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Camacho-Torregrosa S, Albert-Ros X, Aznar-Cardona J, Mollar-Talamantes M, Bordonaba-Mateos MA, Galán-Bernardino JV. [Frail-VIG index: Convergent and discriminatory validity with respect to Short Physical Performance Battery in general population]. Rev Esp Geriatr Gerontol 2023; 58:75-83. [PMID: 36842943 DOI: 10.1016/j.regg.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/21/2023] [Accepted: 01/26/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Studies of frailty in primary health care (PHC) using frailty indexes are scarce. Frail-VIG index assesses the level of frailty through a multidimensional approach. The main objective was to investigate the convergent and discriminative validity of the frail-VIG index with respect to Short Physical Performance Battery (SPPB) in general population ≥ 70 years. POPULATION, MATERIALS AND METHODS Descriptive cross-sectional study. We included 416 non-institutionalized patients aged 70 years or over from two lists of general practitioners in a semi-urban healthcare center. Main variables were: frail-VIG index and SPPB. RESULTS The value of the area under the ROC curve of frail-VIG index respect SPPB < 7 was 0.81 (95% CI: 0.76-0.86). Pearson's correlation coefficient was -0.59 (95% CI: -0.524 to -0.649). The mean of frail-VIG index in those classified as not frail by SPPB < 7 was 0.103 (95% CI: 0.094-0.112) and in the frail was 0.242 (95% CI: 0.215-0.269). We obtained significant differences in the mean and distribution of the SPPB according to the frail-VIG index categories. The frailty prevalence according to the frail-VIG index was 29.3% (95% CI: 25.2-33.9), initial 19%, intermediate 7.5% and advanced 2.9%. There were frailty people by frail-VIG index and not by SPPB < 7 the 10.4%; on the contrary the 9.6%, the mean of affected domains of frail-VIG index was 3.9 and 2.2, respectively. CONCLUSIONS The frail-VIG index presents adequate convergent and discriminative validity with respect to the SPPB that supports the use in PHC. There is a 20% of participants classified as frail in a discordant way, who presents a different profile.
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Affiliation(s)
- Susana Camacho-Torregrosa
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España; Grupo de Atención al Mayor de la Sociedad Valenciana de Medicina Familiar y Comunitaria, Valencia, España.
| | - Xavier Albert-Ros
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España; Grupo de Atención al Mayor de la Sociedad Valenciana de Medicina Familiar y Comunitaria, Valencia, España
| | - Javier Aznar-Cardona
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España
| | - María Mollar-Talamantes
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España
| | - María Alicia Bordonaba-Mateos
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España
| | - José Vicente Galán-Bernardino
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España
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Belenguer-Varea A, Avellana-Zaragoza JA, Inglés M, Cunha-Pérez C, Cuesta-Peredo D, Borrás C, Viña J, Tarazona-Santabalbina FJ. Effect of Familial Longevity on Frailty and Sarcopenia: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1534. [PMID: 36674289 PMCID: PMC9865421 DOI: 10.3390/ijerph20021534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Familial longevity confers advantages in terms of health, functionality, and longevity. We sought to assess potential differences in frailty and sarcopenia in older adults according to a parental history of extraordinary longevity. A total of 176 community-dwelling subjects aged 65-80 years were recruited in this observational case-control study, pair-matched 1:1 for gender, age, and place of birth and residence: 88 centenarians' offspring (case group) and 88 non-centenarians' offspring (control group). The main variables were frailty and sarcopenia based on Fried's phenotype and the European Working Group on Sarcopenia in Older People (EWGSOP) definitions, respectively. Sociodemographics, comorbidities, clinical and functional variables, the presence of geriatric syndromes, and laboratory parameters were also collected. Related sample tests were applied, and conditional logistic regression was performed. Cases had a higher percentage of robust patients (31.8% vs. 15.9%), lower percentages of frailty (9.1% vs. 21.6%) and pre-frailty (59.1% vs. 62.5%) (p = 0.001), and lower levels of IL-6 (p = 0.044) than controls. The robust adjusted OR for cases was 3.00 (95% CI = 1.06-8.47, p = 0.038). No significant differences in muscle mass were found. Familial longevity was also associated with less obesity, insomnia, pain, and polypharmacy and a higher education level and total and low-density lipoprotein cholesterol. The results suggest an inherited genetic component in the frailty phenotype, while the sarcopenia association with familial longevity remains challenging.
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Affiliation(s)
- Angel Belenguer-Varea
- Division of Geriatrics, Hospital Universitario de la Ribera, 46600 Valencia, Spain
- School of Doctorate, Universidad Católica de Valencia San Vicente Martir, 46001 Valencia, Spain
| | - Juan Antonio Avellana-Zaragoza
- Division of Geriatrics, Hospital Universitario de la Ribera, 46600 Valencia, Spain
- School of Doctorate, Universidad Católica de Valencia San Vicente Martir, 46001 Valencia, Spain
| | - Marta Inglés
- Freshage Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, CIBERFES-ISCIII, INCLIVA, 46010 Valencia, Spain
| | - Cristina Cunha-Pérez
- School of Doctorate, Universidad Católica de Valencia San Vicente Martir, 46001 Valencia, Spain
| | - David Cuesta-Peredo
- Department of Quality Management, Hospital Universitario de la Ribera, 46600 Valencia, Spain
| | - Consuelo Borrás
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, CIBERFES-ISCIII, INCLIVA, 46010 Valencia, Spain
| | - José Viña
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, CIBERFES-ISCIII, INCLIVA, 46010 Valencia, Spain
| | - Francisco José Tarazona-Santabalbina
- Division of Geriatrics, Hospital Universitario de la Ribera, 46600 Valencia, Spain
- School of Doctorate, Universidad Católica de Valencia San Vicente Martir, 46001 Valencia, Spain
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 46010 Valencia, Spain
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Derechos humanos y dimensión social de personas vulnerables durante la pandemia por el nuevo coronavirus SARS-CoV-2. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2022. [PMCID: PMC7685042 DOI: 10.1016/j.acci.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introducción Los criterios de hospitalización y la aplicación del principio de justicia distributiva en situación de excepción y urgencias en el pico de una segunda ola ocasionada por el nuevo coronavirus SARS-CoV-2 deben ser replanteados y revisados a la luz de los derechos humanos y la dimensión social de la persona. Objetivo Revisar los derechos humanos y la dimensión social de personas vulnerables en la pandemia por el nuevo coronavirus SARS-CoV-2. Metodología Se realizó un análisis y reflexión de los derechos humanos y la dimensión social de personas vulnerables afectadas con el nuevo coronavirus SARS-CoV-2. Resultados Los derechos humanos son indivisibles e interdependientes, esto significa que no pueden disfrutarse plenamente si no están todos integrados. Por lo cual hay la obligación de respetarlos, protegerlos y cumplirlos. La dimensión social de la persona se relacionó con calidad de vida, ciclo vital, esperanza de vida y su valor social. Los conceptos médicos que se usan indistintamente para identificar personas vulnerables por su condición funcional son: adulto mayor, comorbilidad, fragilidad, demencia y discapacidad. Sin embargo, se trata de entidades clínicas distintas que están causalmente relacionadas y que ocasionan vulnerabilidad en pacientes COVID-19. Discusión La enfermedad COVID-19 es un serio desafío global que consiste en un llamado a revitalizar los valores universales contenidos en los estándares internacionales de derechos humanos. Las decisiones y prácticas relacionadas con el manejo de la pandemia deben formularse e implementarse con base al respeto, la dignidad, los derechos y los valores humanos. Conclusión Las personas vulnerables por su condición funcional aumentan el riesgo de padecer la enfermedad COVID-19, y el riesgo de no ingreso a la UCI en tiempos de excepción o urgencias. Una adecuada valoración de los derechos humanos y de la dimensión social de la persona hará que estos pacientes no sean discriminados.
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Zamora-Sánchez JJ, Zabaleta-Del-Olmo E, Gea-Caballero V, Julián-Rochina I, Pérez-Tortajada G, Amblàs-Novellas J. Convergent and discriminative validity of the Frail-VIG index with the EQ-5D-3L in people cared for in primary health care. BMC Geriatr 2021; 21:243. [PMID: 33849481 PMCID: PMC8045391 DOI: 10.1186/s12877-021-02186-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/30/2021] [Indexed: 01/07/2023] Open
Abstract
Background The Frail-VIG frailty index has been developed recently. It is an instrument with a multidimensional approach and a pragmatic purpose that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. Our aim was to investigate the convergent and discriminative validity of the Frail-VIG frailty index with regard to EQ-5D-3L value. Methods We carried out a cross-sectional study in two Primary Health Care (PHC) centres of the Catalan Institute of Health (Institut Català de la Salut), Barcelona (Spain) from February 2017 to January 2019. Participants in the study were all people included under a home care programme during the study period. No exclusion criteria were applied. We used the EQ-5D-3L to measure Health-Related Quality of Life (HRQoL) and the Frail-VIG index to measure frailty. Trained PHC nurses administered both instruments during face-to-face assessments in a participant’s home during usual care. The relationships between both instruments were examined using Pearson’s correlation coefficient and multiple linear regression analyses. Results Four hundred and twelve participants were included in this study. Frail-VIG score and EQ-5D-3L value were negatively correlated (r = − 0.510; P < 0.001). Non-frail people reported a substantially better HRQoL than people with moderate and severe frailty. EQ-5D-3L value declined significantly as the Frail-VIG index score increased. Conclusions Frail-VIG index demonstrated a convergent validity with the EQ-5D-3L value. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with better and worse HRQoL. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.
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Affiliation(s)
- Juan-José Zamora-Sánchez
- Gerència Territorial de Barcelona, Institut Català de la Salut, Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain.,School of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Edurne Zabaleta-Del-Olmo
- Gerència Territorial de Barcelona, Institut Català de la Salut, Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain. .,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain. .,Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, Spain.
| | - Vicente Gea-Caballero
- Nursing school "La Fe", Valencia, Spain.,GREIACC Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Iván Julián-Rochina
- Nursing Department, Universitat de Valencia, Valencia, Spain.,Fragilidad y Deterioro Cognitivo (FROG) Research Group, Universitat de Valencia, Valencia, Spain
| | - Gemma Pérez-Tortajada
- Primary care centre "Fondo", Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Santa Coloma de Gramenet, Spain
| | - Jordi Amblàs-Novellas
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), 08500, Vic, Spain
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Esteban-Burgos AA, Lozano-Terrón MJ, Puente-Fernandez D, Hueso-Montoro C, Montoya-Juárez R, García-Caro MP. A New Approach to the Identification of Palliative Care Needs and Advanced Chronic Patients among Nursing Home Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063171. [PMID: 33808567 PMCID: PMC8003433 DOI: 10.3390/ijerph18063171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 01/05/2023]
Abstract
Background: Proper planning of Palliative Care in nursing homes requires advanced knowledge of the care needs that residents show. The aim of the study was to evaluate Palliative Needs and other conditions such as fragility, complexity, and prognosis and also to suggest new indicators for the establishment of the resident’s advanced chronic condition. Methods: Cross-sectional study conducted in 149 nursing homes Complex Chronic residents evaluated by trained professionals. Palliative Care Needs, assessed by the NECPAL ICO-CCOMS© tool, and fragility, case and palliative complexity and prognosis were evaluate through a comprehensive assessment. Descriptive analyses and association measures were performed setting the statistical significance at 0.05. Results: More than 50% of the residents had positive Surprise Question and other Palliative Needs and were classified as Advanced Chronic Patients. Distress and/or Severe Adaptative Disorder was the most frequent need shown by the residents and significant differences in levels of frailty and other characteristics, were found between the Positive and the Negative Surprise Question Groups. Statistically significant correlations were also found between aspects of both groups. Conclusions: Nursing homes residents show Palliative Needs regardless of the response to the Surprise Question of the NECPAL tool. Other characteristics such as presence of an intermediate level of frailty are suggested as a new perspective to identify advanced chronic patients among nursing homes residents.
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Affiliation(s)
- Ana A. Esteban-Burgos
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Doctoral Programme in Clinical Medicine and Public Health, University of Granada, 18012 Granada, Spain
| | | | - Daniel Puente-Fernandez
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Doctoral Programme in Clinical Medicine and Public Health, University of Granada, 18012 Granada, Spain
- Correspondence:
| | - César Hueso-Montoro
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
| | - Rafael Montoya-Juárez
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
| | - María P. García-Caro
- Department of Nursing, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.); (M.P.G.-C.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
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Busquet-Duran X, Jiménez-Zafra EM, Tura-Poma M, Bosch-de la Rosa O, Moragas-Roca A, Martin-Moreno S, Martínez-Losada E, Crespo-Ramírez S, Lestón-Lado L, Salamero-Tura N, Llobera-Estrany J, Oriol-Peregrina N, Moreno-Gabriel E, Manresa-Domínguez JM, Torán-Monserrat P. Assessing Face Validity of the HexCom Model for Capturing Complexity in Clinical Practice: A Delphi Study. Healthcare (Basel) 2021; 9:healthcare9020165. [PMID: 33557220 PMCID: PMC7913893 DOI: 10.3390/healthcare9020165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Capturing complexity is both a conceptual and a practical challenge in palliative care. The HexCom model has proved to be an instrument with strong reliability and to be valid for describing the needs and strengths of patients in home care. In order to explore whether it is also perceived to be helpful in enhancing coordinated and patient-centred care at a practical level, a methodological study was carried out to assess the face validity of the model. In particular, a Delphi method involving a group of 14 experts representing the full spectrum of healthcare professionals involved in palliative care was carried out. The results show that there is a high level of agreement, with a content validity index-item greater than 0.92 both with regard to the complexity model and the HexCom-Red, HexCom-Basic, and the HexCom-Clin instruments, and higher than 0.85 regarding the HexCom-Figure and the HexCom-Patient instruments. This consensus confirms that the HexCom model and the different instruments that are derived from it are valued as useful tools for a broad range of healthcare professional in coordinately capturing complexity in healthcare practice.
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Affiliation(s)
- Xavier Busquet-Duran
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Nursing Department, Fundació Universitària Bages (FUB), University of Vic, 08500 Vic, Spain
- Correspondence:
| | - Eva Maria Jiménez-Zafra
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Magda Tura-Poma
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Olga Bosch-de la Rosa
- Red Cross Psychosocial Care Team (EAPS), 08402 Granollers, Spain; (O.B.-d.l.R.); (S.C.-R.)
| | - Anna Moragas-Roca
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Susana Martin-Moreno
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Emilio Martínez-Losada
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Silvia Crespo-Ramírez
- Red Cross Psychosocial Care Team (EAPS), 08402 Granollers, Spain; (O.B.-d.l.R.); (S.C.-R.)
| | - Lola Lestón-Lado
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Núria Salamero-Tura
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Joana Llobera-Estrany
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Núria Oriol-Peregrina
- Degree in Speech and Language Therapy, University of Vic-Central University of Catalonia/UOC, 08242 Manresa, Spain;
- Sociosanitari Vallparadís, 08221 Terrassa, Spain
| | - Eduard Moreno-Gabriel
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
| | - Josep Maria Manresa-Domínguez
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Pere Torán-Monserrat
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
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García-García E, González-Romero GM, Martín-Pérez EM, Zapata Cornejo EDD, Escobar-Aguilar G, Cárdenas Bonnet MF. Real-World Data and Machine Learning to Predict Cardiac Amyloidosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030908. [PMID: 33494357 PMCID: PMC7908075 DOI: 10.3390/ijerph18030908] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 01/15/2023]
Abstract
(1) Background: Cardiac amyloidosis or “stiff heart syndrome” is a rare condition that occurs when amyloid deposits occupy the heart muscle. Many patients suffer from it and fail to receive a timely diagnosis mainly because the disease is a rare form of restrictive cardiomyopathy that is difficult to diagnose, often associated with a poor prognosis. This research analyses the characteristics of this pathology and proposes a statistical learning algorithm that helps to detect the disease. (2) Methods: The hospitalization clinical (medical and nursing ones) records used for this study are the basis of the learning and training techniques of the algorithm. The approach consisted of using the information generated by the patients in each admission and discharge episode and treating it as data vectors to facilitate their aggregation. The large volume of clinical histories implied a high dimensionality of the data, and the lack of diagnosis led to a severe class imbalance caused by the low prevalence of the disease. (3) Results: Although there are few patients with amyloidosis in this study, the proposed approach demonstrates that it is possible to learn from clinical records despite the lack of data. In the validation phase, the algorithm first acted on data from the general study population. It then was applied to a sample of patients diagnosed with heart failure. The results revealed that the algorithm detects disease when data vectors profile each disease episode. (4) Conclusions: The prediction levels showed that this technique could be useful in screening processes on a specific population to detect the disease.
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Affiliation(s)
- Elena García-García
- Fundación San Juan de Dios, Centro CC de la Salud San Rafael, Universidad Nebrija, 28036 Madrid, Spain; (E.G.-G.); (G.M.G.-R.)
| | - Gracia María González-Romero
- Fundación San Juan de Dios, Centro CC de la Salud San Rafael, Universidad Nebrija, 28036 Madrid, Spain; (E.G.-G.); (G.M.G.-R.)
| | | | | | - Gema Escobar-Aguilar
- Fundación San Juan de Dios, Centro CC de la Salud San Rafael, Universidad Nebrija, 28036 Madrid, Spain; (E.G.-G.); (G.M.G.-R.)
- Correspondence:
| | - Marlon Félix Cárdenas Bonnet
- Sopra Steria, 28050 Madrid, Spain; (E.d.D.Z.C.); (M.F.C.B.)
- Escuela Superior de Ingeniería y Tecnología, Universidad Internacional de la Rioja (UNIR), 26006 Logroño, Spain
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Assessing the strengths and weaknesses of the Clinical Frailty Scale through correlation with a frailty index. Aging Clin Exp Res 2020; 32:2225-2232. [PMID: 31898172 DOI: 10.1007/s40520-019-01450-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Care for the elderly patient is a challenge that geriatricians now share with other medical specialties. Frailty has emerged as a key concept. Due to its simplicity and applicability, the Clinical Frailty Scale (CFS) is gaining increasing acceptance. AIM Compare the CFS with the Frail-VIG index (IF-VIG), an index based on the accumulation of deficits and developed on the basis of comprehensive geriatric assessment. METHODS Cross-sectional and single-center study carried out at the Acute Geriatric Unit of a University Hospital. Patients consecutively recruited on admission over a 6-month period (n = 184). The concurrent validity of the CFS was measured by assessing the concordance between the two measurement methods. The degree of association was determined by applying a linear regression model, calculating the Pearson correlation coefficient (r). RESULTS The prevalence of frailty was 91.8%. A mean IF-VIG score of 0.41 (SD ± 0.14) was found. The two most frequently recorded CFS categories were 6 and 7. An effective correlation was established (r = 0.706, p < 0.001). In the cohort with severe dementia, the association fell (r = 0.442). In the whole population, it rose adding Charlson index score (r = 0.747). CONCLUSIONS The strong correlation of the CFS with a frailty index supports its use. Incorporating comorbidity into the physical function domains of the CFS improved the correlation. However, the CFS was unsuitable in patients with dementia. To infer prognosis, in categories 6 and 7, the situational diagnosis should be extended with more discriminative tools.
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González-Montalvo JI, Ramírez-Martín R, Menéndez Colino R, Alarcón T, Tarazona-Santabalbina FJ, Martínez-Velilla N, Vidán MT, Pi-Figueras Valls M, Formiga F, Rodríguez Couso M, Hormigo Sánchez AI, Vilches-Moraga A, Rodríguez-Pascual C, Gutiérrez Rodríguez J, Gómez-Pavón J, Sáez López P, Bermejo Boixareu C, Serra Rexach JA, Martínez Peromingo J, Sánchez Castellano C, González Guerrero JL, Martín-Sánchez FJ. [Cross-speciality geriatrics: A health-care challenge for the 21st century]. Rev Esp Geriatr Gerontol 2020; 55:84-97. [PMID: 31870507 DOI: 10.1016/j.regg.2019.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years.
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Affiliation(s)
- Juan Ignacio González-Montalvo
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España.
| | | | | | - Teresa Alarcón
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | | | - Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | - Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, IDIBELL, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
| | | | - Ana Isabel Hormigo Sánchez
- Servicio de Geriatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Arturo Vilches-Moraga
- Servicio de Geriatría, Salford Royal NHS Foundation Trust, Facultad de Medicina, Universidad de Manchester, Manchester, Inglaterra
| | | | - José Gutiérrez Rodríguez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
| | - Javier Gómez-Pavón
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, España
| | - Pilar Sáez López
- Unidad de Geriatría, Hospital Universitario Fundación de Alcorcón, IdiPAZ, Alcorcón, Madrid, España
| | | | - José Antonio Serra Rexach
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | | | - José Luis González Guerrero
- Servicio de Geriatría, Hospital San Pedro de Alcántara, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, IdiSSC, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Abstract
PURPOSE OF REVIEW The growing number of patients with terminal and chronic conditions and co-morbidities constitutes a challenge for any healthcare system, to provide effective and efficient patient-centred care at the end of life. Resources are limited, and complexity is rising within patients' situations and healthcare professionals interventions. This review presents the state of art of the role of complexity in specialist palliative care provision. RECENT FINDINGS Although studies related to complexity in palliative care are still limited, interesting reviews on complexity frameworks in co-morbidity conditions and palliative care are growing more present in current literature. They identify multidimensional issues, resource utilisation, and the relationship between them as fundamental aspects of complexity constructs, helping to define and understand complexity, and to therefore design validated tools to support healthcare professionals identifying the most complex patients, such as Hui's criteria, PALCOM, INTERMED, and IDC-Pal which is presented in this review. SUMMARY There is an urgent need to guarantee quality and equity of care for all the patients eligible for palliative care, from those who need a palliative care approach to those needing specialist intensive palliative care. Implementing complexity theory into practice is paramount. In this review, complexity science, complexity frameworks, as well as tools evaluating complexity in palliative care are described.
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Amblàs-Novellas J, Espaulella-Panicot J. [Therapeutic harmonization: the necessary alignment of the healthcare systems with the results that matters to the patients]. Rev Esp Geriatr Gerontol 2018; 53:245-246. [PMID: 30072183 DOI: 10.1016/j.regg.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Jordi Amblàs-Novellas
- Unidad Territorial de Geriatría y Cuidados Paliativos, Consorci Hospitalari de Vic / Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, España; Grupo de investigación en Cronicidad de la Cataluña Central (C3RG), Vic, Barcelona, España; Cátedra de Cuidados Paliativos / Centro de Estudios Sociales y Sanitarios (CESS), Universitat de Vic-Universitat Central de Catalunya, Vic, Barcelona, España; Programa de Prevención y Atención a la Cronicidad, Departament de Salut, Generalitat de Catalunya, Barcelona, España.
| | - Joan Espaulella-Panicot
- Unidad Territorial de Geriatría y Cuidados Paliativos, Consorci Hospitalari de Vic / Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, España; Grupo de investigación en Cronicidad de la Cataluña Central (C3RG), Vic, Barcelona, España; Cátedra de Cuidados Paliativos / Centro de Estudios Sociales y Sanitarios (CESS), Universitat de Vic-Universitat Central de Catalunya, Vic, Barcelona, España
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12
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[Oral anticoagulation therapy in the elderly population with atrial fibrillation. A review article]. Rev Esp Geriatr Gerontol 2018; 53:344-355. [PMID: 30072184 DOI: 10.1016/j.regg.2018.04.450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/17/2018] [Accepted: 04/25/2018] [Indexed: 12/31/2022]
Abstract
Aging is an important risk factor for patients with atrial fibrillation. The estimated prevalence of atrial fibrillation in patients aged ≥80 years is 9-10%, and is associated with a four to five fold increased risk of embolic stroke, and with an estimated increased stroke risk of 1.45-fold per decade in aging. Older age is also associated with an increased risk of major bleeding with oral anticoagulant therapy. This review will focus on the role of oral anticoagulation with new oral anticoagulants, non-vitamin K antagonist in populations with common comorbid conditions, including age, chronic kidney disease, coronary artery disease, on multiple medication, and frailty. In patients 75 years and older, randomised trials have shown new oral anticoagulants to be as effective as warfarin, or in some cases superior, with an overall better safety profile, consistently reducing rates of intracranial haemorrhages. Prior to considering oral anticoagulant therapy in an elderly frail patient, a comprehensive assessment should be performed to include the risks and benefits, stroke risk, baseline kidney function, cognitive status, mobility and fall risk, multiple medication, nutritional status assessment, and life expectancy.
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13
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Duems Noriega O. [Frailty: Critical term for critical care]. Rev Esp Geriatr Gerontol 2018; 53:363-365. [PMID: 30017695 DOI: 10.1016/j.regg.2018.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Oscar Duems Noriega
- Servicio de Geriatría, Hospital General de Granollers, Granollers, Barcelona, España.
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Calvo Aguirrey JJ, Alustiza Navarro J, Uranga Zaldúa J, Sarasqueta Eizaguirre C, Bueno Yáñez O. [Alusti test: New scale for assessment of physical performance in the geriatric population]. Rev Esp Geriatr Gerontol 2018; 53:255-261. [PMID: 29903666 DOI: 10.1016/j.regg.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 03/08/2018] [Accepted: 03/19/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Physical and psychological functional conditions are key factors in the elderly population. Many evaluation tools are available, but they cannot be applied to the whole geriatric population. The use Alusti Test is presented. This test consists of 2versions, which enable it to encompass this wide and complex population spectrum. MATERIALS AND METHODS A prospective study with the institutionalised, hospitalised, and community population, was conducted between September and December 2016. A comparative analysis was conducted using the Barthel Index (BI), Gait Speed Test (GST), Timed «Up & Go» Test (TUG), Short Physical Performance Battery (SPPB), and Tinetti Test. RESULTS A total of 363 subjects were enrolled (mean age: 83.25 years), with varying levels of functional and cognitive conditions. The test was simple and quick to apply (3-6min), 100% applicable and usable with broad floor and ceiling effects (0-100 points) with an intraclass correlation coefficient (ICC) that shows a high inter-observer reliability (ICC = 0.99), and a good correlation in its full version with BI (ICC = 0.86) (95% CI: 0.82-0.88), and the Tinetti test (ICC = 0.76; 95% CI: 0.71-0.81), as well as in the abbreviated version BI (ICC = 0.71; 95% CI: 0.65-0.75) and Tinetti Test (ICC = 0.90; 95% CI: 0.88-0.92). This allows the variation of the functional condition to be measured, which in our sample showed an increase of 10.9%, after a period of hospital admission. CONCLUSIONS It is considered that Alusti test meets the requirements for physical performance assessment in the whole the geriatric population. The highest level of accuracy is given by the Tinetti test, which has greater applicability.
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Affiliation(s)
| | | | | | | | - Olga Bueno Yáñez
- Hospital Universitario Donostia, San Sebastián (Guipúzcoa), España
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15
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Calle A, Onder G, Morandi A, Bellelli G, Ortolani E, Pérez LM, Mesas M, Sanniti A, Mazzanti P, Platto CN, Gentile S, Martinez N, Roquè M, Inzitari M. Frailty Related Factors as Predictors of Functional Recovery in Geriatric Rehabilitation: The Sarcopenia And Function in Aging Rehabilitation (SAFARI) Multi-Centric study. J Nutr Health Aging 2018; 22:1099-1106. [PMID: 30379309 DOI: 10.1007/s12603-018-1060-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Frailty-related characteristics, such as sarcopenia, malnutrition and cognitive impairment, are often overlooked, both in clinical practice and research, as potential contributors to functional recovery during geriatric rehabilitation. OBJECTIVE The aim of the study was to identify frailty-related characteristics associated with functional recovery in a cohort of post-orthopedic surgery and post-stroke older adults. DESIGN Multi-centric cohort study. Participanst and Settings: Patients over 65 years, admitted to three geriatric rehabilitation units, in Spain and Italy, after an orthopedic event or a stroke, from December 2014 to May 2016. MEASUREMENTS The Absolute Functional Gain (AFG) defined as the difference between Barthel Index score at discharge and at admission, and the Relative Functional Gain (RFG) that represents the percentage of recovery of the function lost due to the event, were selected as outcomes. Both outcomes were analyzed as continuous and dichotomous variables. Analyses were also stratified as diagnostic at admission. RESULTS We enrolled 459 patients (mean age±SD=80.75±8.21 years), 66.2% women, 69.5% with orthopedic conditions and with a length of stay of 28.8±9.1 days. Admission after a stroke (Odds Ratio=0.36, 95% Confidence Interval=0.22-0.59]) and a better functional status at admission (OR=0.96, 95% CI=0.94-0.97), were associated with a lower likelihood of AFG, while a better pre-event Barthel index (OR=1.03 for each point in score, 95% CI=1.01-1.04), being able to walk (OR=2.07, 95% CI=1.16-3.70), and a better cognitive status at admission (OR=1.05, 95% CI=1.01-1.09), were associated with a higher chance of AFG. Post-stroke patients with delirium at admission had a re-duced chance of AFG (OR=0.25, 95% CI=0.07-0.91]). Patients admitted after an ortho-pedic event with better pre-event functional status (OR=1.04, 95% CI=1.02-1.06) and able to walk at admission (OR=2.79, 95% CI=1.29-6.03]) had an increased chance of AFG. Additionally, in both diagnostics groups, a better handgrip strength increased the chance of RFG. CONCLUSIONS Among frailty-related variables, physical, cognitive and muscular function at admission could be relevant for functional improvement during geriatric reha-bilitation. If confirmed, this data might orient targeted interventions.
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Affiliation(s)
- A Calle
- Alicia Calle, MD, Parc Sanitari Pere Virgili, Esteve Terradas Nº30, 08023 Barcelona, Spain, Tel: +34 932594102, E-mail:
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16
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Rodríguez-Mañas L, Walston JD. Frailty, what are we talking about? Implications for the daily clinical practice. Rev Esp Geriatr Gerontol 2017; 52:179-181. [PMID: 28595963 PMCID: PMC5784261 DOI: 10.1016/j.regg.2017.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 05/16/2023]
Affiliation(s)
| | - Jeremy D Walston
- Division of Geriatric Medicine and Frailty, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
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