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Fougère B, Morley JE, Arai H, Bauer JM, Bernabei R, Cherubini A, Dong B, Martin FC, Flicker L, Merchant RA, Rodriguez Mañas L, Woo J, Vellas B. RETRACTED ARTICLE: Precision Medicine: The Future Management of Geriatric Conditions. J Nutr Health Aging 2023; 27:1292-1295. [PMID: 38242610 DOI: 10.1007/s12603-018-1045-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Bertrand Fougère
- Tours University Hospital - Division of Geriatric medicine, Bretonneau Hospital, Building B1A Level 4, 2, boulevard Tonnellé, 37044, Tours cedex 9, France; Inserm UMR1027, Toulouse University III Paul Sabatier, Toulouse, France; Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
| | - J E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - H Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - J M Bauer
- Center for Geriatric Medicine, University of Heidelberg, Heidelberg, Germany
| | - R Bernabei
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - A Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS-INRCA), Ancona, Italy
| | - B Dong
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - F C Martin
- Division of Health and Social Care Research, Kings College, London, UK
| | - L Flicker
- Geriatric Medicine, University of Western Australia, Perth, Australia
| | - R A Merchant
- Division of Geriatric Medicine, National University Hospital, Singapore, Singapore
| | | | - J Woo
- Chinese University of Hong Kong, Hong Kong, China
| | - B Vellas
- Inserm UMR1027, Toulouse University III Paul Sabatier, Toulouse, France; Gérontopôle, Toulouse University Hospital, Toulouse, France
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James K, Growdon ME, Orkaby AR, Schwartz AW. One Step at a Time: Improving Gait Speed Measurement in a Geriatric Medicine Clinic. Geriatrics (Basel) 2023; 8:81. [PMID: 37623274 PMCID: PMC10454464 DOI: 10.3390/geriatrics8040081] [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: 05/25/2023] [Revised: 07/10/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: Mobility assessment is a key component of the assessment of an older adult as a part of the Age-Friendly Health System (AFHS) "geriatric 4Ms" framework. Several validated tools for assessing mobility and estimating fall risk in older adults are available. However, they are often under-utilized in daily practice even in specialty geriatric medicine care settings. We aimed to increase formal mobility assessment with brief gait speed measurement in a geriatric medicine outpatient clinic using phased change interventions. (2) Methods: This quality improvement (QI) initiative was conducted in a single outpatient geriatric medicine clinic. All clinic attendees who could complete a gait speed measurement were eligible for inclusion. The outcome measure was the completion of a 4 m gait speed. Several change interventions were implemented on a phased basis using the Model for Improvement methodology during the period from December 2018 to March 2020. Statistical process control charts were used to record gait speed measurements and detect non-random shifts. (3) Results: During this QI initiative, 80 patients were seen, accounting for 142 clinic visits. In response to change interventions, gait speed measurement at clinic visits increased from a median of 25% of visits to 67% by March 2020. (4) Conclusions: Adopting an AFHS care model is an urgent and challenging task to improve the quality of care for older adults. This initiative details how to effectively incorporate a brief, validated assessment of mobility using gait speed measurement into every geriatric medicine outpatient visit and progresses implementation of the AFHS "geriatric 4Ms". Mobility assessment can aid in identifying older adults at increased fall risk.
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Affiliation(s)
- Kirstyn James
- Department of Geriatric Medicine, Cork University Hospital, T12 DC4A Cork, Ireland
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA 02130, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Matthew E. Growdon
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA 02130, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of Geriatrics, University of California San Francisco School of Medicine, San Francisco, CA 94143, USA
| | - Ariela R. Orkaby
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA 02130, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA 02130, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
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Perea-García M, Martori JC, Del Moral-Pairada M, Amblàs-Novellas J. [Geriatric syndromes in intermediate care resources: Screening, prevalence and inpatient mortality. Multicenter prospective study]. Rev Esp Geriatr Gerontol 2023; 58:134-140. [PMID: 37142459 DOI: 10.1016/j.regg.2023.04.001] [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: 01/11/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To determine the prevalence of geriatric syndromes (GS) in the geriatric population of the different intermediate care resources, as well as its relationship with intrahospital mortality. MATERIAL AND METHODS A prospective observational descriptive study, carried out in intermediate care resources in the Vic area (Barcelona) between July 2018 and September 2019. All people aged ≥65 years and/or criteria of complex chronic patient and/or advanced chronic disease, who were assessed for the presence of GS using the trigger questions of the Frail VIG-Index (IF-VIG), administered at baseline, on admission, on discharge and 30 days after discharge. RESULTS Four hundred and forty-two participants were included, of which 55.4% were women, with a mean age of 83.48 years. There are significant differences (P<.05) between frailty, age and number of GS in relation to the intermediate care resource at the time of admission. There were significant differences in the prevalence of GS between the group of patients who died during the hospitalization (24.7% of the sample) in relation to the survivors: both in a situation baseline (malnutrition, dysphagia, delirium, loss of autonomy, pressure ulcers, and insomnia), as well as in the admission assessment (falls, malnutrition, dysphagia, cognitive impairment, delirium, loss of autonomy, and insomnia). CONCLUSIONS There is a close relationship between the prevalence of GS and in-hospital mortality in intermediate care resources. In the absence of more studies, the use of the IF-VIG as a screening checklist for GS could be useful for its detection.
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Affiliation(s)
- Miquel Perea-García
- Hospital de Sant Celoni, Sant Celoni, Barcelona, España; Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, España.
| | - Joan Carles Martori
- Grupo de Investigación Data Analysis and Modeling, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, España
| | - Marta Del Moral-Pairada
- Centro de Atención Primaria, Consorcio de Atención Primaria de Salud de Eixample (CAPSBE), Barcelona, España
| | - Jordi Amblàs-Novellas
- Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, España
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Chen MZ, Chan YH, Wong MWK, Merchant RA. Comparison of Rapid Cognitive Screen against Montreal Cognitive Assessment in screening for cognitive impairment in the old and old-old. Psychogeriatrics 2022; 22:460-468. [PMID: 35577347 PMCID: PMC9325369 DOI: 10.1111/psyg.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 04/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) was developed as a screening tool for mild cognitive impairment (MCI). Given the need for a rapid screening test in settings such as primary care, we compare the validity of the Rapid Cognitive Screen (RCS) against the MoCA, and determine cut-off scores in the old and old-old. METHODS Cross-sectional study involving community-dwelling 'old' (65 to 79 years old) and 'old-old' (≥ 80 years old) without dementia. Cognitive impairment was defined by MoCA score 17 to 22. Validation was done using the receiver operating characteristic (ROC) curve analysis: area under the curve (AUC), sensitivity (Sn), and specificity (Sp). RESULTS Of the 183 participants (mean age 72.1 ± 5.2 years),15.8% (n = 29) were classified as cognitively impaired. The overall ROC curve had an AUC of 0.82 (95% CI 0.75-0.90, P < 0.01) with an optimal cut-off of 7/8 on RCS (Sn 0.77, Sp 0.72). The 'old' and 'old-old' group had AUC of 0.82 (95% CI 0.74-0.91, P < 0.01) with 8/9 as optimal cut-off (Sn 0.51, Sp 0.96) and AUC of 0.85 (95% CI 0.66-1.03, P < 0.01) with 7/8 as optimal cut-off (Sn 0.71, Sp 1.00) respectively. In multivariate analysis, age was associated with 0.05 (95% CI -0.10-0.00, P < 0.04) point decrement, while >6 years of education was associated with 0.82 (95% CI 0.32-1.33, P < 0.01) point increment in RCS scores. CONCLUSION The three-item RCS is quick and easy to administer. Although RCS met the criterion for good validity against MoCA in predicting cognitive impairment, its utility as a first-line screening tool needs to be further validated in a large-scale population study.
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Affiliation(s)
- Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of MedicineNational University HospitalSingaporeSingapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Michael Wai Kit Wong
- Department of Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of MedicineNational University HospitalSingaporeSingapore
- Department of Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
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Cesari M, Marzetti E, Calvani R. Sarcopenia and SARC-F: "Perfect is the Enemy of Good". J Am Med Dir Assoc 2021; 22:1862-1863. [PMID: 34456011 DOI: 10.1016/j.jamda.2021.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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Crosignani S, Fantinati J, Cesari M. Frailty and Geriatric Medicine During the Pandemic. Front Med (Lausanne) 2021; 8:673814. [PMID: 34164415 PMCID: PMC8215135 DOI: 10.3389/fmed.2021.673814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
The term frailty in the era of coronavirus disease 2019 (COVID-19) has a manifold implication. The vast majority of the countries worldwide being hit by the pandemic have shown the frailty of their health and social care systems. Although the surprise factor could somehow justify the unpreparedness experienced during the first wave, the second wave still led to significant difficulties almost everywhere. Looking at Italy's situation, it is evident how the stress test applied by COVID-19 on the system has threatened its stability, getting it closer to collapsing many times. It is true that Italy, in particular the Northern regions, has been the epicenter of COVID-19 in Europe in a time when information about the severe acute respiratory syndrome coronavirus 2 was still lacking and confusing. Nevertheless, what happened has demonstrated significant issues in the structure, priorities, and organization of the system. It has exemplified the obsolete approach adopted in clinical practice, particularly when applied to frail older persons. The COVID-19 pandemic has made emerging the need for a substantial reshaping of our healthcare system. The hospital-centered model has dramatically failed. To adequately face the new challenges brought by the increasing complexity of our aging society, it is critical to move the barycenter of action toward the community/primary care, promoting the integration of services and centralization of clinical/administrative data. It is vital to train healthcare professionals in the identification and basic principles of geriatric conditions, clarifying the role that geriatricians play. In the present article, some cornerstone concepts of geriatric medicine (i.e., definition of geriatrics, multidisciplinarity, integrated care, and development of clinical databases for filling the evidence-based medicine gaps) are presented, explaining the challenges they have faced during the COVID-19 pandemic and possible solutions for implementing improvements in the future.
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Affiliation(s)
- Silvia Crosignani
- Fellowship in Geriatrics and Gerontology, University of Milan, Milan, Italy
| | - Jacopo Fantinati
- Fellowship in Geriatrics and Gerontology, University of Milan, Milan, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Istituti di Ricovero e Cura a Carattere Scientifico Istituti Clinici Scientifici Maugeri, University of Milan, Milan, Italy
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Montano AR. A concept analysis of interprofessional collaborative practice for community-dwelling older adults. Nurs Forum 2021; 56:413-420. [PMID: 33533058 DOI: 10.1111/nuf.12553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
Models of interprofessional collaborative practice have demonstrated improved outcomes for community-dwelling older adults. However, the concept of interprofessional collaborative practice for community-dwelling older adults needs clarification and a clear definition. A concept analysis based on the method posited by Walker and Avant was conducted to formulate an operational definition of this concept. Defining attributes, antecedents, consequences and empirical referents were identified from a review of the literature. A model case and contrary case were selected to further clarify the concept of interprofessional collaborative practice for community-dwelling older adults. Nurses are ideal leaders of interprofessional teams caring for older adults and can utilize this concept in practice, education and research.
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Affiliation(s)
- Anna-Rae Montano
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
- The Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
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Amblàs-Novellas J, Contel JC, Gutiérrez Jiménez N, Barbeta C, Santaeugènia S. [VIG-Express: Consensus on an express multidimensional/geriatric assessment system in Catalonia]. Aten Primaria 2021; 53:101993. [PMID: 33744809 PMCID: PMC7985280 DOI: 10.1016/j.aprim.2021.101993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/11/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To reach a consensus on an rapid multidimensional/geriatric assessment (RMGA) tool for all health and social professionals of Catalonia as a shared and universal system to assess patients with multimorbidities, frailty, complexity or advanced conditions. DESIGN Three-phase consensus of professionals, combining in-person sessions with telematics. LOCATION Catalonia. PARTICIPANTS A group of 27 interdisciplinary professionals from different care settings. METHOD The Design Thinking methodology for an initial consensus on the characteristics of the RMGA tool (Phase 1) has been combined with the Lean Startup methodology to create a new RMGA tool (Phase 2), and then tested in a group of patients (Phase 3). RESULTS In Phase 1, a consensus was reached that the perfect RMGA tool should allow for an ad hoc assessment of patients, be fast and flexible (<10 min), identify altered dimensions using trigger questions and facilitate the diagnosis of the condition (ideally quantified). In Phase 2, a prototype of a new RMGA tool containing 15 + 2 questions (VIG-Express) was developed, which was then tested in 35 patients in Phase 3. CONCLUSIONS Based on preliminary results, the VIG-Express tool seems to facilitate a simple, rapid multidimensional assessment and the customization of interventions, as well as provide a unique look and shared narrative between professionals from different care settings. More studies will be required to corroborate these findings.
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Affiliation(s)
- Jordi Amblàs-Novellas
- Departament de Salut,Generalitat de Catalunya, Barcelona, España; Plan de Atención Integrada Social y Sanitaria (PAISS), Generalitat de Catalunya, Barcelona, España; Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Centre d'Estudis Sanitaris i Socials (CESS), Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, España
| | - Joan Carles Contel
- Departament de Salut,Generalitat de Catalunya, Barcelona, España; Plan de Atención Integrada Social y Sanitaria (PAISS), Generalitat de Catalunya, Barcelona, España; Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Centre d'Estudis Sanitaris i Socials (CESS), Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, España.
| | - Núria Gutiérrez Jiménez
- Hospital Universitari de Bellvitge, Gerència Territorial Metropolitana sud, Institut Català de la Salut. Generalitat de Catalunya, L'Hospitalet de Llobregat, Barcelona, España
| | - Conxita Barbeta
- Plan de Atención Integrada Social y Sanitaria (PAISS), Generalitat de Catalunya, Barcelona, España; Departament de Treball, Afers socials i Famílies, Generalitat de Catalunya, Barcelona, España
| | - Sebastià Santaeugènia
- Departament de Salut,Generalitat de Catalunya, Barcelona, España; Plan de Atención Integrada Social y Sanitaria (PAISS), Generalitat de Catalunya, Barcelona, España; Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Centre d'Estudis Sanitaris i Socials (CESS), Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, España
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Merchant RA, Morley JE. Editorial: Rapid Geriatric Assessment in Primary Care Practice. J Nutr Health Aging 2021; 25:1034-1036. [PMID: 34725656 DOI: 10.1007/s12603-021-1681-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Reshma A Merchant
- Dr. J. E. Morley, Dammert Professor of Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, Section 2500, 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110 USA,
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Merchant RA, Hui RJY, Kwek SC, Sundram M, Tay A, Jayasundram J, Chen MZ, Ng SE, Tan LF, Morley JE. Rapid Geriatric Assessment Using Mobile App in Primary Care: Prevalence of Geriatric Syndromes and Review of Its Feasibility. Front Med (Lausanne) 2020; 7:261. [PMID: 32733901 PMCID: PMC7360669 DOI: 10.3389/fmed.2020.00261] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022] Open
Abstract
With the aging population and consequent increase in associated prevalence of frailty, dementia, and multimorbidity, primary care physicians will be overwhelmed with the complexity of the psychosocial and clinical presentation. Geriatric syndromes including frailty, sarcopenia, cognitive impairment, and anorexia of aging (AA) either in isolation or in combination are associated with an increased risk of adverse outcomes and if recognized early, and appropriately managed, will lead to decreased disability. Primary care practices are often located in residential settings and are in an ideal position to incorporate preventive screening and geriatric assessment with personalized management. However, primary care physicians lack the time, multidisciplinary resources, or skills to conduct geriatric assessment, and the limited number of geriatricians worldwide further complicates the matter. There is no one effective strategy to implement geriatric assessment in primary care which is rapid, cost-effective, and do not require geriatricians. Rapid Geriatric Assessment (RGA) takes <5 min to complete. It screens for frailty, sarcopenia, AA, and cognition with assisted management pathway without the need of a geriatrician. We developed RGA iPad application for screening with assisted management in two primary care practices and explored the feasibility and overall prevalence of frailty, sarcopenia, and AA. The assessment was conducted by trained nurses and coordinators. Among 2,589 older patients ≥65 years old, the prevalence of frailty was 5.9%, pre-frail 31.2%, and robust 62.9%. Fatigue was present in 17.8%, and among them, the prevalence of undiagnosed depression as assessed by the Patient Health Questionnaire (PHQ)-9 was 76.4% and 13.5% of total. The prevalence of sarcopenia was 15.4%, and 13.9% experienced at least one fall in the past year. AA was prevalent in 10.9%. The time taken to do the assessment with defined algorithm was on average 5 min or less per patient, and 96% managed to complete the assessment prior to seeing their doctor in the same session. The RGA app is a rapid and feasible tool to be used by any healthcare professional in primary care for identification of geriatric syndrome with assisted management.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Richard Jor Yeong Hui
- National University Polyclinics, National University Hospital System, Singapore, Singapore
| | - Sing Cheer Kwek
- National University Polyclinics, National University Hospital System, Singapore, Singapore
| | - Meena Sundram
- National University Polyclinics, National University Hospital System, Singapore, Singapore
| | - Arthur Tay
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Jerome Jayasundram
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Shu Ee Ng
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Li Feng Tan
- Healthy Ageing Program, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
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Kuo YK, Lin YC, Lee CY, Chen CY, Tani J, Huang TJ, Chang H, Wu MH. Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review. Int J Mol Sci 2020; 21:E3010. [PMID: 32344580 PMCID: PMC7216136 DOI: 10.3390/ijms21083010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023] Open
Abstract
Spinal sarcopenia is a complex and multifactorial disorder associated with a loss of strength, increased frailty, and increased risks of fractures and falls. In addition, spinal sarcopenia has been associated with lumbar spine disorders and osteoporosis, which renders making decisions on treatment modalities difficult. Patients with spinal sarcopenia typically exhibit lower cumulative survival, a higher risk of in-hospital complications, prolonged hospital stays, higher postoperative costs, and higher rates of blood transfusion after thoracolumbar spine surgery. Several studies have focused on the relationships between spinal sarcopenia, appendicular muscle mass, and bone-related problems-such as osteoporotic fractures and low bone mineral density-and malnutrition and vitamin D deficiency. Although several techniques are available for measuring sarcopenia, each of them has its advantages and shortcomings. For treating spinal sarcopenia, nutrition, physical therapy, and medication have been proven to be effective; regenerative therapeutic options seem to be promising owing to their repair and regeneration potential. Therefore, in this narrative review, we summarize the characteristics, detection methodologies, and treatment options for spinal sarcopenia, as well as its role in spinal disorders.
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Affiliation(s)
- Yu-Kai Kuo
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Medicine, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung 20401, Taiwan;
| | - Ching-Yu Lee
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan; (C.-Y.L.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chih-Yu Chen
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Stanford Byers Center for Biodesign, Stanford University, Stanford, CA 94305, USA;
| | - Jowy Tani
- Stanford Byers Center for Biodesign, Stanford University, Stanford, CA 94305, USA;
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei 11031, Taiwan
| | - Tsung-Jen Huang
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan; (C.-Y.L.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
| | - Hsi Chang
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Pediatrics, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Meng-Huang Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan; (C.-Y.L.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Stanford Byers Center for Biodesign, Stanford University, Stanford, CA 94305, USA;
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Yang X, Woo J, Ting Lui L, Li Q, Fai Cheng K, Fan Y, Yau F, Lee APW, Lee JSW, Fung E. Cardiac Manifestations of Sarcopenia. J Nutr Health Aging 2020; 24:478-484. [PMID: 32346685 DOI: 10.1007/s12603-020-1358-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Screening questions for sarcopenia used in the community (SARC-F) may be regarded as indicators of exercise tolerance. DESIGN Observational study. SETTING We tested the hypothesis that community-living older people who are screened positive for sarcopenia using the SARC-F tool but without a history of heart failure (HF) have a higher prevalence of cardiac abnormalities compared with those who are SARC-F negative. PARTICIPANTS Participants were recruited from a territory-wide primary care needs assessment for older people based in community centres, and from non-acute hospitals in the same region as the study centre. MEASUREMENTS Participants with a total score of >=4 and who did not have any history of HF were invited to attend for further cardiac assessment. Grip strength, walking speed, and the 6-minute walk test and echocardiography were carried out. Patients with frailty and at least Grade II diastolic dysfunction were considered to have heart failure with preserved ejection fraction (HFpEF) if they also had concomitant elevated N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) of at least 300 pg/ml. RESULTS Diastolic dysfunction (DD) was significantly associated with SARC-F score >=4 and higher circulating NT-proBNP levels. ROC curves evaluating the predictive values of SARC-F, HGS and gait speed for DD showed that a combination of SARC-F and HGS or gait speed provided significant incremental value in predicting DD. CONCLUSIONS Community living older people with sarcopenia detected using a simple questionnaire have a higher prevalence of DD accompanied by elevated NT proBNP. Addition of hand grip strength or walking speed improve the magnitude of the association. SARC-F may be used as a tool to detect early cardiac dysfunction in the community.
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Affiliation(s)
- X Yang
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T., Hong Kong, Tel: 852-3505-3493, Fax: 852-2637-3852,
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Affiliation(s)
- J E Morley
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Hambling CE, Khunti K, Cos X, Wens J, Martinez L, Topsever P, Del Prato S, Sinclair A, Schernthaner G, Rutten G, Seidu S. Factors influencing safe glucose-lowering in older adults with type 2 diabetes: A PeRsOn-centred ApproaCh To IndiVidualisEd (PROACTIVE) Glycemic Goals for older people: A position statement of Primary Care Diabetes Europe. Prim Care Diabetes 2019; 13:330-352. [PMID: 30792156 DOI: 10.1016/j.pcd.2018.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/17/2018] [Accepted: 12/28/2018] [Indexed: 12/23/2022]
Abstract
Diabetes in later life is associated with a range of factors increasing the complexity of glycaemic management. This position statement, developed from an extensive literature review of the subject area, represents a consensus opinion of primary care clinicians and diabetes specialists. It highlights many challenges facing older people living with type 2 diabetes and aims to support primary care clinicians in advocating a comprehensive, holistic approach. It emphasises the importance of the wishes of the individual and their carers when determining glycaemic goals, as well as the need to balance intended benefits of treatment against the risk of adverse treatment effects. Its ultimate aim is to promote consistent high-quality care for older people with diabetes.
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Affiliation(s)
- C E Hambling
- Department of Public Health and Primary Care, School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
| | - X Cos
- Sant Marti de Provençals Primary Care Centres, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), Barcelona, Spain
| | - J Wens
- Department of Medicine and Health Sciences, Primary and Interdisciplinary Care Antwerp, University of Antwerp, Antwerp, Belgium
| | - L Martinez
- Department of General Medicine, Pierre and Marie Curie University, Paris, France
| | - P Topsever
- Department of Family Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kerem Aydinlar Campus, 34752 Atasehir, Istanbul, Turkey
| | - S Del Prato
- Department of Clinical and Experimental Medicine, Section of Diabetes, University of Pisa, Pisa, Italy
| | - A Sinclair
- Foundation for Diabetes Research in Older People (FDROP), Diabetes Frail, Luton, United Kingdom
| | - G Schernthaner
- Department of Medicine 1, Rudolfstiftung Hospital, Juchgasse 25, 1030 Vienna, Austria
| | - G Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, University, Utrecht, the Netherlands
| | - S Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
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15
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Morley JE, Vellas B. Patient-Centered (P4) Medicine and the Older Person. J Am Med Dir Assoc 2019; 18:455-459. [PMID: 28549701 DOI: 10.1016/j.jamda.2017.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 12/25/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Bruno Vellas
- Gérontopôle, CHU Toulouse University Hospital and INSERM U1027, Toulouse, France
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16
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Morley JE. Cognition and Chronic Disease. J Am Med Dir Assoc 2019; 18:369-371. [PMID: 28433119 DOI: 10.1016/j.jamda.2017.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 02/07/2023]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
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17
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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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18
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Affiliation(s)
- J E Morley
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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19
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Affiliation(s)
- Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Pace 9, 20122, Milan, Italy.
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20
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Tuna F, Üstündağ A, Başak Can H, Tuna H. Rapid Geriatric Assessment, Physical Activity, and Sleep Quality in Adults Aged more than 65 Years: A Preliminary Study. J Nutr Health Aging 2019; 23:617-622. [PMID: 31367725 DOI: 10.1007/s12603-019-1212-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE (1) To evaluate geriatric syndromes using the Rapid Geriatric Assessment; (2) To investigate possible association of geriatric syndomes with physical activity and sleep quality in adults aged more than 65 years who applied to outpatients physical medicine and rehabilitation clinic. DESIGN A cross-sectional study. SETTING Outpatient physical medicine and rehabilitation clinic in Edirne, Turkey. PARTICIPANTS A total of 56 adults (mean aged 69.7 ± 4.0 (range, 65-80) years, 33 women). MEASUREMENTS The Rapid Geriatric Assessment, which includes the FRAIL Questionnaire Screening Tool for frailty, Simplified Nutritional Assessment Questionnaire (SNAQ), SARC-F Screen for Sarcopenia, and Rapid Cognitive Screen (RCS), was used to assess geriatric syndromes. The International Physical Activity Questionnaire (IPAQ) was used to obtain data regarding health-related physical activity. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality during the past month. RESULTS The mean age of the patients was 69.7 ± 4.0 years. Of the 56 patients, 12.5% were frail, 50.0% were pre-frail, 35.7% had sarcopenia, 44.6% had a risk of weight loss, 33.9% had dementia, 57.1% were physically inactive, and 53.6% had poor sleep quality. The total FRAIL and SARC-F scores were positively correlated with the global PSQI score (correlation coefficient (r) = 0.300, p < 0.05; r = 0,327, p < 0.05, respectively) and negatively correlated with the total RCS score (r= -0,267, p < 0.05; r = -0,314, p < 0.05, respectively)). The total FRAIL score was positively correlated with the SARC-F score (r = 0.695, p < 0.001), and the concurrence of frailty and sarcopenia in the same patients was 10.7%. The global PSQI score was negatively correlated with the SNAQ score (r = -0.273, p < 0.05). CONCLUSION Frailty and sarcopenia were positively correlated with poor sleep quality and negatively correlated with cognition and physical activity. In clinical practice, the Rapid Geriatric Assessment and determination of physical activity level could assist in disability prevention.
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Affiliation(s)
- F Tuna
- Filiz Tuna, MD. Department of Physical Therapy and Rehabilitation, Trakya University Faculty of Health Science, Edirne, Turkey, , , Telephone: +90 284 2133042 (Ext.:2200), Fax. +90 284 212 61 07
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21
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Affiliation(s)
- John E. Morley
- Division of Geriatric MedicineSaint Louis University School of MedicineSt. LouisUSA
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22
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Chen CY, Gan P, How CH. Approach to frailty in the elderly in primary care and the community. Singapore Med J 2018; 59:240-245. [PMID: 29799055 DOI: 10.11622/smedj.2018052] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Frailty is a distinct clinical syndrome wherein the individual has low reserves and is highly vulnerable to internal and external stressors. Although it is associated with disability and multiple comorbidities, it can also be present in individuals who seem healthy. Frailty is multidimensional and its pathophysiology is complex. Early identification and intervention can potentially decrease or reverse frailty, especially in the early stages. Primary care physicians, community nurses and community social networks have important roles in the identification of pre-frail and frail elderly through the use of simple frailty screening tools and rapid geriatric assessments. Appropriate interventions that can be initiated in a primary care setting include a targeted medical review for reversible medical causes of frailty, medication appropriateness, nutritional advice and exercise prescription. With ongoing training and education, the multidisciplinary engagement and coordination of care of the elderly in the community can help to build resilience and combat frailty in our rapidly ageing society.
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Affiliation(s)
| | - Peiying Gan
- Community Nursing Department, Changi General Hospital, Singapore
| | - Choon How How
- Department of Care and Health Integration, Changi General Hospital, Singapore.,Family Medicine-Academic Clinical Programme, Duke-NUS Academic Medical Centre, Singapore
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23
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Fougère B. RETRACTED ARTICLE: Management of Frailty: Screening and Interventions. J Nutr Health Aging 2018. [DOI: 10.1007/s12603-018-1009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Seematter-Bagnoud L, Büla C. Brief assessments and screening for geriatric conditions in older primary care patients: a pragmatic approach. Public Health Rev 2018; 39:8. [PMID: 29744236 PMCID: PMC5928588 DOI: 10.1186/s40985-018-0086-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/12/2018] [Indexed: 01/12/2023] Open
Abstract
This paper discusses the rationale behind performing a brief geriatric assessment as a first step in the management of older patients in primary care practice. While geriatric conditions are considered by older patients and health professionals as particularly relevant for health and well-being, they remain too often overlooked due to many patient- and physician-related factors. These include time constraints and lack of specific training to undertake comprehensive geriatric assessment. This article discusses the epidemiologic rationale for screening functional, cognitive, affective, hearing and visual impairments, and nutritional status as well as fall risk and social status. It proposes using brief screening tests in primary care practice to identify patients who may need further comprehensive geriatric assessment or specific interventions.
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Affiliation(s)
- Laurence Seematter-Bagnoud
- 1Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Center, Mont Paisible 16, CH-1011 Lausanne, Switzerland.,2Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
| | - Christophe Büla
- 1Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Center, Mont Paisible 16, CH-1011 Lausanne, Switzerland
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25
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Mueller YK, Monod S, Locatelli I, Büla C, Cornuz J, Senn N. Performance of a brief geriatric evaluation compared to a comprehensive geriatric assessment for detection of geriatric syndromes in family medicine: a prospective diagnostic study. BMC Geriatr 2018. [PMID: 29534680 PMCID: PMC5850979 DOI: 10.1186/s12877-018-0761-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Geriatric syndromes are rarely detected in family medicine. Within the AGE program (active geriatric evaluation), a brief assessment tool (BAT) designed for family physicians (FP) was developed and its diagnostic performance estimated by comparison to a comprehensive geriatric assessment. Methods This prospective diagnostic study was conducted in four primary care sites in Switzerland. Participants were aged at least 70 years and attending a routine appointment with their physician, without previous documented geriatric assessment. Participants were assessed by their family physicians using the BAT, and by a geriatriciant who performed a comprehensive geriatric assessment within the following two-month period (reference standard). Both the BAT and the full assessment targeted eight geriatric syndromes: cognitive impairment, mood impairment, urinary incontinence, visual impairment, hearing loss, undernutrition, osteoporosis and gait and balance impairment. Diagnostic accuracy of the BAT was estimated in terms of sensitivity, specificity, and predictive values; secondary outcomes were measures of feasibility, in terms of added consultation time and comprehensiveness in applying the BAT items. Results Prevalence of the geriatric syndromes in participants (N=85, 46 (54.1%) women, mean age 78 years (SD 6))ranged from 30.0% (malnutrition and cognitive impairment) to 71.0% (visual impairment), with a median number of 3 syndromes (IQR 2 to 4) per participant. Sensitivity of the BAT ranged from 25.0% for undernutrition (95%CI 9.8% - 46.7%) to 82.1% for hearing impairment (95%CI 66.5% - 92.5%), while specificity ranged from 45.8% for visual impairment (95%CI 25.6–67.2) to 87.7% for undernutrition (76.3% to 94.9%). Finally, most negative predictive values (NPV) were between 73.5% and 84.1%, excluding visual impairment with a NPV of 50.0%. Family physicians reported BAT use as per instructions for 76.7% of the syndromes assessed. Conclusions Although the BAT does not replace a comprehensive geriatric assessment, it is a useful and appropriate tool for the FP to screen elderly patients for most geriatric syndromes. Trial registration The study was registered on ClinicalTrials.gov on February 20, 2013 (NCT01816087). Electronic supplementary material The online version of this article (10.1186/s12877-018-0761-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yolanda K Mueller
- University Institute of Family Medicine, Department of Ambulatory Care and Community Medicine (DACCM), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland.
| | - Stefanie Monod
- Public Health Office of the Canton of Vaud, Av. des casernes 2, 1014, Lausanne, Switzerland.,Department of Geriatrics, University of Lausanne, Ch. de Mont-Paisible 16, 1011, Lausanne, Switzerland
| | - Isabella Locatelli
- University Institute of Family Medicine, Department of Ambulatory Care and Community Medicine (DACCM), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland.,Institute of Social and Preventive Medicine, University of Lausanne, Rue de la Corniche 10, 1010, Lausanne, Switzerland
| | - Christophe Büla
- Department of Geriatrics, University of Lausanne, Ch. de Mont-Paisible 16, 1011, Lausanne, Switzerland
| | - Jacques Cornuz
- University Institute of Family Medicine, Department of Ambulatory Care and Community Medicine (DACCM), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Nicolas Senn
- University Institute of Family Medicine, Department of Ambulatory Care and Community Medicine (DACCM), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland
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Amblàs-Novellas J, Martori JC, Espaulella J, Oller R, Molist-Brunet N, Inzitari M, Romero-Ortuno R. Frail-VIG index: a concise frailty evaluation tool for rapid geriatric assessment. BMC Geriatr 2018; 18:29. [PMID: 29373968 PMCID: PMC5787254 DOI: 10.1186/s12877-018-0718-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/14/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Demographic changes have led to an increase in the number of elderly frail persons and, consequently, systematic geriatric assessment is more important than ever. Frailty Indexes (FI) may be particularly useful to discriminate between various degrees of frailty but are not routinely assessed due, at least in part, to the large number of deficits assessed (from 30 to 70). Therefore, we have developed a new, more concise FI for rapid geriatric assessment (RGA)-the Frail-VIG index ("VIG" is the Spanish/Catalan abbreviation for Comprehensive Geriatric Assessment), which contains 22 simple questions that assess 25 different deficits. Here we describe this FI and report its ability to predict mortality at 24 months. METHODS Prospective, observational, longitudinal study of geriatric patients followed for 24 months or until death. The study participants were patients (n = 590) admitted to the Acute Geriatric Unit at the at the University Hospital of Vic (Barcelona) during the year 2014. Participants were classified into one of seven groups based on their Frail-VIG score (0-0.15; 0.16-0.25; 0.26-0.35; 0.36-0.45; 0.46-0.55; 0.56-0.65; and 0.66-1). Survival curves for these groups were compared using the log-rank test. ROC curves were used to assess the index's capacity to predict mortality at 24 months. RESULTS Mean (standard deviation) patient age was 86.4 (5.6) years. The 24-month mortality rate was 57.3% for the whole sample. Significant between-group (deceased vs. living) differences (p < 0.05) were observed for most index variables. Survival curves for the seven Frail-VIG groups differed significantly (X2 = 433.4, p < 0.001), with an area under the ROC curve (confidence interval) of 0.90 (0.88-0.92) at 12 months and 0.85 (0.82-0.88) at 24 months. Administration time for the Frail-VIG index ranged from 5 to 10 min. CONCLUSIONS The Frail-VIG index, which requires less time to administer than previously validated FIs, presents a good discriminative capacity for the degree of frailty and a high predictive capacity for mortality in the present cohort. Although more research is needed to confirm the validity of this instrument in other populations and settings, the Frail-VIG may provide clinicians with a RGA method and also a reliable tool to assess frailty in routine practice.
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Affiliation(s)
- Jordi Amblàs-Novellas
- Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu / Hospital Universitari de Vic, Rambla Hospital 52, 08500, Vic, Barcelona, Spain. .,Department of Palliative Care, University of Vic / Central University of Catalonia, Barcelona, Spain. .,Programme for the Prevention and Care of Patients with Chronic Conditions, Department of Health, Government of Catalonia, Barcelona, Spain.
| | - Joan Carles Martori
- Data Analysis and Modeling Research Group. Department of Economics and Business, University of Vic / Central University of Catalonia, Barcelona, Spain
| | - Joan Espaulella
- Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu / Hospital Universitari de Vic, Rambla Hospital 52, 08500, Vic, Barcelona, Spain.,Department of Palliative Care, University of Vic / Central University of Catalonia, Barcelona, Spain
| | - Ramon Oller
- Data Analysis and Modeling Research Group. Department of Economics and Business, University of Vic / Central University of Catalonia, Barcelona, Spain
| | - Núria Molist-Brunet
- Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu / Hospital Universitari de Vic, Rambla Hospital 52, 08500, Vic, Barcelona, Spain
| | - Marco Inzitari
- Parc Sanitari Pere Virgili. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roman Romero-Ortuno
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, UK.,Department of Public Health and Primary Care, Clinical Gerontology Unit, University of Cambridge, Cambridge, UK
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27
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Fougère B, Lagourdette C, Abele P, Resnick B, Rantz M, Kam Yuk Lai C, Chen Q, Moyle W, Vellas B, Morley JE. Involvement of Advanced Practice Nurse in the Management of Geriatric Conditions: Examples from Different Countries. J Nutr Health Aging 2018; 22:463-470. [PMID: 29582884 DOI: 10.1007/s12603-018-1008-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The increasing demand for healthcare services is placing great strain on healthcare systems throughout the world. Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric conditions (e.g., frailty, sarcopenia, falls, anorexia of aging, and cognitive decline) will delay or avert the development of disability. At the same time, recent years have seen an increased interest and use of advanced practice nurses (APN). Models of best practices of supervision and collaboration have been promulgated by many organizations. APN's roles and scope of practice have been expanded in many countries and the quality and cost-effectiveness of healthcare systems have improved. Nevertheless, in older people, evidence of advanced practice roles remains scattered, and there is little synthesis of evidence, and therefore it is not easy to visualize the different practice models and their components. The aim of this paper is to explain the need for advanced practice nurses to manage geriatric conditions.
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Affiliation(s)
- B Fougère
- B. Fougère, Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France, Tel: +33561145657 ; fax: +33561145640, E-mail:
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28
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Morley JE. Editorial: Defining Undernutrition (Malnutrition) in Older Persons. J Nutr Health Aging 2018; 22:308-310. [PMID: 29484342 DOI: 10.1007/s12603-017-0991-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- J E Morley
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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29
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Fougère B, Cesari M, Arai H, Woo J, Merchant RA, Flicker L, Cherubini A, Bauer JM, Vellas B, Morley JE. Editorial: Involving Primary Care Health Professionals in Geriatric Assessment. J Nutr Health Aging 2018; 22:566-568. [PMID: 29717754 DOI: 10.1007/s12603-018-1001-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- B Fougère
- B. Fougère, Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France, Tel: +33561145657 ; fax: +33561145640, E-mail:
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de Souza Orlandi F, Brochine Lanzotti R, Gomes Duarte J, Novais Mansur H, Zazzetta MS, Iost Pavarini SC, Cominetti MR, Matumoto S. Translation, Adaptation and Validation of Rapid Geriatric Assessment to the Brazilian context. J Nutr Health Aging 2018; 22:1115-1121. [PMID: 30379312 DOI: 10.1007/s12603-018-1078-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Translate, cross-culturally adapt and validate the Rapid Geriatric Assessment (RGA) for Brazilian community-dwelling adults. DESIGN Cross-sectional study, using a quantitative approach. SETTING Urban population from the city of São Carlos, located in the interior of São Paulo State, Brazil. PARTICIPANTS 148 individuals aged 60 or over. MEASUREMENTS Participants were assessed using the RGA, Fried Frailty Phenotype, International Physical Activity Questionnaire - long version, Addenbrooke´s Cognitive Exam - Revised Version, Mini Nutritional Assessment, short Form - 36, EuroQol 5-Dimension, Geriatric Depression Scale - short version, in addition to performing Dual Energy X-ray Absorptiometry to diagnose sarcopenia, according to the criteria established by the European Working Group on Sarcopenia in Older People. RESULTS In the translation and adaption process of the RGA, steps recommended by the literature were followed: initial translation, synthesis of translations, backward translation, evaluation from the panel of judges, and pre-test. When evaluating the psychometric properties of the scale, satisfactory reliability (internal consistency and stability) and validity (content, concurrent criterion and convergent, divergent and discriminant construct) were verified. CONCLUSION The Brazilian version of the RGA is reliable and valid, and can be used in the Brazilian context to evaluate the elderly population.
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Affiliation(s)
- F de Souza Orlandi
- Fabiana de Souza Orlandi, Rod. Washington Luis, km 235 CEP: 13565-905 São Carlos, São Paulo, Brazil (+55) 16 3306-6673/
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Bauer JM, Morley JE. The relevance of healthy diets for the prevention of frailty and cognitive impairment. Curr Opin Clin Nutr Metab Care 2018; 21:1-3. [PMID: 29049044 DOI: 10.1097/mco.0000000000000438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jürgen M Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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Affiliation(s)
- B Vellas
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Morley JE. A Decade of JAMDA. J Am Med Dir Assoc 2017; 18:993-997. [PMID: 29169742 DOI: 10.1016/j.jamda.2017.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO.
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Morley JE, Sanford A, Bourey R. Sleep Apnea: A Geriatric Syndrome. J Am Med Dir Assoc 2017; 18:899-904. [DOI: 10.1016/j.jamda.2017.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 12/25/2022]
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Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2017. J Am Med Dir Assoc 2017; 18:928-940. [PMID: 29080572 DOI: 10.1016/j.jamda.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/09/2023]
Abstract
This is the 11th annual Clinical Update from the AMDA meeting article. This year the topics covered are hypertension after the Systolic Blood Pressure Intervention Trial; chronic obstructive pulmonary disease risk factors, diagnosis and management including end-of-life planning, and the difficulties with exacerbations such as breathlessness; diagnosis and treatment of cognitive impairment and dementia; and wound care and pressure ulcer management.
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Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Affiliation(s)
- B Fougère
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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