. The FI-lab is the proportion of laboratory parameters that yield abnormal results from a total of 23. The FI-lab and CFS were assessed at admission. Data on activities of daily living (ADL), cognition, geriatric syndromes, and comorbidities were also collected. Main outcomes were in-hospital mortality and 90-day mortality after admission. RESULTS In total, 378 inpatients (mean age 85.2 ± 5.8 years, 59.3% female) were enrolled. ADL and cognition correlated strongly with the CFS (Spearman's |r|> 0.60) but weakly with the FI-lab (|r|< 0.30). Both the CFS and FI-lab correlated weakly with geriatric syndromes and comorbidities (|r|< 0.40). The correlation between the CFS and FI-lab was also weak (r = 0.28). The CFS and FI-lab were independently associated with in-hospital mortality and 90-day mortality after admission. The Akaike information criterion was lower for models using both the CFS and FI-lab than for models using either tool alone. CONCLUSIONS The CFS and FI-lab each reflected only some of the aspects of frailty in acutely hospitalized older patients. The model fit was better when the two frailty scales were used together to assess the mortality risk than when either was used alone.
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Affiliation(s)
- Hirotaka Nakashima
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan.
| | - Masaaki Nagae
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Hitoshi Komiya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Chisato Fujisawa
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Kazuhisa Watanabe
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Yosuke Yamada
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Tomihiko Tajima
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Shuzo Miyahara
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Tomomichi Sakai
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
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Zhao H, Tu J, She Q, Li M, Wang K, Zhao W, Huang P, Chen B, Wu J. Prognostic significance of frailty in hospitalized elderly patients with community-acquired pneumonia: a retrospective cohort study. BMC Geriatr 2023; 23:308. [PMID: 37198576 DOI: 10.1186/s12877-023-04029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Frailty is associated with poor prognosis in a wide range of illnesses. However, its prognostic implications for older patients with community-acquired pneumonia (CAP) are not adequately addressed. METHODS In this study, patients were classified into 3 groups according to the frailty index based on standard laboratory tests (FI-Lab) score: robust (FI-Lab < 0.2), pre-frail (FI-Lab 0.2-0.35), and frail (FI-Lab ≥ 0.35). The relationships between frailty and all-cause mortality and short-term clinical outcomes (length of stay, duration of antibiotic therapy, in-hospital mortality) were examined. RESULTS Finally, 1164 patients were included, the median age was 75 years (interquartile range: 69, 82), and 438 patients (37.6%) were women. According to FI-Lab, 261(22.4%), 395(33.9%), and 508(43.6%) were robust, pre-frail, and frail. After adjustment for confounding variables, frailty was independently associated with prolonged antibiotic treatment (p = 0.037); pre-frailty and frailty were independently associated with longer inpatient days (p < 0.05 for both). The risk of in-hospital mortality was independently increased in frail patients (HR = 5.01, 95% CI = 1.51-16.57, p = 0.008) but not pre-frail patients (HR = 2.87, 95% CI = 0.86-9.63, p = 0.088) compared to robust patients. During a median follow-up of 33.9 months (interquartile range: 32.8 to 35.1 months), 408 (35.1%) patients died, of whom 29 (7.1%) were robust, 112 (27.5%) were pre-frail, and 267 (65.9%) were frail. Compared to robust patients, frail and pre-frail were significantly associated with increased risk for all-cause death (HR = 4.29, 95%CI: 1.78-10.35 and HR = 2.42 95%CI: 1.01-5.82, respectively). CONCLUSIONS Frailty is common among older patients with CAP and is strongly associated with increased mortality, longer length of stay, and duration of antibiotics. A routine frail assessment at the admission of elderly patients with CAP is necessary as the first step for appropriate multidisciplinary interventions.
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Affiliation(s)
- Hongye Zhao
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
- Department of General Practice, The First People's Hospital of Lianyungang, Lianyungang Clinical College of Nanjing Medical Unversity, Lianyungang, 222000, China
| | - Junlan Tu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Quan She
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Min Li
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Kai Wang
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Weihong Zhao
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Peng Huang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Bo Chen
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China.
| | - Jianqing Wu
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China.
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Ji J, Sun CL, Cohen HJ, Muss HB, Bae M, Sedrak MS. Toxicity risk score and clinical decline after adjuvant chemotherapy in older breast cancer survivors. J Natl Cancer Inst 2023; 115:578-585. [PMID: 36762832 PMCID: PMC10165485 DOI: 10.1093/jnci/djad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/01/2023] [Accepted: 01/28/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Chemotoxicity risk scores were developed to predict grade 3-5 chemotherapy toxicity in older women with early breast cancer. However, whether these toxicity risk scores are associated with clinically meaningful decline in patient health remains unknown. METHODS In a prospective study of women aged 65 years and older with stage I-III breast cancer treated with chemotherapy, we assessed chemotoxicity risk using the Cancer and Aging Research Group-Breast Cancer (CARG-BC) score (categorized as low, intermediate, and high). We measured patient health status before (T1) and after (T2) chemotherapy using a clinical frailty index (Deficit Accumulation Index, categorized as robust, prefrail, and frail). The population of interest was robust women at T1. The primary outcome was decline in health status after chemotherapy, defined as a decline in Deficit Accumulation Index from robust at T1 to prefrail or frail at T2. Multivariable logistic regression was used to examine the association between T1 CARG-BC score and decline in health status, adjusted for sociodemographic and clinical characteristics. RESULTS Of the 348 robust women at T1, 83 (24%) experienced declining health status after chemotherapy, of whom 63% had intermediate or high CARG-BC scores. After adjusting for sociodemographic and clinical characteristics, women with intermediate (odds ratio = 3.14, 95% confidence interval = 1.60 to 6.14, P < .001) or high (odds ratio = 3.80, 95% confidence interval = 1.35 to 10.67, P = .01) CARG-BC scores had greater odds of decline in health status compared with women with low scores. CONCLUSIONS In this cohort of older women with early breast cancer, higher CARG-BC scores before chemotherapy were associated with decline in health status after chemotherapy independent of sociodemographic and clinical risk factors.
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Affiliation(s)
- Jingran Ji
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Can-Lan Sun
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Harvey J Cohen
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Hyman B Muss
- Department of Medicine, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Marie Bae
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Mina S Sedrak
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
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Hakeem FF, Maharani A, Todd C, O'Neill TW. Development, validation and performance of laboratory frailty indices: A scoping review. Arch Gerontol Geriatr 2023; 111:104995. [PMID: 36963345 DOI: 10.1016/j.archger.2023.104995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Frailty is a syndrome characterised by decline in functional ability and increasing vulnerability to disease and associated with adverse outcomes. Several established methods exist for assessing frailty. This scoping review aims to characterise the development and validation of frailty indices based on laboratory test results (FI-Lab) and to assess their utility. METHODS Studies were included in the review if they included data concerning the development and/or testing an FI-Lab using the deficit accumulation method. Studies were identified using PubMed/MEDLINE, Embase (Elsevier), OpenGrey and Google Scholar from 2010 to 2021. Two reviewers independently screened all abstracts, and those that met the inclusion criteria were reviewed in detail. Data extracted included details about the study characteristics, number, type and coding of laboratory variables included, validation, and outcomes. A narrative synthesis of the available evidence was adopted. RESULTS The search yielded 915 articles, of which 29 studies were included. In general, 89% of studies were conducted after 2016 and 51% in a hospital-based setting. The number of variables included in FI-Labs ranged from 13 to 77, and 51% included some non-laboratory variables in their indices, with pulse and blood pressure being the most frequent. The validity of FI-Lab was demonstrated through change with age, correlation with established frailty indices and association with adverse health outcomes. The most frequent outcome studied was mortality (79% of the studies), with FI-Lab associated with increased mortality in all but one. Other outcomes studied included self-reported health, institutionalisation, and activities of daily living. The effect of combining the FI-Lab with a non-laboratory-based FI was assessed in 7 studies with a marginal increase in predictive ability. CONCLUSION Frailty indices constructed based on the assessment of laboratory variables, appear to be a valid measure of frailty and robust to the choice of variables included.
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Affiliation(s)
- Faisal F Hakeem
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, AlMadinah AlMunawwarah, Saudi Arabia; Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK.
| | - Asri Maharani
- Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, UK; Division of Population Health, Health Services Research & Primary Care, University of Manchester, UK
| | - Chris Todd
- School of Health Sciences, The University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK; NIHR Applied Research Collaboration- Greater Manchester, Manchester, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester, UK
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A novel easy-to-use index to predict institutionalization and death in older population - a 10-year population-based follow-up study. BMC Geriatr 2023; 23:80. [PMID: 36750784 PMCID: PMC9903495 DOI: 10.1186/s12877-023-03760-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Various indexes have been developed to estimate the risk for mortality, institutionalization, and other adverse outcomes for older people. Most indexes are based on a large number of clinical or laboratory parameters. An index based on only a few parameters would be more practical to use in every-day clinical practice. Our aim was to create an index to predict the risk for mortality and institutionalization with as few parameters as possible without compromising their predictive ability. METHODS A prospective study with a 10-year follow-up period. Thirty-six clinical and fourteen laboratory parameters were combined to form an index. Cox regression model was used to analyze the association of the index with institutionalization and mortality. A backward statistical method was used to reduce the number of parameters to form an easy-to-use index for predicting institutionalization and mortality. RESULTS The mean age of the participants (n = 1172) was 73.1 (SD 6.6, range 64‒97) years. Altogether, 149 (14%) subjects were institutionalized, and 413 (35%) subjects deceased during the follow-up. Institutionalization and mortality rates increased as index scores increased both for the large 50-parameter combined index and for the reduced indexes. After a backward variable selection in the Cox regression model, three clinical parameters remained in the index to predict institutionalization and six clinical and three laboratory parameters in the index to predict mortality. The reduced indexes showed a slightly better predictive value for both institutionalization and mortality compared to the full index. CONCLUSIONS A large index with fifty parameters included many unimportant parameters that did not increase its predictive value, and therefore could be replaced with a reduced index with only a few carefully chosen parameters, that were individually associated with institutionalization or death.
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Sapp DG, Cormier BM, Rockwood K, Howlett SE, Heinze SS. The frailty index based on laboratory test data as a tool to investigate the impact of frailty on health outcomes: a systematic review and meta-analysis. Age Ageing 2023; 52:afac309. [PMID: 36626319 PMCID: PMC9831271 DOI: 10.1093/ageing/afac309] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 01/11/2023] Open
Abstract
The frailty index (FI) quantifies frailty as deficit accumulation. It has been adapted to employ laboratory test data (FI-Lab). Our objective was to systematically review and meta-analyse the FI-Lab's ability to predict mortality. Secondary objectives were to review the FI-Lab's association with adverse health outcomes and whether FI-Lab scores differed between the sexes. A systematic literature search was carried out using six online databases to identify studies that measured the FI-Lab in humans. Hazard ratios (HRs) were combined in a meta-analysis to create a pooled risk estimate for mortality. Of the 1,201 papers identified, spanning January 2010 until 11 July 2022, 38 were included. FI-Lab scores per 0.01 unit increase predicted mortality overall (HR = 1.04; 95% confidence interval (CI) = 1.03-1.05) and for studies with a mean age of 81+ years (HR = 1.04; 95% CI = 1.03-1.05). The quality of evidence for these meta-analyses are moderate and high, respectively. Further, higher FI-Lab scores were associated with more frequent adverse health outcomes. Sex differences in FI-Lab scores varied, with no consistent indication of a sex effect. The FI-Lab is associated with mortality and with a variety of adverse health outcomes. No consistent sex differences in FI-Lab scores were observed, with several studies in disagreement. Notably, these conclusions were most relevant to older (65+ years old) individuals; further evidence in younger people is needed in both clinical and population representative studies.
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Affiliation(s)
- David G Sapp
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Brianna M Cormier
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Kenneth Rockwood
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Stefan S Heinze
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
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Zan YM, Zheng TP, Wang Y, Shao JF, Wang ZY, Zhao WH, Wu JQ, Xu W. Combining a Frailty Index Based on Laboratory Data and Pneumonia Severity Assessments to Predict In-Hospital Outcomes in Older Adults with Community-Acquired Pneumonia. J Nutr Health Aging 2023; 27:270-276. [PMID: 37170434 DOI: 10.1007/s12603-023-1905-1] [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] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Due to the increased morbidity, mortality, and cost of community-acquired pneumonia (CAP) in older people, strategies directed at improving disease evaluation and prevention are imperative. We independently compared the 30-day in-hospital mortality prediction ability of a frailty index based on laboratory data (FI-Lab) with that of the CURB-65 and the Pneumonia Severity Index (PSI) and then proposed combining them to further improve prediction efficiency. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Patients aged ≥ 65 years (n = 2039) with CAP who were admitted to Jiangsu Provincial People's Hospital of Nanjing Medical University and Jiangsu Provincial Hospital of Chinese Medicine from January 2019 to June 2022. MEASURES The 29-item FI-Lab, PSI and, CURB-65 were administered at admission. We defined frailty by the cut-off value of the FI-Lab score (> 0.43). Multivariable logistic regression analysis, together with the calculation of the area under the receiver operating characteristic curve (ROC-AUC), was conducted to identify stratified risks and relationships between the three indices and 30-day mortality. Participants were divided into the following three groups based on age: 65-74 years, 75-84 years, and ≥ 85 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality due to frailty were calculated. RESULTS A total of 495 participants ranging from 65 to 100 years of age were ultimately included and divided into age groups (65-74 years, n = 190, 38.4%; 75-84 years, n = 183, 37.0%; ≥ 85 years, n = 122, 24.6%). A total of 142 (28.7%) of the 495 patients were defined as having frailty. All three scores tested in this study were significantly associated with 30-day mortality in the total sample. The ORs were as follows: 1.06 (95% CI: 1.03-1.09, P < 0.001) and 2.33 (95% CI: 1.26-4.31, P = 0.007) for the FI-Lab when the score was treated as a continuous and categorical variable, respectively; 1.04 (95% CI: 1.02-1.05, P < 0.001) for the PSI; and 3.70 (95% CI: 2.48-5.50, P < 0.001) for the CURB-65. In the total sample, the ROC-AUCs were 0.783 (95% CI: 0.744-0.819) for the FI-Lab, 0.812 (95% CI: 0.775-0.845) for the PSI, and 0.799 (95% CI: 0.761-0.834) for the CURB-65 (P < 0.001). The ROC-AUC slightly improved when the FI-Lab was added to the PSI (AUC 0.850, 95% CI: 0.809-0.892, P = 0.031) and to the CURB-65 (AUC 0.839, 95% CI: 0.794-0.885, P = 0.002). Older patients with frailty showed a higher risk of in-hospital mortality, with an HR of 2.25 (95% CI: 1.14-3.58, P < 0.001). CONCLUSION AND IMPLICATIONS The FI-Lab seems to generate simple and readily available data, suggesting that it could be a useful complement to the CURB-65 and the PSI as effective predictors of 30-day mortality due to CAP in older populations.
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Affiliation(s)
- Y M Zan
- Wei Xu, MD, Key Laboratory of Geriatrics of Jiangsu Province, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210029, China. Email address: (Wei Xu). Tel: 86-25-68305111. Fax: 86-25-68305111
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Lin Y, Shi X, Huang L, Chen A, Zhu H. Frailty Index was Associated With Adverse Outcomes in Admitted Elderly Patients With Type 2 Diabetes Mellitus. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231201022. [PMID: 37724847 PMCID: PMC10510342 DOI: 10.1177/00469580231201022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/20/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
We aimed to investigate the role of the laboratory frailty index (LFI) in diabetic complications and incident disability in admitted older patients with type 2 diabetes mellitus (T2DM). We retrospectively collected the clinical data of older patients with T2DM from December 2018 to May 2020. Frailty was quantified using the LFI, which considers the accumulation of 27 items of abnormal laboratory outcomes. Univariate and multivariate analyses were performed to evaluate the relationship between LFI and diabetes-related adverse outcomes. In total, 293 consecutive older patients with T2DM were recruited for this study. According to the predefined LFI criteria, 110 (37.5%) participants were non-frail, 131 (44.7%) were prefrail, and 52 (17.8%) were frail. Univariate and multivariate analysis revealed that LFI was associated with the diabetic microangiopathy complications (odds ratio for prefrail [ORprefrail] 1.760, 95% confidence interval for prefrail [CIprefrail] 1.019-3.041, P = .043; ORfrail 4.667, 95% CIfrail 2.012-10.826, P < .001) and activities of daily living (ADL) disability (ORprefrail 2.323, 95% CIprefrail 1.209-4.463, P = .011; ORfrail 9.367, 95% CIfrail 4.030-21.775, P < .001), but not with the diabetic macroangiopathy complications and diabetic peripheral neuropathy. Frailty, as determined by the LFI, was proven to be an effective tool for the prediction of diabetic microangiopathy complications and ADL disability.
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Affiliation(s)
- Yi Lin
- Department of Endocrinology, The Third Affiliated Hospital of Shanghai University, Wenzhou People’s Hospital, Zhejiang, China
| | - Xiaochong Shi
- Department of Endocrinology, The Third Affiliated Hospital of Shanghai University, Wenzhou People’s Hospital, Zhejiang, China
| | - Lingling Huang
- Department of Endocrinology, The Third Affiliated Hospital of Shanghai University, Wenzhou People’s Hospital, Zhejiang, China
| | - Aixia Chen
- Department of Endocrinology, The Third Affiliated Hospital of Shanghai University, Wenzhou People’s Hospital, Zhejiang, China
| | - Haihui Zhu
- Department of Endocrinology, The Third Affiliated Hospital of Shanghai University, Wenzhou People’s Hospital, Zhejiang, China
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Resendes NM, Chada A, Torres-Morales A, Fernandez M, Diaz-Quiñones A, Gomez C, Oomrigar S, Burton L, Ruiz JG. Association between a Frailty Index from Common Laboratory Values and Vital Signs (FI-LAB) and Hospital and Post-Hospital Outcomes in Veterans with COVID-19 Infection. J Nutr Health Aging 2023; 27:89-95. [PMID: 36806863 PMCID: PMC9893965 DOI: 10.1007/s12603-023-1886-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Determine the association of higher FI-LAB scores, derived from common laboratory values and vital signs, with hospital and post-hospital outcomes in Veterans hospitalized with COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS A retrospective, multicenter, cohort study of 7 Veterans Health Administration (VHA) medical centers in Florida and Puerto Rico. Patients aged 18 years and older hospitalized with COVID-19 and followed for up to 1 year post discharge or until death. Clinical Frailty Measure: FI-LAB. MAIN OUTCOMES AND MEASURES Hospital and post-hospital outcomes. RESULTS Of the 671 eligible patients, 615 (91.5%) patients were included (mean [SD] age, 66.1 [14.8] years; 577 men [93.8%]; median stay, 8 days [IQR:3-15]. There were sixty-one in-hospital deaths. Veterans in the moderate and high FI-LAB groups had a higher proportion of inpatient mortality (13.3% and 20.6%, respectively) than the low group (4.1%), p <0.001. Moderate and high FI-LAB scores were associated with greater inpatient mortality when compared to the low group, OR:3.22 (95%CI:1.59-6.54), p=.001 and 6.05 (95%CI:2.48-14.74), p<0.001, respectively. Compared with low FI-LAB scores, moderate and high scores were also associated with prolonged length of stay, intensive care unit (ICU) admission, and transfer. CONCLUSIONS AND RELEVANCE In this study of patients admitted to 7 VHA Hospitals during the first surge of the pandemic, higher FI-LAB scores were associated with higher in-hospital mortality and other in-hospital outcomes; FI-LAB can serve as a validated, rapid, feasible, and objective frailty tool in hospitalized adults with COVID-19 that can aid clinical care.
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Affiliation(s)
- N M Resendes
- Natasha Melo Resendes, Miami VA Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), GRECC (11GRC), Bruce W. Carter Miami VAMC, 1201 NW 16th Street, Miami, Florida 33125, USA, Telephone: (305) 575-3388 / Fax: (305) 575-3365, E-mail: , ORCID: 0000-0003-2867-7227
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13
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Ysea-Hill O, Gomez CJ, Mansour N, Wahab K, Hoang M, Labrada M, Ruiz JG. The association of a frailty index from laboratory tests and vital signs with clinical outcomes in hospitalized older adults. J Am Geriatr Soc 2022; 70:3163-3175. [PMID: 35932256 DOI: 10.1111/jgs.17977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 06/19/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Frailty, a state of vulnerability to stressors resulting from loss of physiological reserve due to multisystemic dysfunction, is common among hospitalized older adults. Hospital clinicians need objective and practical instruments that identify older adults with frailty. The FI-LAB is based on laboratory values and vital signs and may capture biological changes of frailty that predispose hospitalized older adults to complications. The study's aim was to assess the association of the FI-LAB versus VA-FI with hospital and post-hospital clinical outcomes in older adults. METHODS Retrospective cohort study was conducted on Veterans aged ≥60 admitted to a VA hospital. We identified acute hospitalizations January 2011-December-2014 with 1-year follow-up. A 31-item FI-LAB was created from blood laboratory tests and vital signs collected within the first 48 h of admission and scores were categorized as low (<0.25), moderate (0.25-0.40), and high (>0.40). For each FI-LAB group, we obtained odds ratio (OR) and confidence intervals (CI) for hospital and post-hospital outcomes using multivariate binomial logistic regression. Additionally, we calculated hazard ratios (HR) and CI for all-cause in-hospital mortality comparing the high and moderate FI-LAB group with the low group. RESULTS Patients were 1407 Veterans, mean age 72.7 (SD = 9.0), 67.8% Caucasian, 96.1% males, 47.0% (n = 661), 41.0% (n = 577), and 12.0% (n = 169) were in the low, moderate, and high FI-LAB groups, respectively. Moderate and high scores were associated with prolonged LOS, OR:1.62 (95% CI:1.29-2.03); and 3.36 (95% CI:2.27-4.99), ICU admission, OR:1.40 (95% CI:1.03-1.90); and OR:2.00 (95% CI:1.33-3.02), nursing home placement OR:2.36 (95% CI:1.26-4.44); and 5.99 (95% CI:2.83-12.70), 30-day readmissions OR:1.74 (95% CI:1.20-2.52); and 2.20 (95% CI:1.30-3.74), 30-day mortality OR: 2.51 (95% CI:1.01-6.23); and 8.97 (95% CI:3.42-23.53), 6-month mortality OR:3.00 (95% CI:1.90-4.74); and 6.16 (95% CI:3.55-10.71), and 1-year mortality OR: 2.66 (95% CI:1.87-3.79); and 4.76 (95% CI:3.00-7.54) respectively. The high FI-LAB group showed higher risk of in-hospital mortality, HR:18.17 (95% CI:4.01-80.52) with an area-under-the-curve of 0.843 (95% CI:0.75-0.93). CONCLUSIONS High and moderate FI-LAB scores were associated with worse in-hospital and post-hospital outcomes. The FI-LAB may identify hospitalized older patients with frailty at higher risk and assist clinicians in implementing strategies to improve outcomes.
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Affiliation(s)
- Otoniel Ysea-Hill
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, Florida, USA
| | - Christian J Gomez
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, Florida, USA
| | - Natalie Mansour
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, Florida, USA
| | - Kamal Wahab
- Department of Medicine, University of Miami, Jackson Health System, Miami, Florida, USA
| | - Mihn Hoang
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.,Medical Service, Bruce W. Carter Miami VAMC, Miami, Florida, USA
| | - Mabel Labrada
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.,Medical Service, Bruce W. Carter Miami VAMC, Miami, Florida, USA
| | - Jorge G Ruiz
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, Florida, USA.,Department of Medicine, University of Miami, Jackson Health System, Miami, Florida, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Huang S, Wang Y, Chen L, Chen X. Use of a frailty index based upon routine laboratory data to predict complication and mortality in older community-acquired pneumonia patients. Arch Gerontol Geriatr 2022; 101:104692. [DOI: 10.1016/j.archger.2022.104692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/19/2022] [Accepted: 03/20/2022] [Indexed: 11/17/2022]
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Kim Y, Song K, Kang CM, Lee H. Impact of preoperative laboratory frailty index on mortality and clinical outcomes in older surgical patients with cancer. Sci Rep 2022; 12:9200. [PMID: 35654943 PMCID: PMC9163125 DOI: 10.1038/s41598-022-13426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/05/2022] [Indexed: 11/09/2022] Open
Abstract
Frailty in older patients is associated with poor postoperative outcomes. The use of uncomplicated frailty measurement tools is preferred in busy clinical settings. Therefore, we validated the frailty index using routine laboratory data and the surgical outcomes of older patients with cancer who underwent cancer resection. We retrospectively analyzed 9015 patients aged 65 years and older who underwent cancer resection at a single tertiary hospital. Based on electronic-medical-record data regarding preoperative blood test results and vital signs, Laboratory Frailty Index (FI-Lab) scores were generated to measure preoperative frailty. The associations of FI-Lab with postoperative length of stay (LOS), readmission within 30 days, intensive care unit (ICU) admission within 30 days, and mortality were evaluated. The mean FI-Lab score of the 9015 patients was 0.20 ± 0.10. Increased FI-Lab scores (0.25–0.4; > 0.4) were associated with longer LOS, increased readmission within 30 days of surgery, ICU admission, and increased mortality, compared with FI-Lab scores < 0.25. The FI-Lab score, as a frailty indicator, was able to predict the risk of poor postoperative outcomes. Therefore, the FI-Lab is a potentially useful tool for assessing preoperative frailty in older patients with cancer in acute clinical setting.
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Affiliation(s)
- Yoonjoo Kim
- Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea.,Department of Nursing, College of Healthcare Sciences, Far East University, Eumseong-gun, Chungcheongbuk-do, South Korea
| | - Kijun Song
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Chang Moo Kang
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea
| | - Hyangkyu Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea.
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16
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Blodgett JM, Pérez-Zepeda MU, Godin J, Kehler DS, Andrew MK, Kirkland S, Rockwood K, Theou O. Frailty indices based on self-report, blood-based biomarkers and examination-based data in the Canadian Longitudinal Study on Aging. Age Ageing 2022; 51:6581611. [PMID: 35524747 PMCID: PMC9078045 DOI: 10.1093/ageing/afac075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Frailty can be operationalised using the deficit accumulation approach, which considers health deficits across multiple domains. We aimed to develop, validate and compare three different frailty indices (FI) constructed from self-reported health measures (FI-Self Report), blood-based biomarkers (FI-Blood) and examination-based assessments (FI-Examination). METHODS Up to 30,027 participants aged 45-85 years from the baseline (2011-2015) comprehensive cohort of the Canadian Longitudinal Study on Aging were included in the analyses. Following standard criteria, three FIs were created: a 48-item FI-Self Report, a 23-item FI-Blood and a 47-item FI-Examination. In addition a 118-item FI-Combined was constructed. Mortality status was ascertained in July 2019. RESULTS FI-Blood and FI-Examination demonstrated broader distributions than FI-Self Report. FI-Self Report and FI-Blood scores were higher in females, whereas FI-Examination scores were higher in males. All FI scores increased nonlinearly with age and were highest at lower education levels. In sex and age-adjusted models, a 0.01 increase in FI score was associated with a 1.08 [95% confidence interval (CI): 1.07,1.10], 1.05 (1.04,1.06), 1.07 (1.05,1.08) and a 1.13 (1.11,1.16) increased odds of mortality for FI-Self Report, FI-Blood, FI-Examination and FI-Combined, respectively. Inclusion of the three distinct FI types in a single model yielded the best prognostic accuracy and model fit, even compared to the FI-Combined, with all FIs remaining independently associated with mortality. CONCLUSION Characteristics of all FIs were largely consistent with previously established FIs. To adequately capture frailty levels and to improve our understanding of the heterogeneity of ageing, FIs should consider multiple types of deficits including self-reported, blood and examination-based measures.
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Affiliation(s)
- Joanna M Blodgett
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mario U Pérez-Zepeda
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada,Instituto Nacional de Geriatria, Mexico City, Mexico,Centro de Investigacion en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac Mexico Campus Norte, Huixquilucan Mexico
| | - Judith Godin
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - D Scott Kehler
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada,School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa K Andrew
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan Kirkland
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada,Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada,School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada,Address correspondence to: Olga Theou, School of Physiotherapy and Department of Medicine, Dalhousie University and Nova Scotia Health, Halifax, Nova Scotia, Canada. Tel: 902-473-4846; Fax: 902-473-1050.
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Association of a modified laboratory frailty index with adverse outcomes in geriatric rehabilitation inpatients: RESORT. Mech Ageing Dev 2022; 203:111648. [PMID: 35219637 DOI: 10.1016/j.mad.2022.111648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/24/2022]
Abstract
A higher number of laboratory measurements is associated with mortality in patients admitted to hospital, but is not part of the frailty index based on laboratory tests (FILab). This study aimed to modify the FI-Lab (mFI-Lab) by accounting for the number of laboratory measurements and compare its validity to predict institutionalization and mortality at three-month post-discharge with the clinical frailty scale (CFS) in geriatric rehabilitation inpatients. In 1819 patients (median age 83.3 [77.6-88.3], 56.6% female), a higher FI-Lab was not associated with institutionalization but a higher risk of mortality. A higher mFI-Lab was associated with lower odds of institutionalization but a higher risk of mortality. A higher CFS was associated with institutionalization and higher mortality. The Akaike information criterion value was lowest for the CFS, followed by the mFI-Lab and the FI-Lab. The CFS is better than the mFI-Lab predicting short-term adverse outcomes in geriatric rehabilitation inpatients. When using laboratory data to estimate frailty, the mFI-Lab rather than the FI-Lab should be used.
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Walczak S, Velanovich V. Predicting Elective Surgical Patient Outcome Destination Based on the Preoperative Modified Frailty Index and Laboratory Values. J Surg Res 2022; 275:341-351. [PMID: 35339003 DOI: 10.1016/j.jss.2022.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/29/2022] [Accepted: 02/14/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION To determine the accuracy of preoperative modified frailty index (mFI) with or without laboratory values (mFI-labs or labs-continuous) in predicting postoperative discharge destination. Discharge destination is important to providers and patients. The ability to accurately predict discharge destination preoperatively can improve hospital resource utilization and help set patient and family expectations. METHODS Cohort analysis of the 2018 American College of Surgeon National Surgical Quality Improvement Project (ACS-NSQIP) Participant Use File of patients undergoing operations with complete data point sets: age, sex, operation work relative-value units; mFI-clinical based on 12 clinical findings, mFI-labs based on seven laboratory values. The nine hierarchical destinations: home, home with assistance, multi-level community, unskilled-care facility, rehabilitation facility, skilled-nursing facility, acute care hospital, hospice, or death, from best to worst outcome. Data were analyzed using univariate analysis, multiple logistic regression and supervised learning artificial neural networks. RESULTS Univariate and multivariate in general showed that patients with higher mFI-clinical and mFI-lab scores, as well as older age and more complex operations were more likely to be discharged to facilities other than home. However, these statistical techniques could not predict the exact destination. An artificial neural network analysis demonstrated perfect location prediction in 64.9% of cases and within one level of prefect prediction is 87.4%. CONCLUSIONS Using a limited number of preoperative factors, combining the mFI-clinical with laboratory values significantly improves the destination prediction performance significantly better than using the values separately. Preoperative knowledge of the likely discharge destination can benefit postoperative care planning and delivery.
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Affiliation(s)
- Steven Walczak
- School of Information and Florida Center for Cybersecurity, University of South Florida, Tampa, Florida
| | - Vic Velanovich
- Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida.
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Soh CH, Guan L, Reijnierse EM, Lim WK, Maier AB. Comparison of the modified Frailty-Index based on laboratory tests and the Clinical Frailty Scale in predicting mortality among geriatric rehabilitation inpatients: RESORT. Arch Gerontol Geriatr 2022; 100:104667. [PMID: 35240386 DOI: 10.1016/j.archger.2022.104667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To compare the associations of the FI-lab, modified (m)FI-lab and Clinical Frailty Scale (CFS) with one-year mortality. STUDY DESIGN An observational longitudinal inception cohort of inpatients admitted to the geriatric rehabilitation wards in the Royal Melbourne Hospital, Victoria, Australia. MAIN OUTCOME MEASURES The measured ratio was defined as the proportion of measured laboratory tests to the total number of tests (n = 77). The FI-lab is the proportion of abnormal results to the total measured laboratory tests. The mFI-lab was calculated by dividing the FI-lab by the measured ratio. The measured ratio of laboratory tests, FI-lab, mFI-lab and CFS were assessed at admission to geriatric rehabilitation. Patients' mortality data were obtained from the Registry of Births, Deaths and Marriages Victoria and medical records. RESULTS The total of 1819 inpatients had a median age of 83.3 [77.5-88.3] years and 56.5% were female. The median measured ratio, FI-lab, mFI-lab and CFS scores were 0.58 [0.47-0.70], 0.31 [0.23-0.38], 0.51 [0.38-0.69] and 6 (Abbasi et al., 2018Gill, Gahbauer, Allore & Han, 2006; Howlett et al., 2014;) respectively. The one-year mortality rate was 17.1%. The measured ratio was not associated with one-year mortality. Higher FI-lab (hazard ratio (HR)=1.180, 95%CI: 1.037-1.343), mFI-lab (HR=1.074, 95%CI: 1.030-1.119) and CFS scores (HR=1.350, 95%CI: 1.191-1.530) were associated with higher risk of one-year mortality. The area under the curve (AUC) of FI-lab, mFI-lab and CFS with one-year mortality were 0.581, 0.587 and 0.612 respectively. CONCLUSION The FI-lab, mFI-lab and CFS poorly predict mortality in geriatric rehabilitation inpatients despite the statistically significant associations shown.
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Frailty assessment using routine clinical data: An integrative review. Arch Gerontol Geriatr 2021; 99:104612. [PMID: 34986459 DOI: 10.1016/j.archger.2021.104612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Frailty is a common but complex problem in older adults. Frailty assessment using routine clinical data has been suggested as a pragmatic approach based on electronic health records from primary care center or hospital settings. PURPOSE We aimed to explore the tools and outcome variables used in the published studies on frailty assessment using routine clinical data. METHODS An integrative literature review was conducted using the method of Whittemore and Knafl. A literature search was conducted in PubMed, EMBASE, and CINAHL from January 2010 to October 2021. RESULTS A total of 45 studies and thirteen frailty assessment tools were analyzed. The assessment items were generally biased toward frailty's risk factors rather than the mechanisms or phenotypes of frailty. Similar to using conventional tools, routine clinical data-based frailty was associated with adverse health outcomes. CONCLUSIONS Frailty assessment based on routine clinical data could efficiently evaluate frailty using electronic health records from primary care centers or hospitals. However, they need refinement to consider the risk factors, mechanisms, and frailty phenotypes.
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Hembree T, Theou O, Thirlwell S, Reich RR, Cao B, Sehovic M, Syed M, Verma N, Nguyen TC, Keerty D, Wesolow J, Koverzhenko V, Extermann M, Huang J, Ramsakal A. A simple test-based frailty index to predict survival among cancer patients with an unplanned hospitalization: An observational cohort study. Cancer Med 2021; 10:5765-5774. [PMID: 34350715 PMCID: PMC8419777 DOI: 10.1002/cam4.4107] [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: 03/19/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Frailty is a state of increased vulnerability to stressors, and predicts risk of adverse outcomes, such as mortality. Frailty can be defined by a frailty index (FI) using an accumulation of deficits approach. An FI comprised of 20 items derived from our previously studied test-based frailty index (TBFI) and an additional 33 survey-based elements sourced from the standard CGA was developed to evaluate if predictive validity of survival was improved. METHODS One hundred eighty-nine cancer patients during acute hospitalization were consented between September 2018 and May 2019. Frailty scores were calculated, and patients were categorized into four groups: non-frail (0-0.2), mildly frail (0.2-0.3), moderately frail (0.3-0.4), and severely frail (>0.4). Patients were followed for 1-year to assess FI and TBFI prediction of survival. Area under the curve (AUC) statistics from ROC analyses were compared for the FI versus TBFI. RESULTS Increasing frailty was similarly associated with increased risk of mortality (HR, 4.5 [95% CI, 2.519-8.075] and HR, 4.1 [95%CI, 1.692-9.942]) and the likelihood of death at 6 months was about 11-fold (odds ratio, 10.9 [95% CI, 3.97-33.24]) and 9.73-fold (95% CI, 2.85-38.50) higher for severely frail patients compared to non-frail patients for FI and TBFI, respectively. This association was independent of age and type of cancer. The FI and TBFI were predictive of survival for older and younger cancer patients with no significant differences between models in discriminating survival (FI AUC, 0.747 [95% CI, 0.6772-0.8157] and TBFI AUC, 0.724 [95% CI, 0.6513-0.7957]). CONCLUSIONS The TBFI was predictive of survival, and the addition of an in-person assessment (FI) did not greatly improve predictive validity. Increasing frailty, as measured by a TBFI, resulted in a meaningfully increased risk of mortality and may be well-suited for screening of hospitalized cancer patients.
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Affiliation(s)
- Timothy Hembree
- Department of Internal and Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada.,Geriatric Medicine Research Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Sarah Thirlwell
- Department of Supportive Care Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Richard R Reich
- Biostatistics Core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Biwei Cao
- Biostatistics Core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Marina Sehovic
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Misbahuddin Syed
- Department of Internal and Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Neha Verma
- Department of Internal and Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Thu-Cuc Nguyen
- Department of Internal and Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Dinesh Keerty
- Department of Internal and Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jaqueline Wesolow
- Department of Internal and Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Viktoriya Koverzhenko
- Department of Internal and Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Martine Extermann
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jessica Huang
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Asha Ramsakal
- Department of Internal and Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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22
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Jin X, Ren Y, Shao L, Guo Z, Wang C, He Y, Zhou L, Cong M, Ma H, Wang W, Zhou C, Feng Y, Ba Y, Gao J, Lu M, Zhang M, Gu XW, Song C, Xu H, Shi H. Prevalence of frailty and prediction of mortality in Chinese cancer patients using a frailty index-based clinical algorithm-A multicentre study. Cancer Med 2021; 10:6207-6217. [PMID: 34318626 PMCID: PMC8446570 DOI: 10.1002/cam4.4155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose To investigate the frailty status in Chinese cancer patients through establishing a novel prediction algorithm. Methods The percentage of frailty in various age groups, locations, and tumor types in Chinese cancer patients was investigated. The prediction capacity of frailty on mortality of Chinese cancer patients was analysed by the frailty index composing of routine laboratory data (FI‐LAB) accessible from a blood test and calculated as the ratio of abnormal factors to 22 total variables. The establishment of a novel algorithm, MCP (mortality of cancer patients), to predict the 5‐year mortality in Chinese cancer patients was accomplished and the algorithm's prediction capacity was tested in the training and validation sets using receiver operating characteristic (ROC) analysis. Results We found that the risk of death in cancer patients can be successfully identified through FI‐LAB. The univariable and multivariable Cox regression were used to evaluate the effect of frailty on death. In the 5‐year follow‐up, 20.6% of the 2959 participants (age = 55.8 ± 11.7 years; 43.5% female) died, while the mean FI‐LAB score in baseline was 0.23 (standard deviation = 0.13; range = 0–0.73). Frailty (after adjusting for gender, age, and other confounders) directly correlated with an increased risk of death, hazard ratio of 12.67 (95% confidence interval [CI]: 7.19, 22.31), compared to those without frailty. In addition, the MCP algorithm (MCP) = 3.678 × FI‐LAB + 1.575 × sex + 1.779 × first tumor node metastasis staging, presented an area under the ROC (AUC) of 0.691 (95% CI: 0.656–0.726) and 0.648 (95% CI: 0.613–0.684) in the training and validation sets, respectively. Conclusion Frailty as defined by FI‐LAB was common and indicated a significant death risk in cancer patients. Our novel developed algorithm MCP had a passable prediction capacity on 5‐year MCP.
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Affiliation(s)
- Xi Jin
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yue Ren
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Shao
- Institute of Translational Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Zengqing Guo
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Chang Wang
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Ying He
- Department of Clinical Nutrition, Chongqing General Hospital, Chongqing, China
| | - Lan Zhou
- Department of Nutrition, Third Affiliated Hospital of Kunming Medical College, Tumor Hospital of Yunnan Province, Kunming, China
| | - Minghua Cong
- Comprehensive Oncology Department, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hu Ma
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wei Wang
- Cancer Center, The First People's Hospital of Foshan, Foshan, China
| | - Chunling Zhou
- Department of Clinical Nutrition, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yongdong Feng
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Ba
- Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Jianguo Gao
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Miaomiao Lu
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengmeng Zhang
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xue-Wei Gu
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chunhua Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hongxia Xu
- Department of Nutrition, Department of Nutrition, Daping Hospital & Research Institute of Surgery, Third Military Medical University, Chongqing, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University/The 9th Clinical Medical College, Peking University, Beijing, China
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23
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Diebel LWM, Rockwood K. Determination of Biological Age: Geriatric Assessment vs Biological Biomarkers. Curr Oncol Rep 2021; 23:104. [PMID: 34269912 PMCID: PMC8284182 DOI: 10.1007/s11912-021-01097-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/19/2022]
Abstract
Purpose of Review Biological age is the concept of using biophysiological measures to more accurately determine an individual’s age-related risk of adverse outcomes. Grading of the degree of frailty and measuring biomarkers are distinct methods of measuring biological age. This review compares these strategies for estimating biological age for clinical purposes. Recent Findings The degree of frailty predicts susceptibility to adverse outcomes independently of chronological age. The utility of this approach has been demonstrated across a range of clinical contexts. Biomarkers from various levels of the biological aging process are improving in accuracy, with the potential to identify aberrant aging trajectories before the onset of clinically manifest frailty. Summary Grading of frailty is a demonstrably, clinically, and research-relevant proxy estimate of biological age. Emerging biomarkers can supplement this approach by identifying accelerated aging before it is clinically apparent. Some biomarkers may even offer a means by which interventions to reduce the rate of aging can be developed.
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Affiliation(s)
- Lucas W M Diebel
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada.,Centre for Health Care of the Elderly, Veterans' Memorial Building, 4121-5955 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E9, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada. .,Centre for Health Care of the Elderly, Veterans' Memorial Building, 4121-5955 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E9, Canada. .,Department of Medicine, Divisions of Geriatric Medicine & Neurology, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada.
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24
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Gu JJ, Liu Q, Zheng LJ. A Frailty Assessment Tool to Predict In-Hospital Mortality in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:1093-1100. [PMID: 33907395 PMCID: PMC8068494 DOI: 10.2147/copd.s300980] [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: 01/08/2021] [Accepted: 03/21/2021] [Indexed: 01/18/2023] Open
Abstract
Background The exacerbation of chronic obstructive pulmonary disease (AECOPD) is a chronic, frequent, and life-threatening lung disease. In 2014, a frailty index (FI) based on deficits in commonly used laboratory tests (FI-Lab) was suggested to identify older adults at increased risk of death. Objective We aim to study the prognostic value of the FI-Lab in older Chinese patients who were admitted because of AECOPD. Methods We screened 1932 older patients hospitalized with AECOPD from September 2016 to June 2019 at Zhenjiang First People’s Hospital, China. A multivariate logistic regression analysis was used to identify prognostic factors for in-hospital mortality. Results A total of 77 survivors and 77 non-survivors were finally included in the study. Both the mean DECAF (including dyspnea, eosinopenia, consolidation, acidemia, and atrial fibrillation) score and the mean FI-Lab value of non-survivors were statistically higher than those of survivors (4.45 ± 0.80 versus 3.03 ± 0.90, P=0.000; 0.51 ± 0.13 versus 0.29 ± 0.10, P=0.000, respectively). Logistic regression analysis suggested that DECAF Rank and FI-Lab Rank were strongly related factors of death in AECOPD patients. The areas under the receiver-operating characteristic (ROC) curves were 0.906 for FI-Lab and 0.870 for DECAF (P=0.2991). Conclusion FI-Lab is a simple, efficient, and objective tool to stratify the risk of in-hospital mortality of AECOPD.
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Affiliation(s)
- Jin-Jin Gu
- Department of Geriatrics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, People's Republic of China
| | - Qiang Liu
- Department of Laboratory Medicine, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, People's Republic of China
| | - Li-Jie Zheng
- Department of Laboratory Medicine,The Affiliated People's Hospital of Jiangsu University, Zhejiang, 212002, People's Republic of China
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25
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Bello GA, Ornstein KA, Lucchini RG, Hung WW, Ko FC, Colicino E, Taioli E, Crane MA, Todd AC. Development and Validation of a Clinical Frailty Index for the World Trade Center General Responder Cohort. J Aging Health 2021; 33:531-544. [PMID: 33706594 DOI: 10.1177/0898264321997675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: To develop and validate a clinical frailty index to characterize aging among responders to the 9/11 World Trade Center (WTC) attacks. Methods: This study was conducted on health monitoring data on a sample of 6197 responders. A clinical frailty index, WTC FI-Clinical, was developed according to the cumulative deficit model of frailty. The validity of the resulting index was assessed using all-cause mortality as an endpoint. Its association with various cohort characteristics was evaluated. Results: The sample's median age was 51 years. Thirty items were selected for inclusion in the index. It showed a strong correlation with age, as well as significant adjusted associations with mortality, 9/11 exposure severity, sex, race, pre-9/11 occupation, education, and smoking status. Discussion: The WTC FI-Clinical highlights effects of certain risk factors on aging within the 9/11 responder cohort. It will serve as a useful instrument for monitoring and tracking frailty within this cohort.
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Affiliation(s)
- Ghalib A Bello
- Department of Environmental Medicine and Public Health, World Trade Center Health Program General Responder Data Center, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roberto G Lucchini
- Department of Environmental Medicine and Public Health, World Trade Center Health Program General Responder Data Center, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,5450Florida International University, School of Public Health, Miami, FL, USA.,University of Brescia, Brescia, Italy
| | - William W Hung
- Brookdale Department of Geriatrics and Palliative Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, New York, NY, USA
| | - Fred C Ko
- Brookdale Department of Geriatrics and Palliative Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, New York, NY, USA
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Institute for Translational Epidemiology, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Thoracic Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael A Crane
- Department of Environmental Medicine and Public Health, World Trade Center Health Program Clinical Center of Excellence at Mount Sinai, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, World Trade Center Health Program General Responder Data Center, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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26
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Prognostic performance of clinical assessment tools following hip fracture in patients with chronic kidney disease. Int Urol Nephrol 2021; 53:2359-2367. [PMID: 33686533 PMCID: PMC7939449 DOI: 10.1007/s11255-021-02798-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/08/2021] [Indexed: 12/04/2022]
Abstract
Purpose People living with chronic kidney disease (CKD) are at a higher risk of hip fracture with an associated increased mortality risk compared to individuals without CKD. Our study aimed to evaluate the clinical assessment tools that best predict mortality risk following hip fracture for patients with CKD. Methods Patients with CKD G3b-5D admitted to Lancashire Teaching Hospitals NHS Foundation Trust, U.K. between June 2013 and Dec 2019 were included. The association between CKD and post-fracture mortality risk was evaluated. All patients were assessed using tools that evaluated frailty status, co-morbidity, pre-operative risk, functional status and cardiopulmonary fitness. Receiver operating characteristic curve analyses were performed to determine the prognostic accuracy of the assessment tools for 30 day and 1 year mortality following hip fracture in patients with CKD. Results 397 patients fulfilled inclusion criteria with a mean age of 83.5 ± 9.2 years. Older age, female sex, intracapsular fracture and more severe CKD, co-morbidity and frailty status were all associated with an increased mortality risk. Patients with dialysis-dependent CKD and severe/very severe frailty had a hazard ratio for mortality of 2.55 (95% Cl 2.11–2.98) and 3.11 (95% Cl 2.47–3.93), respectively. The Clinical Frailty Scale demonstrated the best prognostic accuracy for both 30 day [Area Under the Curve (AUC) 0.91, 95% Cl 0.84–0.97] and 1 year mortality (AUC 0.93, 95% Cl 0.87–1.00). Conclusion Patients with advanced CKD and severe frailty have a high mortality risk following hip fracture. The Clinical Frailty Scale is an excellent prognostic tool for mortality in this setting and could be easily incorporated into routine clinical practice.
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27
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Gendron WH, Fertan E, Pelletier S, Roddick KM, O'Leary TP, Anini Y, Brown RE. Age related weight loss in female 5xFAD mice from 3 to 12 months of age. Behav Brain Res 2021; 406:113214. [PMID: 33677013 DOI: 10.1016/j.bbr.2021.113214] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/04/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023]
Abstract
In addition to cognitive decline, patients with Alzheimer's disease (AD) exhibit sensory, motor, and neuropsychiatric deficits. Many AD patients also show weight loss, suggesting that AD may involve a metabolic syndrome. The 5xFAD mouse model shows age-related weight loss compared to wildtype controls, and thus may exhibit metabolic dysfunction. This longitudinal study measured age-related weight loss in female 5xFAD and B6SJL/JF2 wild-type mice from 3 to 12 months of age, and examines some of the behavioural and physiological phenotypes in these mice that have been proposed to contribute to this weight loss. Because some mice had to be singly housed during the study, we also examined genotype by housing interactions. The 5xFAD mice weighed less and ate less than WT littermates starting at 6 months of age, exhibited less home cage activity, had higher frailty scores, less white adipose tissue, and lower leptin expression. At 9 and 12 months of age, heavier 5xFAD mice performed better on the rotarod, suggesting that metabolic deficits which begin between 6 and 9 months of age may exacerbate the behavioural deficits in 5xFAD mice. These results indicate that the 5xFAD mouse is a useful model to study the behavioural and metabolic changes in AD.
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Affiliation(s)
- William H Gendron
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Emre Fertan
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Stephanie Pelletier
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Kyle M Roddick
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Timothy P O'Leary
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Younes Anini
- Departments of Physiology and Biophysics, Halifax, Nova Scotia, B3H 4R2, Canada; Departments of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Richard E Brown
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada; Departments of Physiology and Biophysics, Halifax, Nova Scotia, B3H 4R2, Canada.
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28
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Impact of nutritional status according to GLIM criteria on the risk of incident frailty and mortality in community-dwelling older adults. Clin Nutr 2021; 40:1192-1198. [DOI: 10.1016/j.clnu.2020.07.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 12/22/2022]
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29
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Sciubba D, Jain A, Kebaish KM, Neuman BJ, Daniels AH, Passias PG, Kim HJ, Protopsaltis TS, Scheer JK, Smith JS, Hamilton K, Bess S, Klineberg EO, Ames CP. Development of a Preoperative Adult Spinal Deformity Comorbidity Score That Correlates With Common Quality and Value Metrics: Length of Stay, Major Complications, and Patient-Reported Outcomes. Global Spine J 2021; 11:146-153. [PMID: 32875843 PMCID: PMC7882823 DOI: 10.1177/2192568219894951] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY DESIGN Retrospective review of a multicenter prospective registry. OBJECTIVES Our goal was to develop a method to risk-stratify adult spinal deformity (ASD) patients on the basis of their accumulated health deficits. We developed a novel comorbidity score (CS) specific to patients with ASD based on their preoperative health state and investigated whether it was associated with major complications, length of hospital stay (LOS), and self-reported outcomes after ASD surgery. METHODS We identified 273 operatively treated ASD patients with 2-year follow-up. We assessed associations between major complications and age, comorbidities, Charlson Comorbidity Index score, and Oswestry Disability Index score. Significant factors were used to construct the ASD-CS. Associations of ASD-CS with major complications, LOS, and patient-reported outcomes were analyzed. RESULTS Major complications increased significantly with ASD-CS (P < .01). Compared with patients with ASD-CS of 0, the odds of major complications were 2.8-fold higher (P = .068) in patients with ASD-CS of 1 through 3; 4.5-fold higher (P < .01) in patients with ASD-CS of 4 through 6; and 7.5-fold higher (P < .01) in patients with ASD-CS of 7 or 8. Patients with ASD-CS of 7 or 8 had the longest mean LOS (10.7 days) and worst mean Scoliosis Research Society-22r total score at baseline; however, they experienced the greatest mean improvement (0.98 points) over 2 years. CONCLUSIONS The ASD-CS is significantly associated with major complications, LOS, and patient-reported outcomes in operatively treated ASD patients.
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Affiliation(s)
| | - Amit Jain
- The Johns Hopkins University, Baltimore, MD, USA
| | - Khaled M. Kebaish
- The Johns Hopkins University, Baltimore, MD, USA,Khaled M Kebaish, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA.
| | | | - Alan H. Daniels
- The Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Han J. Kim
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - Justin S. Smith
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kojo Hamilton
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shay Bess
- New York University, New York, NY, USA
| | - Eric O. Klineberg
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Christopher P. Ames
- University of California San Francisco School of Medicine, San Francisco, CA, USA
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30
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Heikkilä E, Salminen M, Viljanen A, Katajamäki T, Koivula MK, Pulkki K, Isoaho R, Kivelä SL, Viitanen M, Löppönen M, Vahlberg T, Viikari L, Irjala K. A practical laboratory index to predict institutionalization and mortality - an 18-year population-based follow-up study. BMC Geriatr 2021; 21:139. [PMID: 33632124 PMCID: PMC7905906 DOI: 10.1186/s12877-021-02077-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Previously, several indexes based on a large number of clinical and laboratory tests to predict mortality and frailty have been produced. However, there is still a need for an easily applicable screening tool for every-day clinical practice. Methods A prospective study with 10- and 18-year follow-ups. Fourteen common laboratory tests were combined to an index. Cox regression model was used to analyse the association of the laboratory index with institutionalization and mortality. Results The mean age of the participants (n = 1153) was 73.6 (SD 6.8, range 64.0–100.0) years. Altogether, 151 (14.8%) and 305 (29.9%) subjects were institutionalized and 422 (36.6%) and 806 (69.9%) subjects deceased during the 10- and 18-year follow-ups, respectively. Higher LI (laboratory index) scores predicted increased mortality. Mortality rates increased as LI scores increased both in unadjusted and in age- and gender-adjusted models during both follow-ups. The LI did not significantly predict institutionalization either during the 10- or 18-year follow-ups. Conclusions A practical index based on routine laboratory tests can be used to predict mortality among older people. An LI could be automatically counted from routine laboratory results and thus an easily applicable screening instrument in clinical settings.
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Affiliation(s)
- Elisa Heikkilä
- Department of Clinical Medicine, Faculty of Medicine, Unit of Clinical Chemistry, Turku University, 20521, Turku, Finland. .,Tykslab, Laboratory Division, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland.
| | - Marika Salminen
- Department of Clinical Medicine, Faculty of Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland.,City of Turku, Welfare Division, 20101, Turku, Finland
| | - Anna Viljanen
- Municipality of Lieto, Health Care Center, 21420, Lieto, Finland.,Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, Turku City Hospital, University of Turku, 20700, Turku, Finland
| | - Taina Katajamäki
- Department of Clinical Medicine, Faculty of Medicine, Unit of Clinical Chemistry, Turku University, 20521, Turku, Finland.,Tykslab, Laboratory Division, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
| | - Marja-Kaisa Koivula
- Department of Clinical Medicine, Faculty of Medicine, Unit of Clinical Chemistry, Turku University, 20521, Turku, Finland.,Tykslab, Laboratory Division, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland.,HUS Diagnostic Center, Helsinki University Hospital, Hospital District of Helsinki and Uusimaa (HUS), 00029, Helsinki, Finland
| | - Kari Pulkki
- Diagnostic Center, Clinical Chemistry and Hematology, Helsinki University Hospital and University of Helsinki, 00029, Helsinki, Finland
| | - Raimo Isoaho
- Department of Clinical Medicine, Faculty of Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland.,City of Vaasa, Social and Health Care, 65101, Vaasa, Finland
| | - Sirkka-Liisa Kivelä
- Department of Clinical Medicine, Faculty of Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland.,Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki, 00014, Helsinki, Finland
| | - Matti Viitanen
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, Turku City Hospital, University of Turku, 20700, Turku, Finland
| | - Minna Löppönen
- City of Raisio, Social and Health Care for Elderly, 21200, Raisio, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Faculty of Medicine, Unit of Biostatistics, University of Turku, Turku, Finland
| | - Laura Viikari
- City of Turku, Welfare Division, 20101, Turku, Finland.,Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, Turku City Hospital, University of Turku, 20700, Turku, Finland
| | - Kerttu Irjala
- Department of Clinical Medicine, Faculty of Medicine, Unit of Clinical Chemistry, Turku University, 20521, Turku, Finland
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The Accumulating Deficits Model for Postoperative Mortality and Readmissions: Comparison of four Methods Over Multiple Calendar Year Cohorts: Brief Title: Stability of the Modified Frailty Index. Ann Surg 2020; 276:293-297. [PMID: 33201109 DOI: 10.1097/sla.0000000000004421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess four measures of the accumulating deficits model of frailty for postoperative mortality and readmissions including their stability over time. BACKGROUND Frailty has been assessed by multiple methods. It is unclear whether variation in how frailty is measured is important and would be stable over time. METHODS Rockwood's 57-item frailty index (FI) was mapped onto 14,568 ICD9 diagnosis codes from Healthcare Cost and Utilization Project State Inpatient Database for the state of Florida (HCUP-SID-FL) for calendar years 2011-2015, inclusive, with 962 ICD9 codes matching onto 42 items. This became the modified frailty index (mFI) used. Three measures of the mFI were differentiated: the number of admission diagnoses, number of chronic conditions upon admission, and number of increased deficits accumulated during the admission. The Charlson Co-Morbidity Index was a fourth measure of frailty. The mFI of patients who survived or died and were readmitted or not were compared. RESULTS Across all years, 4,796,006 patient observations were compared to the number of diagnoses matched on the 42 items of the mFI. The median mFI scores for each method was statistically significantly higher for patients who died compared those that survived and for patients readmitted compared to patients not re-admitted for all years. There was little-to-no variation in the year to year median mFI scores. CONCLUSIONS The four methods of calculating frailty performed similarly and were stable. The actual method of determining the accumulated deficits may not be as important as enumerating their number.
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Ermogenous C, Green C, Jackson T, Ferguson M, Lord JM. Treating age-related multimorbidity: the drug discovery challenge. Drug Discov Today 2020; 25:1403-1415. [DOI: 10.1016/j.drudis.2020.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/19/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
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Low total cholesterol and high density lipoprotein are independent predictors of poor outcomes following aneurysmal subarachnoid hemorrhage: A preliminary report. Clin Neurol Neurosurg 2020; 197:106062. [PMID: 32688095 DOI: 10.1016/j.clineuro.2020.106062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (aSAH) is devastating, with delayed cerebral ischemia (DCI) significantly contributing to the high morbidity and mortality rates. Cholesterol has been studied as a measure of nutritional status in other neurological pathologies, but reports examining cholesterol's effects on aSAH outcomes are sparse. This study aimed to elucidate the effect of low total cholesterol (TC) and high density lipoprotein (HDL) on mortality and DCI following aSAH. METHODS We performed a retrospective cohort study at a quaternary academic medical center between June 2014 and July 2018. All patients had aSAH confirmed by digital subtraction angiography and had TC measured on admission. Primary outcomes were mortality and DCI. Secondary outcome was radiographic vasospasm. Univariate and multivariate logistic regressions were performed. RESULTS There were 75 aSAH patients, with an average age of 58.7 ± 1.7 (range: 14-89) and Hunt & Hess score of 2.8 ± 0.1, included for analysis. Those with a low TC < 160 mg/dL had 3 times increased odds of DCI (OR = 3.4; 95 %CI: 1.3-9.0; p = 0.0175) and a nearly 5 times increased odds of death (OR = 4.9; 95 %CI: 1.1-18.3; p = 0.0339). Low HDL < 40 mg/dL was associated with 12 times increased odds of DCI (OR = 12.3; 95 %CI: 2.7-56.4; p = 0.0003) but no significant differences in death (p = 0.2205). In multivariate analysis, low TC was an independent risk factor for increased mortality (OR = 5.6; 95 %CI: 1.2-27.6; p = 0.0335) while low HDL was associated with increased risk for DCI (OR = 17.9; 95 %CI: 3.1-104.4; p = 0.0013). There was no effect of TC or HDL on radiographic vasospasm. CONCLUSIONS Low TC and HDL are independent predictors of increased mortality and DCI, respectively, following aSAH. Low TC and HDL may be markers of poor overall health, in addition to having some pathophysiological effect on cerebral vasculature. These results may have practical implications for the improvement of aSAH prognostication and management.
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Ellis HL, Wan B, Yeung M, Rather A, Mannan I, Bond C, Harvey C, Raja N, Dutey-Magni P, Rockwood K, Davis D, Searle SD. Complementing chronic frailty assessment at hospital admission with an electronic frailty index (FI-Laboratory) comprising routine blood test results. CMAJ 2020; 192:E3-E8. [PMID: 31907228 DOI: 10.1503/cmaj.190952] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acutely ill and frail older adults have complex social and health care needs. It is important to understand how this complexity affects acute outcomes for admission to hospital. We validated a frailty index using routine admission laboratory tests with outcomes after patients were admitted to hospital. METHODS In a prospective cohort of older adults admitted to a large tertiary hospital in the United Kingdom, we created a frailty index from routine admission laboratory investigations (FI-Laboratory) linked to data comprising hospital outcomes. We evaluated the association between the FI-Laboratory and total days spent in hospital, discharge to a higher level of care, readmission and mortality. RESULTS Of 2552 admissions among 1750 older adults, we were able to generate FI-Laboratory values for 2254 admissions (88.3% of the cohort). More than half of admitted patients were women (55.3%) and the mean age was 84.6 (SD 14.0) years. We found that the FI-Laboratory correlated weakly with the Clinical Frailty Scale (CFS; r 2 = 0.09). An increase in the CFS and the equivalent of 3 additional abnormal laboratory test results in the FI-Laboratory, respectively, were associated with an increased proportion of inpatient days (rate ratios [RRs] 1.43, 95% confidence interval [CI] 1.35-1.52; and 1.47, 95% CI 1.41-1.54), discharge to a higher level of care (odd ratios [ORs] 1.39, 95% CI 1.27-1.52; and 1.30, 95% CI 1.16-1.47) and increased readmission rate (hazard ratios [HRs] 1.26, 95% CI 1.17-1.37; and 1.18, 95% CI 1.11-1.26). Increases in the CFS and FI-Laboratory were associated with increased mortality HRs of 1.39 (95% CI 1.28-1.51) and 1.45 (95% CI 1.37-1.54), respectively. INTERPRETATION We determined that FI-Laboratory, distinct from baseline frailty, could be used to predict risk of many adverse outcomes. The score is therefore a useful way to quantify the degree of acute illness in frail older adults.
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Affiliation(s)
- Hugh Logan Ellis
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
| | - Bettina Wan
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
| | - Michael Yeung
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
| | - Arshad Rather
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
| | - Imran Mannan
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
| | - Catherine Bond
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
| | - Catherine Harvey
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
| | - Nadia Raja
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
| | - Peter Dutey-Magni
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
| | - Kenneth Rockwood
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
| | - Daniel Davis
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
| | - Samuel D Searle
- University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS
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Spannella F, Ristori L, Giulietti F, Re S, Schiavi P, Giordano P, Sarzani R. A 95-year-old patient with unexpected coronavirus disease 2019 masked by aspiration pneumonia: a case report. J Med Case Rep 2020; 14:82. [PMID: 32576232 PMCID: PMC7309209 DOI: 10.1186/s13256-020-02432-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus-2 infection has become a pandemic disease (coronavirus disease 2019). The infection has moved from China to the rest of the world and Italy represents one of the most affected countries. Older adults are more susceptible to develop complications with the consequent highest mortality rates. Case presentation We report a case of a 95-year-old Caucasian woman affected by pneumonia, initially defined as common aspiration pneumonia in a bedridden patient with vascular dementia, which later turned out to be coronavirus disease 2019 pneumonia during the initial spread of severe acute respiratory syndrome coronavirus-2 in our district. Some features of a computed tomography scan of her chest and her clinical history with known dysphagia had led at first to a different diagnosis with a consequent exposure of health professionals to infectious risk in two distinct hospitals. In this case report, we describe the clinical/imaging features of coronavirus disease 2019 pneumonia and the diagnostic process that led to a correct diagnosis in a nonagenarian with multiple comorbidities. Conclusions This case report highlights both the possible pitfalls in diagnosing coronavirus disease 2019 pneumonia in very old patients with comorbidities and the greater than expected spread of the infection, even in individuals with reduced interpersonal contacts and no defined epidemiological link.
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Affiliation(s)
- Francesco Spannella
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Letizia Ristori
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Serena Re
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Paola Schiavi
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Piero Giordano
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS INRCA, via della Montagnola n. 81, 60127, Ancona, Italy. .,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
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Hutchins-Wiese HL, Walsh SE. Frailty and Nutrition Risk Screening in Home-Delivered Meal Clients. J Nutr Gerontol Geriatr 2020; 39:114-130. [PMID: 32009572 DOI: 10.1080/21551197.2020.1719258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Community service providers, such as Meals on Wheels (MOW) programs, help older adults remain in their homes despite advanced care needs. The purpose of this study was to determine if a frailty index (FI) could be calculated from self-reported health, function, and nutrition information already collected by MOW providers to provide additional information for care planning and risk stratification. Data from 258 MOW clients at one provider were used to calculate the FI from 40 possible health and age-related variables collected during routine health assessments. The average FI was 0.29 ± 0.13(SD), range 0.05-0.68. Frailty was categorized as non-frail, vulnerable, frail, and most frail; nutrition risk increased incrementally with these categories; however, they appear to assess risk from differing angles and etiologies. The addition of the FI can provide a more holistic picture of MOW client health than nutrition risk alone and the FI can be calculated from routinely-collected data.
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Affiliation(s)
| | - Sarah E Walsh
- School of Health Sciences, Eastern Michigan University, Ypsilanti, MI, USA
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37
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Park J, Sherman DG, Agogo G, Hoogendijk EO, Liu Z. Frailty modifies the intervention effect of chair yoga on pain among older adults with lower extremity osteoarthritis: Secondary analysis of a nonpharmacological intervention trial. Exp Gerontol 2020; 134:110886. [PMID: 32088398 PMCID: PMC7438234 DOI: 10.1016/j.exger.2020.110886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In an 8-week nonpharmacological pain intervention trial among older adults with lower extremity osteoarthritis (OA), we aimed to examine: a) the baseline frailty level of the participants; b) whether such intervention is more beneficial for baseline frailer older adults than for their counterparts with less frailty; and c) whether the intervention could also alter frailty. METHODS Participants were randomly assigned to either chair yoga (CY) or health education program (HEP) groups and attended twice-weekly 45-minute CY or HEP sessions for 8 weeks. Following a standard procedure, 82 variables were used to construct a frailty index (FI, 0-1). Primary outcomes were: Western Ontario and McMaster Universities (WOMAC) pain and pain interference. Linear mixed-effects models were used to evaluate the modifying effect of baseline frailty on the intervention effect of CY on primary outcomes. Similar models were used to evaluate the effect of CY on frailty. RESULTS A total of 112 participants (n = 63 CY, n = 49 HEP; 75.3 [SD = 7.5] years) with 85 females (75.9%) were included. The mean values of baseline FI for the CY and HEP groups were similar (0.428 [0.05] and 0.433 [0.05], P = 0.355). Each 0.01 increment in baseline FI was associated with higher WOMAC pain (beta = 0.28, P < 0.001) and pain interference (beta = 0.51, P < 0.001). There was a significant interaction effect between intervention, time, and baseline FI (P = 0.020 for WOMAC pain; P = 0.010 for pain interference), indicating that participants with higher level of baseline FI had greater declines in WOMAC pain and pain interference. There was no significantly greater decline in FI for the CY group compared to the HEP group (between-group difference - 0.01; P = 0.509) and there were no significant trend changes in FI (P for interaction = 0.605). CONCLUSIONS Frailty modifies the intervention effect of CY on pain among older adults with lower extremity OA, underscoring the importance of assessing frailty to improve the management of pain in this population.
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Affiliation(s)
- Juyoung Park
- Florida Atlantic University, Phyllis and Harvey Sandler School of Social Work, Boca Raton, FL, USA
| | - Diane G Sherman
- Florida Atlantic University, Phyllis and Harvey Sandler School of Social Work, Boca Raton, FL, USA
| | - George Agogo
- Centers for Disease Control and Prevention (CDC), Village Market, Nairobi, Kenya; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC-location VU University Medical Center, Amsterdam, Netherlands
| | - Zuyun Liu
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA; Department of Precision Health and Data Science, School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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38
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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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Spannella F, Giulietti F, Bordicchia M, Burnett JC, Sarzani R. Association Between Cardiac Natriuretic Peptides and Lipid Profile: a Systematic Review and Meta-Analysis. Sci Rep 2019; 9:19178. [PMID: 31844088 PMCID: PMC6915780 DOI: 10.1038/s41598-019-55680-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/20/2019] [Indexed: 02/08/2023] Open
Abstract
Cardiac natriuretic peptides (NPs) play a fundamental role in maintaining cardiovascular (CV) and renal homeostasis. Moreover, they also affect glucose and lipid metabolism. We performed a systematic review and meta-analysis of studies investigating the association of NPs with serum lipid profile. A PubMed and Scopus search (2005–2018) revealed 48 studies reporting the association between NPs and components of lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and triglycerides (TG)]. Despite high inconsistency across studies, NPs levels were inversely associated with TC [k = 32; pooled r = −0.09; I2 = 90.26%], LDLc [k = 31; pooled r = −0.09; I2 = 82.38%] and TG [k = 46; pooled r = −0.11; I2 = 94.14%], while they were directly associated with HDLc [k = 41; pooled r = 0.06; I2 = 87.94%]. The relationship with LDLc, HDLc and TG lost significance if only studies on special populations (works including subjects with relevant acute or chronic conditions that could have significantly affected the circulating levels of NPs or lipid profile) or low-quality studies were taken into account. The present study highlights an association between higher NP levels and a favorable lipid profile. This confirms and extends our understanding of the metabolic properties of cardiac NPs and their potential in CV prevention.
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Affiliation(s)
- Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - Marica Bordicchia
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - John C Burnett
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy. .,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy.
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Pérez-Zepeda MU, García-Peña C, Carrillo-Vega MF. Individual and cumulative association of commonly used biomarkers on frailty: a cross-sectional analysis of the Mexican Health and Aging Study. Aging Clin Exp Res 2019; 31:1429-1434. [PMID: 30706427 DOI: 10.1007/s40520-019-01127-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/11/2019] [Indexed: 01/07/2023]
Abstract
Frailty has been recognized as a common condition in older adults, however, there is scarce information on the association between frailty and commonly used biomarkers. The aim of this study was to assess the individual and cumulative association of biomarkers with frailty status. This is a cross-sectional analysis of the 2012 wave of the Mexican Health and Aging Study. A sub-sample of 60-year or older adults with anthropometric measurements was analyzed. Frailty was defined with a 31-item frailty index and those considered frail had a score ≥ 0.21. Biomarkers were further categorized as normal/abnormal and tested both one by one and grouped (according to their usual cutoff values). Adjusted logistic models were performed. A total of 1128 older adults were analyzed and their mean age was 69.45 years and 51.24% of them were women. 26.7% (n = 301) were categorized as frail. Individual biomarkers associated with frailty after adjusting for confounding were: hemoglobin [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.13-2.46, p = 0.009], glycated hemoglobin (OR 2.04, 95% CI 1.54-2.7, p < 0.001) and vitamin D (OR 1.53, 95% CI 1.13-2.07, p = 0.005). Those with ≥ 4 abnormal biomarkers had an independent association with frailty when compared to those without any abnormal biomarker (OR 2.64, 95% CI 1.3-5.25, p = 0.005). Aside from the individual associations of specific biomarkers, our findings show that an incremental association of abnormal biomarkers increases the probability of frailty, accounting for the multidimensional nature of frailty and the possible interplay between components of the system that potentiate to give rise to a negative condition such as frailty.
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Affiliation(s)
- Mario Ulises Pérez-Zepeda
- Instituto Nacional de Geriatría, Mexico, México
- Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - María Fernanda Carrillo-Vega
- Instituto Nacional de Geriatría, Periférico Sur 2767, colonia San Jerónimo Lídice, delegación Magdalena Contreras, 10200, Mexico, Mexico.
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41
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Knoop V, Costenoble A, Vella Azzopardi R, Vermeiren S, Debain A, Jansen B, Scafoglieri A, Bautmans I, Bautmans I, Verté D, Beyer I, Petrovic M, De Donder L, Kardol T, Rossi G, Clarys P, Scafoglieri A, Cattrysse E, de Hert P, Jansen B. The operationalization of fatigue in frailty scales: a systematic review. Ageing Res Rev 2019; 53:100911. [PMID: 31136819 DOI: 10.1016/j.arr.2019.100911] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify the different fatigue items in existing frailty scales. METHODS PubMed, Web of Knowledge and PsycINFO were systematically screened for frailty scales. 133 articles were included, describing 158 frailty scales. Fatigue items were extracted and categorized in 4 fatigue constructs: "mood state related tiredness", "general feeling of tiredness", "activity based feeling of tiredness" and "resistance to physical tiredness". RESULTS 120 fatigue items were identified, of which 100 belonged to the construct "general feeling of tiredness" and only 9 to the construct "resistance to physical tiredness". 49,4% of the frailty scales included at least 1 fatigue item, representing 15 ± 9,3% of all items in these scales. Fatigue items have a significantly higher weight in single domain (dominantly physical frailty scales) versus multi domain frailty scales (21 ± 3.2 versus 10.6 ± 9.8%, p=<0,05). CONCLUSION Fatigue is prominently represented in frailty scales, covering a great diversity in fatigue constructs and underlying pathophysiological mechanisms by which fatigue relates to frailty. Although fatigue items were more prevalent and had a higher weight in physical frailty scales, the operationalization of fatigue leaned more towards psychological constructs. This review can be used as a reference for choosing a suitable frailty scale depending on the type of fatigue of interest.
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42
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Heinze-Milne S, Banga S, Howlett S. Frailty Assessment in Animal Models. Gerontology 2019; 65:610-619. [DOI: 10.1159/000501333] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/05/2019] [Indexed: 11/19/2022] Open
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Wang Y, Zhang R, Shen Y, Su L, Dong B, Hao Q. Prediction of chemotherapy adverse reactions and mortality in older patients with primary lung cancer through frailty index based on routine laboratory data. Clin Interv Aging 2019; 14:1187-1197. [PMID: 31308642 PMCID: PMC6616135 DOI: 10.2147/cia.s201873] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/09/2019] [Indexed: 02/05/2023] Open
Abstract
Objectives To assess the role of a pre-chemotherapy frailty index based on routine laboratory data in predicting mortality and chemotherapy adverse reactions among older patients with primary lung cancer. Design Retrospective cohort study. Setting West China Hospital, Chengdu, China. Participants We included patients aged ≥60 years with primary lung cancer receiving the first course of chemotherapy. Measurements Data were collected from medical records, local government death databases or telephone interviews. Outcomes included chemotherapy adverse reactions and all-cause mortality. We constructed a frailty index based on 44 laboratory variables (FI-LAB) before chemotherapy, and chose the following cutoff points: robust (0.0-0.2), pre-frail (0.2-0.35) and frail (≥0.35). Results We included 1,020 patients (71.4% male; median age: 65 years old). Both pre-frailty and frailty was associated with any chemotherapy adverse reactions and infections during chemotherapy (OR=3.48, 95%CI: 1.77-6.87; OR=3.58, 95%CI: 1.55-8.26, respectively). Frail patients had a shorter median overall survival rate compared to robust patients (18.05 months vs 38.89 months, log-rank p<0.001). After adjusting for some potential confounding variables, the risk of all-cause mortality was dramatically increased in frail patients (HR:2.13, 95% CI:1.51-3.00) with an average follow-up of 3.9 years. Each 0.01 or per standard deviation (SD) increase in the FI-LAB value significantly increased the HR of death by 2.0% (HR:1.02, 95% CI: 1.01-1.03) and 23.0% (HR: 1.23, 95% CI: 1.13-1.34), respectively. Conclusions Frailty assessed by routine laboratory data indicates increased risks of chemotherapy adverse reactions and death in older patients with primary lung cancer receiving the first course of chemotherapy.
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Affiliation(s)
- Yuting Wang
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Rui Zhang
- Health Informatics Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yanjiao Shen
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Lin Su
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Birong Dong
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qiukui Hao
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Kehler DS, Theou O, Rockwood K. Bed rest and accelerated aging in relation to the musculoskeletal and cardiovascular systems and frailty biomarkers: A review. Exp Gerontol 2019; 124:110643. [PMID: 31255732 DOI: 10.1016/j.exger.2019.110643] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 12/27/2022]
Abstract
Prolonged bed rest and lifelong physical inactivity cause deleterious effects to multiple physiological systems that appear to hasten aging processes. Many such changes are similar to those seen with microgravity in space, but at a much faster rate. Head down tilt bed rest models are used to study whole-body changes that occur with spaceflight. We propose that bed rest can be used to quantify accelerated human aging in relation to frailty. In particular, frailty as a measure of the accumulation of deficits estimates the variability in aging across systems, and moves away from the traditional single-system approach. Here, we provide an overview of the impact of bed rest on the musculoskeletal and cardiovascular systems as well as frailty-related biological markers and inflammatory cytokines. We also propose future inquiries to study the accumulation of deficits with head down bed rest and bed rest in the clinical setting, specifically to understand how unrepaired and unremoved subclinical and subcellular damage give rise to clinically observable health problems.
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Affiliation(s)
- D S Kehler
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - O Theou
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - K Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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45
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Age-related deficit accumulation and the diseases of ageing. Mech Ageing Dev 2019; 180:107-116. [DOI: 10.1016/j.mad.2019.04.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
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46
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Trendelenburg A, Scheuren A, Potter P, Müller R, Bellantuono I. Geroprotectors: A role in the treatment of frailty. Mech Ageing Dev 2019; 180:11-20. [DOI: 10.1016/j.mad.2019.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 12/25/2022]
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Chao CT, Huang JW, Chiang CK, Hung KY. Applicability of laboratory deficit-based frailty index in predominantly older patients with end-stage renal disease under chronic dialysis: A pilot test of its correlation with survival and self-reported instruments. Nephrology (Carlton) 2019; 25:73-81. [PMID: 30834584 DOI: 10.1111/nep.13583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 01/28/2023]
Abstract
AIM Laboratory deficit-based frailty index (LFI) exhibited outcome-prediction ability in the elderly, but not in those with end-stage renal disease (ESRD). We hypothesized that LFI results might have outcome correlation and correlate closely with other instruments in ESRD patients. METHODS We prospectively enroled ESRD patients between 2014 and 2015 and administered self-report frailty instruments (Strawbridge questionnaire, Edmonton frail scale (EFS), Groningen frailty indicator (GFI), Tilburg frailty indicator, G8 questionnaire and FRAIL scale), and Cardiovascular Health Study (CHS) scale, with two types of LFI calculated. They were followed up until June 30, 2017. Correlations between the results of six instruments, CHS scale, and those of LFI were identified, followed by Kaplan-Meier survival analyses and logistic regression analyses to compare those with high and low LFI. RESULTS The frailty prevalence was 33.3% (CHS), 78.8% Strawbridge questionnaire, 45.5% (EFS), 57.6% (GFI), 27.3% (Tilburg frailty indicator), 84.8% (G8) and 18.2% (FRAIL) among ESRD participants. LFI-1 results were significantly correlated with those of LFI-2 (P < 0.01), EFS (P = 0.04) and GFI (P < 0.01), while LFI-2 results were not. Those with CHS or GFI-identified frailty had significantly lower 1,25-(OH)2 -D levels than those without. After 32.3 ± 5.4 months, patients with high LFI-1 scores, but not LFI-2, had a significantly higher mortality than those with lower scores. GFI and EFS scores were also independently associated with LFI-1, while CHS scores exhibited borderline association only. CONCLUSION Among a group of predominantly older ESRD patients, LFI differentiates patients with good and poor outcomes, supporting its applicability in these patients.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu branch, Taipei, Taiwan
| | - Jenq-Wen Huang
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Kang Chiang
- Department of Integrative Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Yu Hung
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
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48
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Jäger J, Sieber CC, Gaßmann KG, Ritt M. Changes of a frailty index based on common blood and urine tests during a hospital stay on geriatric wards predict 6-month and 1-year mortality in older people. Clin Interv Aging 2019; 14:473-484. [PMID: 30880928 PMCID: PMC6394369 DOI: 10.2147/cia.s191117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background We aimed to evaluate the abilities of a 21-item frailty index based on laboratory blood and urine tests (FI-Lab21) assessed at different points in time, ie, at admission to hospital (FI-Lab21admission) and before discharge from hospital (FI-Lab21discharge), and the change of the FI-Lab21 during the hospital stay to predict 6-month and 1-year mortality in hospitalized geriatric patients. Methods Five hundred hospitalized geriatric patients aged ≥65 years were included in this analysis. Follow-up data were acquired after a period of 6 months and 1 year. Results The FI-Lab21admission and FI-Lab21discharge scores were 0.33±0.15 and 0.31±0.14, respectively (P<0.001). The FI-Lab21admission and FI-Lab21discharge both predicted 6-month and 1-year mortality (areas under the receiver operating characteristic curves: 0.72, 0.72, 0.77, and 0.75, respectively, all P<0.001). The predictive abilities for 6-month and 1-year mortality of the FI-Lab21admission were inferior compared with those of the FI-Lab21discharge (all P<0.05). Patients with a reduction in or stable FI-Lab21 score during the hospital stay revealed lower 6-month and 1-year mortality rates compared with the persons whose FI-Lab21 score increased during the hospital stay (all P<0.05). After adjustment for age, sex, and FI-Lab21admission, each 1% decrease in the FI-Lab21 during the hospital stay was associated with a decrease in 6-month and 1-year mortality of 5.9% and 5.3% (both P<0.001), respectively. Conclusion The FI-Lab21 assessed at admission or discharge and the changes of the FI-Lab21 during the hospital stay emerged as interesting and feasible approaches to stratify mortality risk in hospitalized geriatric patients.
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Affiliation(s)
- Jakob Jäger
- Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-90408 Nürnberg, Germany, .,Department of Internal Medicine III (Medicine of Ageing), Geriatrics Center Erlangen, Malteser Hospital Erlangen, D-91054 Erlangen, Germany,
| | - Cornel Christian Sieber
- Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-90408 Nürnberg, Germany, .,Department of General Internal Medicine and Geriatrics, Hospital of the Order of St John of God, D-93049 Regensburg, Germany
| | - Karl-Günter Gaßmann
- Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-90408 Nürnberg, Germany, .,Department of Internal Medicine III (Medicine of Ageing), Geriatrics Center Erlangen, Malteser Hospital Erlangen, D-91054 Erlangen, Germany,
| | - Martin Ritt
- Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-90408 Nürnberg, Germany, .,Department of Internal Medicine III (Medicine of Ageing), Geriatrics Center Erlangen, Malteser Hospital Erlangen, D-91054 Erlangen, Germany,
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49
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Hao Q, Sun X, Yang M, Dong B, Dong B, Wei Y. Prediction of mortality in Chinese very old people through the frailty index based on routine laboratory data. Sci Rep 2019; 9:221. [PMID: 30659252 PMCID: PMC6338748 DOI: 10.1038/s41598-018-36569-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 11/25/2018] [Indexed: 02/05/2023] Open
Abstract
The increased risk of death in older adults can be successfully identified through frailty index (FI), based on comprehensive geriatric assessment data and self-reported data from the accumulated deficit, although the method depending on routine laboratory data (FI-LAB) remains uncertain. In the current study, the capacity of FI-LAB in evaluating the risk of mortality in a very old Chinese community cohort was analyzed. The 90-year- and above old individuals from a Dujiangyan community in Sichuan Province, China, who had completed a health assessment at baseline (in 2005) and whose laboratory data were analyzed (n = 736) from cumulative data from the Project of Longevity and Aging. The FI-LAB data was constructed from routine laboratory data and calculated as the ratio of abnormal factors in 22 variables (including red blood cells, white blood cells, and alanine transaminase) that can be assessed through blood tests. The multivariable Cox regression was used to evaluate the effect of frailty on death. In the four-year follow-up, 53.5% of the 736 participants (age = 93.6 ± 3.4 years; 67.5% women), were reported dead. The FI-LAB mean baseline value was 0.21 (standard deviation = 0.10; range = 0 to 0.55). Frailty (after adjusting for gender, age, and other confounders) could be directly correlated with increased death risk, with a hazard ratio of 1.31 (95% confidence interval (CI): 1.07–1.61) in comparison with those without frailty among the individuals. Frailty as defined by FI-LAB, established only on routine laboratory data, indicates a significant death risk in the very old people.
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Affiliation(s)
- Qiukui Hao
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelian Sun
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Yang
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Biao Dong
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Birong Dong
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
| | - Yuquan Wei
- Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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50
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Justice JN, Nambiar AM, Tchkonia T, LeBrasseur NK, Pascual R, Hashmi SK, Prata L, Masternak MM, Kritchevsky SB, Musi N, Kirkland JL. Senolytics in idiopathic pulmonary fibrosis: Results from a first-in-human, open-label, pilot study. EBioMedicine 2019; 40:554-563. [PMID: 30616998 PMCID: PMC6412088 DOI: 10.1016/j.ebiom.2018.12.052] [Citation(s) in RCA: 682] [Impact Index Per Article: 136.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/14/2018] [Accepted: 12/21/2018] [Indexed: 01/19/2023] Open
Abstract
Background Cellular senescence is a key mechanism that drives age-related diseases, but has yet to be targeted therapeutically in humans. Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal cellular senescence-associated disease. Selectively ablating senescent cells using dasatinib plus quercetin (DQ) alleviates IPF-related dysfunction in bleomycin-administered mice. Methods A two-center, open-label study of intermittent DQ (D:100 mg/day, Q:1250 mg/day, three-days/week over three-weeks) was conducted in participants with IPF (n = 14) to evaluate feasibility of implementing a senolytic intervention. The primary endpoints were retention rates and completion rates for planned clinical assessments. Secondary endpoints were safety and change in functional and reported health measures. Associations with the senescence-associated secretory phenotype (SASP) were explored. Findings Fourteen patients with stable IPF were recruited. The retention rate was 100% with no DQ discontinuation; planned clinical assessments were complete in 13/14 participants. One serious adverse event was reported. Non-serious events were primarily mild-moderate, with respiratory symptoms (n = 16 total events), skin irritation/bruising (n = 14), and gastrointestinal discomfort (n = 12) being most frequent. Physical function evaluated as 6-min walk distance, 4-m gait speed, and chair-stands time was significantly and clinically-meaningfully improved (p < .05). Pulmonary function, clinical chemistries, frailty index (FI-LAB), and reported health were unchanged. DQ effects on circulat.ing SASP factors were inconclusive, but correlations were observed between change in function and change in SASP-related matrix-remodeling proteins, microRNAs, and pro-inflammatory cytokines (23/48 markers r ≥ 0.50). Interpretation Our first-in-humans open-label pilot supports study feasibility and provides initial evidence that senolytics may alleviate physical dysfunction in IPF, warranting evaluation of DQ in larger randomized controlled trials for senescence-related diseases. ClinicalTrials.gov identifier: NCT02874989 (posted 2016–2018).
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Affiliation(s)
- Jamie N Justice
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Internal Medicine - Gerontology and Geriatric Medicine, Wake Forest School of Medicine (WFSM), 1 Medical Center Blvd, Winston-Salem, NC 27157, United States.
| | - Anoop M Nambiar
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Internal Medicine, University of Texas Health Sciences Center at San Antonio (UTHSCSA) and South Texas Veterans Health Care System, San Antonio, TX 78229, United States.
| | - Tamar Tchkonia
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, United States.
| | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, United States.
| | - Rodolfo Pascual
- Internal Medicine - Pulmonary, Critical Care, Allergy, Immunologic Medicine, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States.
| | - Shahrukh K Hashmi
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, United States.
| | - Larissa Prata
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, United States.
| | - Michal M Masternak
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL 32827, United States.
| | - Stephen B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Internal Medicine - Gerontology and Geriatric Medicine, Wake Forest School of Medicine (WFSM), 1 Medical Center Blvd, Winston-Salem, NC 27157, United States.
| | - Nicolas Musi
- Barshop Institute for Longevity and Aging Studies, Center for Healthy Aging, University of Texas Health Sciences Center at San Antonio and South Texas Veterans Health Care System, San Antonio, TX 78229, United States; San Antonio Geriatric Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX 78229, United States.
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, United States.
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