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Li G, Pan Y. Can the Frailty of Older Adults in China Change? Evidence from a Random-Intercept Latent Transition Profile Analysis. Behav Sci (Basel) 2023; 13:723. [PMID: 37754001 PMCID: PMC10525735 DOI: 10.3390/bs13090723] [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: 06/27/2023] [Revised: 08/18/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND A major aspect of caring for older adults in the medical field is addressing their health risks. The term "frailty" is generally used to describe the changes in health risks of older adults. Although there is considerable heterogeneity in the Chinese older adult population who are classified as frail, there remain few relevant studies. Furthermore, there is a lack of research on the frailty status transitions of older Chinese adults at different time points. This research intends to determine the frailty status and category of older adults according to their physical, psychological, social, and cognitive function domains, and on this basis, to investigate changes in their frailty states. METHODS This article studied 2791 respondents who were over 60 years old (n = 2791; 53.2% were women) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) follow-up survey on factors affecting the health of older adults in China. In this article, the frailty variables include self-reported health, social function, mental health, cognitive function, functional limitations, and morbidity status. Random-intercept latent transition profile analysis (RI-LTPA) was used to divide older adults into different subgroups, and then an in-depth analysis of the state transitions was conducted. RESULTS The latent profile analysis revealed that the evaluation results of the frailty state of older adults showed obvious group heterogeneity. Each fitting index supported four latent states, which were named according to the degree of the symptoms (i.e., multi-frailty, severe socially frailty, mild socially frailty, and relatively healthy frailty). Based on the categorical probability and the probability of transition, it can be concluded that most of the samples belonged to the healthy population, and the health status had generally improved across the four time points. The relatively healthy frailty group and the severe socially frailty group have relatively strong stabilities. The multi-frailty group and the mild socially frailty group had the highest probability of joining to the relatively healthy frailty group. Strengthening social interactions among older adults and promoting their participation in social activities can significantly improve their frail state. CONCLUSIONS This study supplements related research on frailty. Firstly, it deepens the meaning of frailty, which is defined based on four aspects: physical, psychological, cognitive, and social functioning. Secondly, it divides frailty into different sub-categories. Frailty is discussed from the perspective of longitudinal research, which can provide practical adjustment suggestions for older adult nursing intervention systems and measures in China.
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Affiliation(s)
- Guangming Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou 510631, China
- School of Psychology, Center for Studies of Psychological Application and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Yuxi Pan
- School of Psychology, Center for Studies of Psychological Application and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
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Sabot P, Di Martino C, Moroni C, Pentini AA, Pabjan B, Machado MMP, Katkonienė A, Czajkowski P, Bardauskienė R, Beuscart JB. Reconsidering frailty from a human and social sciences standpoint: towards an interdisciplinary approach to vulnerability. Age Ageing 2023; 52:7147821. [PMID: 37130592 DOI: 10.1093/ageing/afad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Indexed: 05/04/2023] Open
Abstract
Although frailty is an important, well-characterized concept in the provision of medical care to older adults, it has not been linked to the concept of vulnerability developed in the humanities and social sciences. Here, we distinguish between the two main dimensions of vulnerability: a fundamental, anthropological dimension in which people are exposed to a risk of injury, and a relational dimension in which people depend on each other and on their environment. The relational notion of vulnerability might provide healthcare professionals with a better understanding of frailty (and its potential interaction with precarity). Precarity situates people in their relationship with a social environment that might threaten their living conditions. Frailty corresponds to individual-level changes in adaptation to a living environment and the loss of ability to evolve or react in that environment. Therefore, we suggest that by considering the geriatric notion of frailty as a particular form of relational vulnerability, healthcare professionals could better understand the specific needs of frail, older people-and thus provide more appropriate care.
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Affiliation(s)
- Philippe Sabot
- Department of Philosophy, Univ. Lille, CNRS, UMR 8163-STL-Savoirs Textes Langage, Lille F-59000, France
| | - Carla Di Martino
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille F-59000, France
| | - Christine Moroni
- Department of Psychology, Univ. Lille, ULR 4072-PSITEC-Psychologie: Interactions, Temps, Emotions, Cognition, Lille F-59000, France
| | | | - Barbara Pabjan
- Institute of Sociology, University of Wrocław, Wrocław, Poland
| | - Maria Manuela Pereira Machado
- Health Sciences Research Unit: Nursing (UICISA:E/ESEnfC_ESE/UMinho), School of Nursing (ESE UMinho), University of Minho Braga 4710-057, Portugal
| | - Agata Katkonienė
- Faculty of Human and Social Studies, Mykolas Romeris University, Vilnius LT-08303, Lithuania
| | | | - Raminta Bardauskienė
- Faculty of Human and Social Studies, Mykolas Romeris University, Vilnius LT-08303, Lithuania
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille F-59000, France
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Mirón Mombiela R, Vucetic J, Monllor P, Cárdenas-Herrán JS, Taltavull de La Paz P, Borrás C. Diagnostic Performance of Muscle Echo Intensity and Fractal Dimension for the Detection of Frailty Phenotype. ULTRASONIC IMAGING 2021; 43:337-352. [PMID: 34238072 DOI: 10.1177/01617346211029656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To determine the relationship between muscle echo intensity (EI) and fractal dimension (FD), and the diagnostic performance of both ultrasound parameters for the identification of frailty phenotype. A retrospective interpretation of ultrasound scans from a previous cohort (November 2014-February 2015) was performed. The sample included healthy participants <60 years old, and participants ≥60 divided into robust, pre-frail, and frail groups according to Fried frailty criteria. A region of interest of the rectus femoris from the ultrasound scan was segmented, and histogram function was applied to obtain EI. For fractal analysis, images were processed using two-dimensional box-counting techniques to calculate FD. Statistical analyses were performed with diagnostic performance tests. A total of 102 participants (mean age 63 ± 16, 57 men) were evaluated. Muscle fractal dimension correlated with EI (r = .38, p < .01) and showed different pattern in the scatter plots when participants were grouped by non-frail (control + robust) and frail (pre-frail + frail). The diagnostic accuracy for EI to categorize frailty was of 0.69 (95%CI: 0.59-0.78, p = .001), with high intra-rater (ICC: 0.98, 95%CI: 0.98-0.99); p < .001) and inter-rater (ICC: 0.89, 95%CI: 0.75-0.95; p < .001) reliability and low measurement error for both parameters (EI: -0.18, LOA95%: -10.8 to 10.5; FD: 0.00, LOA95%: -0.09 to 0.10) in arbitrary units. The ROC curve combining both parameters was not better than EI alone (p = .18). Muscle FD correlated with EI and showed different patterns according to frailty phenotype, with EI outperforming FD as a possible diagnostic tool for frailty.
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Affiliation(s)
- Rebeca Mirón Mombiela
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
- Department of Physiology, Faculty of Medicine, University of Valencia, Valencia, Spain
- Radiologisk Afdeling, Herlev Hospital, Herlev, Denmark
| | - Jelena Vucetic
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
- Department of Physiology, Faculty of Medicine, University of Valencia, Valencia, Spain
- Hospital ICOT Ciudad de Telde, Calle Míster Blisse, Telde, Spain
| | - Paloma Monllor
- Department of Physiology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | | | | | - Consuelo Borrás
- Department of Physiology, Faculty of Medicine, University of Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
- Center for Biomedical Network Research on Frailty and Healthy Aging (CIBERFES), CIBER-ISCIII, Spain
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Romero-Ortuño R, Martínez-Velilla N, Sutton R, Ungar A, Fedorowski A, Galvin R, Theou O, Davies A, Reilly RB, Claassen J, Kelly ÁM, Ivanov PC. Network Physiology in Aging and Frailty: The Grand Challenge of Physiological Reserve in Older Adults. FRONTIERS IN NETWORK PHYSIOLOGY 2021; 1:712430. [PMID: 36925570 PMCID: PMC10012993 DOI: 10.3389/fnetp.2021.712430] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/25/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Román Romero-Ortuño
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Spain
| | - Richard Sutton
- Faculty of Medicine, Imperial College London, Heart Science, National Heart and Lung Institute, London, United Kingdom
| | - Andrea Ungar
- Geriatric Department, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University and Department of Cardiology, Skåne University Hospital, Malmo, Sweden
| | - Rose Galvin
- Ageing Research Centre, School of Allied Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Olga Theou
- Physiotherapy and Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Andrew Davies
- School of Medicine, Trinity College Dublin, University College Dublin and Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Richard B Reilly
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Jurgen Claassen
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Áine M Kelly
- Discipline of Physiology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Plamen Ch Ivanov
- Keck Laboratory for Network Physiology, Boston University, Boston, MA, United States
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Estimation of homeostatic dysregulation and frailty using biomarker variability: a principal component analysis of hemodialysis patients. Sci Rep 2020; 10:10314. [PMID: 32587279 PMCID: PMC7316742 DOI: 10.1038/s41598-020-66861-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 05/26/2020] [Indexed: 01/01/2023] Open
Abstract
Increased intraindividual variability in several biological parameters is associated with aspects of frailty and may reflect impaired physiological regulation. As frailty involves a cumulative decline in multiple physiological systems, we aimed to estimate the overall regulatory capacity by applying a principal component analysis to such variability. The variability of 20 blood-based parameters was evaluated as the log-transformed coefficient of variation (LCV) for one year’s worth of data from 580 hemodialysis patients. All the LCVs were positively correlated with each other and shared common characteristics. In a principal component analysis of 19 LCVs, the first principal component (PC1) explained 27.7% of the total variance, and the PC1 score exhibited consistent correlations with diverse negative health indicators, including diabetes, hypoalbuminemia, hyponatremia, and relative hypocreatininemia. The relationship between the PC1 score and frailty was subsequently examined in a subset of the subjects. The PC1 score was associated with the prevalence of frailty and was an independent predictor for frailty (odds ratio per SD: 2.31, P = 0.01) using a multivariate logistic regression model, which showed good discrimination (c-statistic: 0.85). Therefore, the PC1 score represents principal information shared by biomarker variabilities and is a reasonable measure of homeostatic dysregulation and frailty.
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Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek-Hutten M, Germini F, D'Avanzo B, Gwyther H, Holland C. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. ACTA ACUST UNITED AC 2019; 16:140-232. [PMID: 29324562 PMCID: PMC5771690 DOI: 10.11124/jbisrir-2017-003382] [Citation(s) in RCA: 291] [Impact Index Per Article: 58.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To summarize the best available evidence regarding the effectiveness of interventions for preventing frailty progression in older adults. INTRODUCTION Frailty is an age-related state of decreased physiological reserves characterized by an increased risk of poor clinical outcomes. Evidence supporting the malleability of frailty, its prevention and treatment, has been presented. INCLUSION CRITERIA The review considered studies on older adults aged 65 and over, explicitly identified as pre-frail or frail, who had been undergoing interventions focusing on the prevention of frailty progression. Participants selected on the basis of specific illness or with a terminal diagnosis were excluded. The comparator was usual care, alternative therapeutic interventions or no intervention. The primary outcome was frailty. Secondary outcomes included: (i) cognition, quality of life, activities of daily living, caregiver burden, functional capacity, depression and other mental health-related outcomes, self-perceived health and social engagement; (ii) drugs and prescriptions, analytical parameters, adverse outcomes and comorbidities; (iii) costs, and/or costs relative to benefits and/or savings associated with implementing the interventions for frailty. Experimental study designs, cost effectiveness, cost benefit, cost minimization and cost utility studies were considered for inclusion. METHODS Databases for published and unpublished studies, available in English, Portuguese, Spanish, Italian and Dutch, from January 2001 to November 2015, were searched. Critical appraisal was conducted using standardized instruments from the Joanna Briggs Institute. Data was extracted using the standardized tools designed for quantitative and economic studies. Data was presented in a narrative form due to the heterogeneity of included studies. RESULTS Twenty-one studies, all randomized controlled trials, with a total of 5275 older adults and describing 33 interventions, met the criteria for inclusion. Economic analyses were conducted in two studies. Physical exercise programs were shown to be generally effective for reducing or postponing frailty but only when conducted in groups. Favorable effects on frailty indicators were also observed after the interventions, based on physical exercise with supplementation, supplementation alone, cognitive training and combined treatment. Group meetings and home visits were not found to be universally effective. Lack of efficacy was evidenced for physical exercise performed individually or delivered one-to-one, hormone supplementation and problem solving therapy. Individually tailored management programs for clinical conditions had inconsistent effects on frailty prevalence. Economic studies demonstrated that this type of intervention, as compared to usual care, provided better value for money, particularly for very frail community-dwelling participants, and had favorable effects in some of the frailty-related outcomes in inpatient and outpatient management, without increasing costs. CONCLUSIONS This review found mixed results regarding the effectiveness of frailty interventions. However, there is clear evidence on the usefulness of such interventions in carefully chosen evidence-based circumstances, both for frailty itself and for secondary outcomes, supporting clinical investment of resources in frailty intervention. Further research is required to reinforce current evidence and examine the impact of the initial level of frailty on the benefits of different interventions. There is also a need for economic evaluation of frailty interventions.
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Affiliation(s)
- João Apóstolo
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Richard Cooke
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
| | - Elzbieta Bobrowicz-Campos
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Silvina Santana
- Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal
| | - Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department. of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Antonio Cano
- Department of Paediatrics, Obstetrics and Gynaecology, Universitat de Valência, Valência, Spain
| | | | - Federico Germini
- Department. of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Barbara D'Avanzo
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Holly Gwyther
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
| | - Carol Holland
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom
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Frailty, Successful Aging, Resilience, and Intrinsic Capacity: a Cross-disciplinary Discourse of the Aging Process. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-0276-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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8
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Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek M, Holland C. Effectiveness of the interventions in preventing the progression of pre-frailty and frailty in older adults: a systematic review protocol. ACTA ACUST UNITED AC 2018; 14:4-19. [PMID: 26878916 DOI: 10.11124/jbisrir-2016-2467] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- João Apóstolo
- 1. Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence Based Practice: a Collaborating Centre of the Joanna Briggs Institute2. Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom3. Economics, Management and Industrial Engineering Department, University of Aveiro, Portugal4. Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Science and Community Health, University of Milan, Milan, Italy5. Department Of Paediatrics, Obstetrics and Gynaecology, Universitat de Valência, Spain6. Roessingh Research and Development, The Netherlands
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Wei Y, Cao Y, Yang X, Xu Y. Investigation on the frailty status of the elderly inpatients in Shanghai using the FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire. Medicine (Baltimore) 2018; 97:e0581. [PMID: 29718855 PMCID: PMC6392545 DOI: 10.1097/md.0000000000010581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This study was to investigate the frailty status of inpatients older than 65 years old in Shanghai.A 6-month cross-sectional survey was conducted using FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire. Totally 587 patients were included. The data, including demographic characteristics, constipation, urinary retention, urinary incontinence, grip strength, and muscle strength, were collected. The data of serum prealbumin, serum albumin, serum total protein, and hemoglobin were obtained from laboratory blood tests.The incidence of nonfrailty, prefrailty, and frailty was 0.249, 0.417, and 0.334, respectively. The high incidence age of frailty was 86 to 90 years old (0.342), and the high incidence age of prefrailty was 65 to 70 years old (0.282). There was significant difference in the grip strength among different degrees of frailty (P < .01). The influencing factors related to prefrailty included prealbumin, grip strength, urinary retention, constipation and education level of illiterate (P < .05). The populations with high prealbumin level, high grip strength and illiteracy population were not easy to enter the prefrailty period, while those with constipation (OR (odds ratio) = 1.867, 95% CI (confidence interval): 1.046-3.330) and urinary retention (OR = 7.007, 95% CI: 1.137-2.757) were more likely to enter the prefrailty period. Factors associated with frailty included age, prealbumin, grip strength, muscle strength, urinary incontinence, urinary retention, and constipation (P < .05). The populations with high prealbumin level, high grip strength, and high muscle strength were not easy to enter frailty period, while those with older age (OR = 1.141, 95% CI: 1.085-1.200), urinary incontinence (OR = 10.314, 95% CI: 1.950-54.548), urinary retention (OR = 3.058, 95% CI: 1.571-5.952), and constipation (OR = 3.004, 95% CI: 1.540-5.857) were easy to enter frailty period.The high incidence ages of frailty and prefrailty are 86 to 90 years old and 65 to 70 years old, respectively. Age, low education level, low grip strength, low muscle strength, low serum prealbumin, urinary retention, urinary incontinence, and constipation are the risk factors of frailty. It is recommended to include frailty as an indicator in the existing assessment to rate the disease and develop a disease observation plan.
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Mirón Mombiela R, Facal de Castro F, Moreno P, Borras C. Ultrasonic Echo Intensity as a New Noninvasive In Vivo Biomarker of Frailty. J Am Geriatr Soc 2017; 65:2685-2690. [DOI: 10.1111/jgs.15002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rebeca Mirón Mombiela
- Hospital General Universitario de Valencia; Valencia Spain
- Department of Physiology; Universidad de Valencia/INCLIVA; Valencia Spain
| | | | - Pilar Moreno
- Hospital General Universitario de Valencia; Valencia Spain
| | - Consuelo Borras
- Department of Physiology; Universidad de Valencia/INCLIVA; Valencia Spain
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11
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[Successful aging and indicators of frailty in the elderly. Octabaix Study]. Aten Primaria 2014; 46:475-82. [PMID: 24792420 PMCID: PMC6983651 DOI: 10.1016/j.aprim.2014.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/28/2013] [Accepted: 01/22/2014] [Indexed: 11/24/2022] Open
Abstract
El envejecimiento satisfactorio como estado óptimo de un proceso de adaptación es poco conocido en las personas más mayores. Objetivo Describir envejecimiento satisfactorio y analizar su asociación con indicadores de fragilidad en personas de 86 años. Diseño Estudio descriptivo transversal al segundo año de seguimiento de un ensayo clínico (estudio Octabaix). Emplazamiento Siete centros de atención primaria. Participantes Personas nacidas en 1924, no institucionalizadas. Medidas principales Se recogieron datos sociodemográficos, comorbilidad y escalas de valoración geriátrica. La fragilidad se definió por presencia de 3 o más de los siguientes criterios: debilidad muscular, lentitud en la marcha, pérdida de peso, agotamiento y escasa actividad física. El envejecimiento satisfactorio se definió según: índice de Barthel > 90/100 y test de Lobo ≥ 24/35. Se realizó un análisis descriptivo bivariante y multivariante mediante regresión logística. Resultados Se evaluaron 273 pacientes, 39,2% hombres. La prevalencia de envejecimiento satisfactorio fue del 47,2% (129). En el grupo sin envejecimineto satisfactorio existía una proporción de fragilidad del 34,7% (50). Se hallaron como criterios de fragilidad asociados a envejecimiento no satisfactorio la escasa actividad (OR: 7,56; IC 95%: 3,8-14,9), la debilidad (OR: 6,08; IC 95%: 2,5-14, 7), la lentitud (OR: 5,1; IC 95%: 2,8-9,5) y el agotamiento (OR: 3,6; IC 95%: 1,6-8,3). La prevalencia de envejecimiento satisfactorio es elevada en personas de 86 años en la comunidad. La escasa actividad física multiplica por 7 la asociación a envejecimiento no satisfactorio, y la debilidad muscular por 6. Por ello, incorporar el cribado dirigido a detectar estos 2 factores podría mejorar intervenciones posteriores hacia un envejecimiento más óptimo, si estos resultados se confirman en futuros estudios.
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Ross SN, Ware K. Hypothesizing the body's genius to trigger and self-organize its healing: 25 years using a standardized neurophysics therapy. Front Physiol 2013; 4:334. [PMID: 24312056 PMCID: PMC3832888 DOI: 10.3389/fphys.2013.00334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/31/2013] [Indexed: 11/13/2022] Open
Abstract
We aim for this contribution to operate bi-directionally, both as a "bedside to bench" reverse-translational fractal physiological hypothesis and as a methodological innovation to inform clinical practice. In 25 years using gym equipment therapeutically in non-research settings, the standardized therapy is consistently observed to trigger universal responses of micro to macro waves of system transition dynamics in the human nervous system. These are associated with observably desirable impacts on disorders, injuries, diseases, and athletic performance. Requisite conditions are therapeutic coaching, erect posture, extremely slow movements in mild resistance exercises, and executive control over arousal and attention. To motivate research into the physiological improvements and in validation studies, we integrate from across disciplines to hypothesize explanations for the relationships among the methods, the system dynamics, and evident results. Key hypotheses include: (1) Correctly-directed system efforts may reverse a system's heretofore misdirected efforts, restoring healthier neurophysiology. (2) The enhanced information processing accompanying good posture is an essential initial condition. (3) Behaviors accompanying exercises performed with few degrees of freedom amplify information processing, triggering destabilization and transition dynamics. (4) Executive control over arousal and attention is essential to release system constraints, amplifying and complexifying information. (5) The dynamics create necessary and in many cases evidently sufficient conditions for the body to resolve or improve its own conditions within often short time periods. Literature indicates how the human system possesses material self-awareness. A broad explanation for the nature and effects of the therapy appears rooted in the cascading recursions of the systems' dynamics, which appear to trigger health-fostering self-reorganizing processes when this therapy provides catalytic initial conditions.
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Affiliation(s)
- Sara N Ross
- Chair of Interdisciplinary Graduate Studies, Antioch University Midwest Yellow Springs, OH, USA
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13
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Moreira VG, Lourenço RA. Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ Study. Clinics (Sao Paulo) 2013; 68:979-85. [PMID: 23917663 PMCID: PMC3714993 DOI: 10.6061/clinics/2013(07)15] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 03/20/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Frailty syndrome can be defined as a state of vulnerability to stressors resulting from a decrease in functional reserve across multiple systems and compromising an individual's capacity to maintain homeostasis. The purpose of this study was to determine the prevalence of frailty and its association with social and demographic factors, functional capacity, cognitive status and self-reported comorbidities in a sample of community-dwelling older individuals who are clients of a healthcare plan. METHODS We evaluated 847 individuals aged 65 years or older who lived in the northern area of the city of Rio de Janeiro, Brazil. The subjects were selected by inverse random sampling and stratified by gender and age. To diagnose frailty, we used the scale proposed by the Cardiovascular Health Study, which consisted of the following items: low gait speed, grip strength reduction, feeling of exhaustion, low physical activity and weight loss. The data were collected between 2009 and 2010, and the frailty prevalence was calculated as the proportion of individuals who scored positive for three or more of the five items listed above. To verify the association between frailty and risk factors, we applied a logistic regression analysis. RESULTS The prevalence of frailty syndrome was 9.1% (95% confidence interval [CI], 7.3-11.3); 43.6% (95% CI, 40.3-47) of the individuals were considered robust, and 47.3% (95% CI 43.8-50.8) were considered pre-frail (p<0.001). The frail individuals tended to be older (odds ratio [OR] 13.2, 95% CI, 8.7-20) and have lower education levels (OR 2.1, 95% CI, 1-4.6), lower cognitive performance (OR 0.76, 95% CI, 0.73-0.79) and reduced health perception (OR 65.8, 95% CI, 39.1-110.8). Frail individuals also had a greater number of comorbidities (OR 6.6, 95% CI, 4.4-9.9) and worse functional capacity (OR 3.8, 95% CI, 2.9-5). CONCLUSION The prevalence of frailty was similar to that seen in other international studies and was significantly associated with educational level, cognition, comorbidities, functional capacity, perception of health and old age.
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Affiliation(s)
- Virgílio Garcia Moreira
- Internal Medicine Department, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Macklai NS, Spagnoli J, Junod J, Santos-Eggimann B. Prospective association of the SHARE-operationalized frailty phenotype with adverse health outcomes: evidence from 60+ community-dwelling Europeans living in 11 countries. BMC Geriatr 2013; 13:3. [PMID: 23286928 PMCID: PMC3585820 DOI: 10.1186/1471-2318-13-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 12/26/2012] [Indexed: 11/27/2022] Open
Abstract
Background Among the many definitions of frailty, the frailty phenotype defined by Fried et al. is one of few constructs that has been repeatedly validated: first in the Cardiovascular Health Study (CHS) and subsequently in other large cohorts in the North America. In Europe, the Survey of Health, Aging and Retirement in Europe (SHARE) is a gold mine of individual, economic and health information that can provide insight into better understanding of frailty across diverse population settings. A recent adaptation of the original five CHS-frailty criteria was proposed to make use of SHARE data and measure frailty in the European population. To test the validity of the SHARE operationalized frailty phenotype, this study aims to evaluate its prospective association with adverse health outcomes. Methods Data are from 11,015 community-dwelling men and women aged 60+ participating in wave 1 and 2 of the Survey of Health, Aging and Retirement in Europe, a population-based survey. Multivariate logistic regression analyses were used to assess the 2-year follow up effect of SHARE-operationalized frailty phenotype on the incidence of disability (disability-free at baseline) and on worsening disability and morbidity, adjusting for age, sex, income and baseline morbidity and disability. Results At 2-year follow up, frail individuals were at increased risk for: developing mobility (OR 3.07, 95% CI, 1.02-9.36), IADL (OR 5.52, 95% CI, 3.76-8.10) and BADL (OR 5.13, 95% CI, 3.53-7.44) disability; worsening mobility (OR 2.94, 95% CI, 2.19- 3.93) IADL (OR 4.43, 95% CI, 3.19-6.15) and BADL disability (OR 4.53, 95% CI, 3.14-6.54); and worsening morbidity (OR 1.77, 95% CI, 1.35-2.32). These associations were significant even among the prefrail, but with a lower magnitude of effect. Conclusions The SHARE-operationalized frailty phenotype is significantly associated with all tested health outcomes independent of baseline morbidity and disability in community-dwelling men and women aged 60 and older living in Europe. The robustness of results validate the use of this phenotype in the SHARE survey for future research on frailty in Europe.
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Affiliation(s)
- Nejma S Macklai
- Institute of Social and Preventive Medicine IUMPS, Lausanne University Hospital, 10 route de la Corniche, 1010, Lausanne, Switzerland.
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Hernandez ME, Ashton-Miller JA, Alexander NB. The effect of age, movement direction, and target size on the maximum speed of targeted COP movements in healthy women. Hum Mov Sci 2012; 31:1213-23. [PMID: 22225924 DOI: 10.1016/j.humov.2011.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 11/01/2011] [Accepted: 11/13/2011] [Indexed: 11/27/2022]
Abstract
Rapid center of pressure (COP) movements are often required to avoid falls. Little is known about the effect of age on rapid and accurate volitional COP movements. We hypothesized that COP movements to a target would be slower and exhibit more submovements in older versus younger adults, particularly in posterior versus anterior movements. Healthy older (N=12, mean age=76 years) and young women (N=13, mean age=23 years) performed anterior and posterior lean movements while standing on a force plate, and were instructed to move their COP 'as fast and as accurately as possible' using visual feedback. The results showed that rapid posterior COP movements were slower and had an increased number of submovements and ratio of peak-to-average velocity, in comparison to anterior movements (p<.005). Moreover, older compared to younger adults were 27% slower and utilized nearly twice as many compensatory submovements (p<.005), particularly when moving posteriorly (p<.05). Older women also had higher ratios of peak-to-average COP velocity than young (p<.05). Thus, despite moving more slowly, older women needed to take more frequent submovements to maintain COP accuracy, particularly posteriorly, thereby providing evidence of a compensatory strategy that may be used for preventing backward falls.
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Affiliation(s)
- Manuel E Hernandez
- Department of Biomedical Engineering, Biomechanics Research Laboratory, Ann Arbor, MI, USA.
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Holanda CMDA, Guerra RO, Nóbrega PVDN, Costa HF, Piuvezam MR, Maciel ÁCC. Salivary cortisol and frailty syndrome in elderly residents of long-stay institutions: a cross-sectional study. Arch Gerontol Geriatr 2011; 54:e146-51. [PMID: 22153978 DOI: 10.1016/j.archger.2011.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 11/14/2011] [Accepted: 11/15/2011] [Indexed: 10/14/2022]
Abstract
Analyze the relationship between frailty and cortisol in elderly residents of long-stay institutions. A cross-sectional study was conducted in the city of João Pessoa-PB-Brazil, on a sample of residents of long-stay institutions. Data were collected on frailty phenotype (weight loss, fatigue, slowness, weakness and low physical activity) and salivary cortisol (first measurement between 6 and 7a.m.; second measurement between 11 and 12a.m.; third measurement between 4 and 5p.m.). Statistical analysis applied Pearson's correlation test, Chi-square test, ANOVA and linear regression. The sample was composed of 69 elderly subjects, 37.7% men and 62.3% women, with a mean age of 77.5 (±7.8) years. The percentage of frail elderly was 45.8%. Frail aged subjects achieved higher cortisol values on the third measurement (p=0.04) and frailty load was significantly associated to the first measurement (r=0.25, p=0.04). Simple linear regression analysis showed a rate of determination (R(2)=0.05) between frailty load and the first cortisol measurement. Greater cortisol values in the morning and before bed among frail aged individuals suggest a positive correlation may exist between cortisol levels and frailty in elderly residents of long-stay institutions.
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Ní Mhaoláin AM, Gallagher D, Crosby L, Ryan D, Lacey L, Coen R, Bruce I, Walsh JB, Cunningham C, Lawlor BA. Correlates of frailty in Alzheimer's disease and mild cognitive impairment. Age Ageing 2011; 40:630-3. [PMID: 21791447 DOI: 10.1093/ageing/afr066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aine M Ní Mhaoláin
- Mercer's Institute for Research on Ageing, St James's Hospital, James's St, Dublin 8, Ireland.
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