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Yuan G, Yang Y, Lin Y, Lin J, Wu Y. Current status and development trends in CKD with frailty research from 2000 to 2021: a bibliometric analysis. Ren Fail 2024; 46:2292142. [PMID: 38178378 PMCID: PMC10773684 DOI: 10.1080/0886022x.2023.2292142] [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: 04/12/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The prevalence of chronic kidney disease (CKD) is gradually increasing in the elderly population. At the same time, frailty has become one of the research hotspots in the field of geriatrics. Bibliometric analyses help to understand the direction of a field. Therefore, this study aimed to analyze the status and emerging trends of frailty in CKD patients. DATA AND METHODS The Web of Science Core Collection (WoSCC) database was screened for relevant literature published between 1 January 2000 and 31 December 2021. Next, publications were analyzed for information including authors, journals, cited references, citing journals, institutions, countries and regions, high-frequency keywords and co-citations using VOSviewer, Microsoft Excel, and R software. RESULTS A total of 2223 articles were obtained, from which 613 relevant articles were selected based on title and abstract screening. There was an upward trend in the number of annual publications and Johansen KL was considered the most contributing author in the field. The Clinical Journal of the American Society of Nephrology was the most productive research journal. Johns Hopkins University is the most published organization. The United States is the global leader in the field and contributes the most to research. Research hotspots focus on epidemiological studies of frailty and frailty intervention. CONCLUSIONS This study presents a comprehensive bibliometric analysis of CKD and frailty research. Key findings highlight the current focus on early screening and assessment of frailty in CKD patients, as well as physical function interventions in frail patients.
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Affiliation(s)
- Guowei Yuan
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yaqin Yang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yujie Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiarong Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yuchi Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Zheng G, Cheng Y, Wang C, Wang B, Zou X, Zhou J, Peng L, Zeng T. Elucidating the causal nexus and immune mediation between frailty and chronic kidney disease: integrative multi-omics analysis. Ren Fail 2024; 46:2367028. [PMID: 39010723 PMCID: PMC11265307 DOI: 10.1080/0886022x.2024.2367028] [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: 04/30/2024] [Accepted: 06/06/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Empirical research has consistently documented the concurrent manifestation of frailty and chronic kidney disease (CKD). However, the existence of a reverse causal association or the influence of confounding variables on these correlations remains ambiguous. METHODS Our analysis of 7,078 participants from National Health and Nutrition Examination Survey(NHANES) (1999-2018) applied weighted logistic regression and Mendelian Randomization (MR) to investigate the correlation between the frailty index (FI) and renal function. The multivariate MR analysis was specifically adjusted for type 2 diabetes and hypertension. Further analysis explored 3282 plasma proteins to link FI to CKD. A two-step network MR highlighted immune cells' mediating roles in the FI-CKD relationship. RESULT Genetically inferred FI and various renal function markers are significantly correlated, as supported by NHANES analyses. Multivariate MR analysis revealed a direct causal association between the FI and CKD. Additionally, our investigation into plasma proteins identified Tmprss11D and MICB correlated with FI and CKD, respectively. A two-step network MR to reveal 15 immune cell types, notably Central Memory CD4+ T cells and Lymphocytes, as crucial mediators between FI and CKD. CONCLUSION Our work establishes a causal connection between frailty and CKD, mediated by specific immune cell profiles. These findings highlight the importance of immune mechanisms in the frailty-CKD interplay and suggest that targeting shared risk factors and immune pathways could improve management strategies for these conditions. Our research contributes to a more nuanced understanding of frailty and CKD, offering new avenues for intervention and patient care in an aging population.
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Affiliation(s)
- Guanghao Zheng
- Department of Medicine, Graduate School of Nanchang University, Nanchang, China
| | - Yu Cheng
- Department of Medicine, Graduate School of Nanchang University, Nanchang, China
| | - Chenlong Wang
- Department of Central Laboratory, The Affiliated Huaian No.1 Peopele’s Hospital, Nanjing Medical University, Huai’an, China
| | - Bin Wang
- Department of Medicine, Graduate School of Nanchang University, Nanchang, China
| | - Xinchang Zou
- Department of Medicine, Graduate School of Nanchang University, Nanchang, China
| | - Jie Zhou
- Department of Medicine, Graduate School of Nanchang University, Nanchang, China
| | - Lifen Peng
- Molecular Experiment Center, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, China
| | - Tao Zeng
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Wang L, Wang Y, Luo Y, Li Y, Li J. The mediating and moderating effect of health-promoting lifestyle on frailty and depressive symptoms for Chinese community-dwelling older adults: A cross-sectional study. J Affect Disord 2024; 361:91-96. [PMID: 38857627 DOI: 10.1016/j.jad.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND This study aims to explore the mediating and moderating effect of health-promoting lifestyles on the relationship between frailty and depressive symptoms to provide a practical reference for effectively promoting the mental health of older adults. METHODS A cross-sectional survey of community-dwelling older adults (n = 3107) was conducted in three cities of Ningxia Province, China. Depressive symptoms, frailty, and health-promoting lifestyles were assessed through the 30-item Geriatric Depression Scale, frailty scale, and health-promoting Lifestyle profile-II, respectively. The Bootstrap methods PROCESS program is employed to test the mediation and moderation model. RESULTS The findings indicated that health-promoting lifestyles are negatively related to depressive symptoms and frailty, while frailty is positively associated with depressive symptoms. Health-promoting lifestyles have mediated the relationship between frailty and depressive symptoms. Besides, the health-promoting lifestyles weakened the positive relationship between frailty and depression symptoms; there existed a moderating effect of health-promoting lifestyles on the relationship between frailty and depression symptoms among older adults. LIMITATIONS Given the cross-sectional study, it is impossible to make causal inferences. CONCLUSIONS A health-promoting lifestyle might be a protective factor for older adults' health in China. The mediating and moderating effect of a health-promoting lifestyle on the relationship between frailty and depression symptoms among older adults should be integrated to achieve maximum utility. Healthcare practitioners and medical service personnel are recommended to advance health education and publicity, encouraging healthy lifestyles among community-dwelling older adults with frailty to prevent depressive symptoms and promote healthy aging.
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Affiliation(s)
- Liqun Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China
| | - Yali Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan 750004, China
| | - Yiling Luo
- Department of Health Management Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021, China
| | - Yan Li
- The Center for Disease Control and Prevention of Yinchuan City, Yinchuan 750011, China
| | - Jiangping Li
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China.
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Duan L, Xiao M, Liu S, Wu Z, Chen R, Zeng R, Xie F, Ye D, Zhu W, Zhao Y, Li W, Wang J. Associations between modifiable risk factors and frailty progression among individuals with pre-frailty. Exp Gerontol 2024; 194:112494. [PMID: 38880184 DOI: 10.1016/j.exger.2024.112494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/02/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND In the context of the present global aging phenomenon, the senior population and pace of aging in China have emerged as prominent issues on the worldwide stage. Frailty, a complicated condition that is closely linked to the clinical syndrome of advancing age, poses a considerable health risk to older individuals. Frailty status was assessed by the frailty index (FI) ranging from 0 to 1, pre-frailty was defined as >0.10 to <0.25, and frailty was defined as ≥0.25. To look at the connection between modifiable risk factors and frailty progression among individuals in the pre-frailty population. METHODS Using pre-frailty patients as characterized by the 32-frailty index, the study focused on middle-aged and elderly persons from China and ultimately recruited 5,411 participants for analysis. The relationship between modifiable factors and changes in pre-frailty status throughout follow-up was investigated. Modifiable factors were body mass index (BMI), abdominal obesity, smoking status, alcohol use, and sleep status. We employed logistic regression to examine the relationships between modifiable risk factors and changes in pre-frailty status, as well as the associations between modifiable factors scores and the corresponding pre-frailty progression. Additionally, we generated the modifiable factors scores and examined how these related to modifications in the pre-frailty stage. RESULTS In this study, after a mean follow-up of 6 years, (OR = 0.59, 95%CI: 0.48-0.71) for BMI ≥ 25 kg/m2 and (OR = 0.74, 95%CI: 0.63-0.89) for concomitant abdominal obesity were significantly associated with lower reversal to a healthy state; (OR = 1.24, 95%CI:1.07-1.44) and (OR = 1.25, 95%CI: 1.10-1.42) for the group that negatively progressed further to frailty were significantly associated with increased frailty progression profile. Subsequently, investigation of modifiable factor scores and changes of pre-frailty status found that as scores increased further, frailty developed (OR = 1.12, 95%CI:1.05-1.18), with scores of 3 and 4 of (OR = 1.38, 95%CI: 1.08-1.77) and (OR = 1.52, 95%CI:1.09-2.14). Finally, we also performed a series of stratified analyses and found that rural unmarried men aged 45 to 60 years with less than a high school degree were more likely to develop a frailty state once they developed abdominal obesity. CONCLUSION In pre-frailty individuals, maintaining more favorable controllable variables considerably enhances the chance of return to normal and, conversely, increase the risk of progressing to the frailty.
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Affiliation(s)
- Lanzhi Duan
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Mengmeng Xiao
- School of Public Health of Southeast University, Nanjing 210009, China
| | - Sijia Liu
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Zhigang Wu
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Ruzhao Chen
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Rui Zeng
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Fayi Xie
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Dongmei Ye
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Wan Zhu
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Yueyue Zhao
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Wei Li
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Jiang Wang
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China.
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Falconer N, Scott IA, Abdel-Hafez A, Cottrell N, Long D, Morris C, Snoswell C, Aziz E, Jie Lam JY, Barras M. The adverse inpatient medication event and frailty (AIME-frail) risk prediction model. Res Social Adm Pharm 2024; 20:796-803. [PMID: 38772838 DOI: 10.1016/j.sapharm.2024.05.003] [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: 07/17/2023] [Revised: 03/04/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Medication harm affects between 5 and 15% of hospitalised patients, with approximately half of the harm events considered preventable through timely intervention. The Adverse Inpatient Medication Event (AIME) risk prediction model was previously developed to guide a systematic approach to patient prioritisation for targeted clinician review, but frailty was not tested as a candidate predictor variable. AIM To evaluate the predictive performance of an updated AIME model, incorporating a measure of frailty, when applied to a new multisite cohort of hospitalised adult inpatients. METHODS A retrospective cohort study was conducted at two tertiary Australian hospitals on patients discharged between 1st January and April 31, 2020. Data were extracted from electronic medical records (EMRs) and clinical coding databases. Medication harm was identified using ICD-10 Y-codes and confirmed by senior pharmacist review of medical records. The Hospital Frailty Risk Score (HFRS) was calculated for each patient. Logistic regression analysis was used to construct a modified AIME model. Candidate variables of the original AIME model, together with new variables including HFRS were tested. Performance of the final model was reported using area under the curve (AUC) and decision curve analysis (DCA). RESULTS A total of 4089 patient admissions were included, with a mean age ± standard deviation (SD) of 64 years (±19 years), 2050 patients (50%) were males, and mean HFRS was 6.2 (±5.9). 184 patients (4.5%) experienced one or more medication harm events during hospitalisation. The new AIME-Frail risk model incorporated 5 of the original variables: length of stay (LOS), anti-psychotics, antiarrhythmics, immunosuppressants, and INR greater than 3, as well as 5 new variables: HFRS, anticoagulants, antibiotics, insulin, and opioid use. The AUC was 0.79 (95% CI: 0.76-0.83) which was superior to the original model (AUC = 0.70, 95% CI: 0.65-0.74) with a sensitivity of 69%, specificity of 81%, positive predictive value of 0.14 (95% CI: 0.10-0.17) and negative predictive value of 0.98 (95% CI: 0.97-0.99). The DCA identified the model as having potential clinical utility between the probability thresholds of 0.05-0.4. CONCLUSION The inclusion of a frailty measure improved the predictive performance of the AIME model. Screening inpatients using the AIME-Frail tool could identify more patients at high-risk of medication harm who warrant timely clinician review.
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Affiliation(s)
- Nazanin Falconer
- Department of Pharmacy, Princess Alexandra Hospital, Metro South Health, 199 Ipswich Road, Brisbane, QLD, 4102, Australia; School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia; UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4102, Australia.
| | - Ian A Scott
- Department of Internal Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Ahmad Abdel-Hafez
- Clinical Informatics, Metro South Health, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia; University of Doha for Science and Technology, Doha, Qatar
| | - Neil Cottrell
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Duncan Long
- Department of Pharmacy, Princess Alexandra Hospital, Metro South Health, 199 Ipswich Road, Brisbane, QLD, 4102, Australia
| | - Christopher Morris
- Department of Internal Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Centaine Snoswell
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia; UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Ebtyhal Aziz
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia; Logan Hospital, Armstrong Rd and Loganlea Rd, Meadowbrook, Queensland QLD, 4131, Australia
| | - Jonathan Yong Jie Lam
- Department of Pharmacy, Princess Alexandra Hospital, Metro South Health, 199 Ipswich Road, Brisbane, QLD, 4102, Australia; School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Michael Barras
- Department of Pharmacy, Princess Alexandra Hospital, Metro South Health, 199 Ipswich Road, Brisbane, QLD, 4102, Australia; School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia
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Kim H, Suh HS, Lee EE. Association between dietary supplements and frailty: a cross-sectional study using national survey data in South Korea. Int J Food Sci Nutr 2024; 75:486-495. [PMID: 38816911 DOI: 10.1080/09637486.2024.2356802] [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: 09/20/2023] [Revised: 04/18/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
We aimed to examine the association between the use of specific types of dietary supplements and frailty using cross-sectional, nationally representative survey data. Adults aged ≥50 years in the Korea National Health and Nutrition Examination Survey 2018-2020 were included. We calculated a 46-item frailty index to assess frailty. In total, 27,384 older adults were included (mean age: 62.47 years; median frailty index: 0.12). Among them, 72% used at least one dietary supplement. The prevalence of dietary supplement use was higher among women than among men and in participants with higher socioeconomic status. Compared to non-users, users of dietary supplements had a healthier diet and nutrient intake, and lower levels of frailty. After adjusting for socioeconomic and dietary factors, users of vitamin C, red ginseng or calcium were found to be significantly less frail. Our findings indicate promising results concerning dietary supplement intake in managing frailty among older Korean adults.
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Affiliation(s)
- Hyunjoo Kim
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hae Sun Suh
- College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul, Republic of Korea
| | - Eunkyung Euni Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
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Penfold RS, Hunt A. Redefining risk in peri-operative frailty: towards routine frailty assessment and a whole pathway approach. Anaesthesia 2024; 79:797-800. [PMID: 38775328 DOI: 10.1111/anae.16264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Rose S Penfold
- Department of Ageing and Health, Usher Institute, University of Edinburgh and Advanced Care Research Centre, University of Edinburgh, Scotland, UK
| | - Adam Hunt
- Research Department of Targeted Intervention, University College London, London, UK
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Yu J, Si H, Liu Q, Li Y, Zhou W, Wang C. Does Social Support Moderate the Relationship Between Frailty and Functional Ability Trajectory Among Community-Dwelling Older Adults? J Gerontol A Biol Sci Med Sci 2024; 79:glae145. [PMID: 38813979 DOI: 10.1093/gerona/glae145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Functional ability is the important prerequisite to live independently and achieve aging in place, which depends on the complex interaction of intrinsic and extrinsic factors. Identifying the trends and influencing factors of functional ability would contribute to the accurate assessment and intervention of geriatric health. This study aimed to disentangle the moderating effect of 3 types of social support, namely objective support, subjective support, and support utilization, on the relationship between frailty and functional ability trajectories. METHODS This was a secondary analysis using data from a prospective 3-wave study with a sample of 777 Chinese community-dwelling older adults. Social support was assessed using the Social Support Rating scale. Frailty was assessed using the FRAIL scale. Functional ability was measured by the Lawton Instrumental Activities of Daily Living scale. Latent growth curve models were implemented to test their relationships. RESULTS Objective support but not subjective support or support utilization moderated on the relationship between frailty and functional ability slope. Functional ability decline over time was buffered by objective support among robust individuals but exacerbated among (pre)frail individuals. CONCLUSIONS The moderating effect of social support on the relationship between frailty and functional ability trajectory varies by support types, which reminded that social support may be a promising intervention target to maintain functional independence for frail individuals, opening up a new perspective on social support in the field of disability prevention. Effective interventions should particularly address objective support in conjunction with empowering the frail older population to optimize the trajectory of functional ability.
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Affiliation(s)
- Jiaqi Yu
- School of Nursing, Peking University, Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, Beijing, China
| | - Qinqin Liu
- School of Nursing, Peking University, Beijing, China
| | - Yanyan Li
- School of Nursing, Peking University, Beijing, China
| | - Wendie Zhou
- School of Nursing, Peking University, Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, Beijing, China
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Das S, Bagepally BS, Eerike M, Cherian JJ, Dasgupta S, Mathews G, Rao S. Performance in a Balance Test and Prediction of All-Cause Mortality in Community-Dwelling Elderly Ambulatory Individuals: A Systematic Review and Meta-analysis. Res Aging 2024; 46:437-448. [PMID: 38336358 DOI: 10.1177/01640275241232392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Objective: This systematic review and meta-analysis was performed to evaluate the association between an inability to perform a static balance test and mortality in community-dwelling older ambulatory individuals. Methods: PubMed, Embase, and Scopus were searched for relevant cohort studies. Hazard ratios (HR) were pooled (random-effect model). Meta-regression was performed with independent demographic variables (PROSPERO ID: CRD42022381137). Results: A total of 11,713 articles were screened and 15 were included. An inability to perform a static balance test was significantly associated with a higher risk of mortality irrespective of whether confounding variables were considered [HR, 1.14 (95% CI: 1.07-1.21); p < .001; i2, 87.96% (p < .01)] or not [HR, 1.11 (95% CI: 1.03-1.20); p = .01; i2, 95.28% (p < .01)] (both moderate GRADE evidence). Also, this association was correlated with progressive age. Conclusion: An inability to successfully complete a static balance test was significantly associated with a higher risk of mortality among community-dwelling older ambulatory individuals.
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Affiliation(s)
- Saibal Das
- Indian Council of Medical Research - Centre for Ageing and Mental Health, Kolkata, India
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Bhavani S Bagepally
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
| | - Madhavi Eerike
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, India
| | - Jerin J Cherian
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Indian Council of Medical Research, New Delhi, India
| | - Shreyashi Dasgupta
- Department of Clinical and Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata, India
| | - George Mathews
- Sports Authority of India, Lakshmibai National College of Physical Education, Trivandrum, India
| | - Shailaja Rao
- Department of Geriatric Medicine, Government Medical College, Aurangabad, India
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Cipolli GC, Ribeiro IC, Yasuda CL, Balthazar MLF, Fattori A, Yassuda MS. Frailty and brain changes in older adults without cognitive impairment: A scoping review. Arch Gerontol Geriatr 2024; 123:105395. [PMID: 38492289 DOI: 10.1016/j.archger.2024.105395] [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: 12/22/2023] [Revised: 02/11/2024] [Accepted: 03/02/2024] [Indexed: 03/18/2024]
Abstract
Little is known about changes in the brain associated with frailty, in particular, which brain areas could be related to frailty in older people without cognitive impairment. This scoping review mapped evidence on functional and/or structural brain changes in frail older adults without cognitive impairment. The methodology proposed by the JBI® was used in this study. The search in PubMed, PubMed PMC, BVS/BIREME, EBSCOHOST, Scopus, Web of Science, Embase, and PROQUEST was conducted up to January 2023. Studies included following the population, concepts, context and the screening and data extraction were performed by two independent reviewers. A total of 9,912 records were identified, 5,676 were duplicates and were excluded. The remaining articles were screened; 31 were read in full and 17 articles were included. The results showed that lesions in white matter hyperintensities, reduced volume of the hippocampus, cerebellum, middle frontal gyrus, low gray matter volume, cortical atrophy, decreased connectivity of the supplementary motor area, presence of amyloid-beta peptide (aβ) in the anterior and posterior putamen and precuneus regions were more frequently observed in frail older adults, compared with non-frail individuals. Studies have suggested that such findings may be of neurodegenerative or cerebrovascular origin. The identification of these brain alterations in frail older adults through neuroimaging studies contributes to our understanding of the underlying mechanisms of frailty. Such findings may have implications for the early detection of frailty and implementation of intervention strategies.
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Affiliation(s)
- Gabriela Cabett Cipolli
- Postgraduate Program in Gerontology, College of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Isadora Cristina Ribeiro
- Postgraduate Program in Medical Pathophysiology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Clarissa Lin Yasuda
- Faculty of Medical Sciences, Department of Neurology, State University of Campinas, Campinas, Brazil
| | | | - André Fattori
- Postgraduate Program in Gerontology, College of Medical Sciences, State University of Campinas, Campinas, Brazil; Faculty of Medical Sciences, Department of Internal Medicine, State University of Campinas, Campinas, Brazil
| | - Mônica Sanches Yassuda
- Postgraduate Program in Gerontology, College of Medical Sciences, State University of Campinas, Campinas, Brazil; Postgraduate Program in Gerontology, University of São Paulo, São Paulo, Brazil.
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Dominguez JF, Sursal T, Kazim SF, Ng C, Vazquez S, DAS A, Naftchi A, Spirollari E, Elkun Y, Gatzoflias S, Ampie L, Feldstein E, Uddin A, Damodara N, Hanft SJ, Gandhi CD, Bowers CA. Frailty is a risk factor for intracranial abscess and is associated with longer length of stay: a retrospective single institution case-control study. J Neurosurg Sci 2024; 68:422-427. [PMID: 35416458 DOI: 10.23736/s0390-5616.22.05720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intracranial abscess (IA) causes significant morbidity and mortality. The impact of baseline frailty status on post-operative outcomes of IA patients remains largely unknown. The present study evaluated if frailty status can be used to prognosticate outcomes in IA patients. METHODS We retrospectively reviewed all IA patients undergoing craniotomy at our institution from 2011 to 2018 (N.=18). These IA patients were age and gender matched with patients undergoing craniotomy for intracranial tumor (IT), an internal control for comparison. Demographic and clinical data were collected to measure frailty, using the modified frailty index-11 (mFI-11) and pre-operative American Society of Anesthesiologists Physical Status Classification System (ASA). Post-operative complications were measured by the Clavien-Dindo Grade (CDG). RESULTS No significant difference in mFI-11 or ASA score was observed between the IA and IT groups (P=0.058 and P=0.131, respectively). IA patients had significantly higher CDG as compared with the control IT patients (P<0.001). There was a trend towards increasing LOS in the IA group as compared to the IT group (P=0.053). Increasing mFI and ASA were significant predictors of LOS by multiple linear regression in the IA group (P=0.006 and P=0.001, respectively), but not in the control IT group. Neither mFI-11 nor ASA were found to be predictors for CDG in either group. Within this case-control group of patients, we found an increase for odds of having IA with increasing mFI (OR=1.838, 95% CI: 1.016-3.362, P=0.044). CONCLUSIONS Frail IA patients tend to have more severe postoperative complications. The mFI-11 seems to predict increased resource utilization in the form of LOS. This study provides the initial retrospective data of another neurosurgical pathology where frailty leads to significantly worse outcomes. We also found that mFI may serve as a potential risk factor for severe disease.
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Affiliation(s)
- Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA -
| | - Tolga Sursal
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Syed F Kazim
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | | | | | - Ankita DAS
- New York Medical College, Valhalla, NY, USA
| | | | | | | | | | - Leonel Ampie
- Department of Neurosurgery, University of Virginia-National Institute of Health, Bethesda, MD, USA
| | - Eric Feldstein
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Anaz Uddin
- New York Medical College, Valhalla, NY, USA
| | - Nitesh Damodara
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Simon J Hanft
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
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12
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Hudelist B, Elia A, Roux A, Paun L, Schumacher X, Hamza M, Demasi M, Moiraghi A, Dezamis E, Chrétien F, Benzakoun J, Oppenheim C, Zanello M, Pallud J. Impact of frailty on survival glioblastoma, IDH-wildtype patients. J Neurooncol 2024; 169:61-72. [PMID: 38762828 DOI: 10.1007/s11060-024-04699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Frailty increases the risk of mortality among patients. We studied the prognostic significance of frailty using the modified 5-item frailty index (5-mFI) in patients harboring a newly diagnosed supratentorial glioblastoma, IDH-wildtype. METHODS We retrospectively reviewed records of patients surgical treated at a single neurosurgical institution at the standard radiochemotherapy era (January 2006 - December 2021). Inclusion criteria were: age ≥ 18, newly diagnosed glioblastoma, IDH-wildtype, supratentorial location, available data to assess the 5-mFI index. RESULTS A total of 694 adult patients were included. The median overall survival was longer in the non-frail subgroup (5-mFI < 2, n = 538 patients; 14.3 months, 95%CI 12.5-16.0) than in the frail subgroup (5-mFI ≥ 2, n = 156 patients; 4.7 months, 95%CI 4.0-6.5 months; p < 0.001). 5-mFI ≥ 2 (adjusted Hazard Ratio (aHR) 1.31; 95%CI 1.07-1.61; p = 0.009) was an independent predictor of a shorter overall survival while age ≤ 60 years (aHR 0.78; 95%CI 0.66-0.93; p = 0.007), KPS score ≥ 70 (aHR 0.71; 95%CI 0.58-0.87; p = 0.001), unilateral location (aHR 0.67; 95%CI 0.52-0.87; p = 0.002), total removal (aHR 0.54; 95%CI 0.44-0.64; p < 0.0001), and standard radiochemotherapy protocol (aHR 0.32; 95%CI 0.26-0.38; p < 0.0001) were independent predictors of a longer overall survival. Frailty remained an independent predictor of overall survival within the subgroup of patients undergoing a first-line oncological treatment after surgery (n = 549) and within the subgroup of patients who benefited from a total removal plus adjuvant standard radiochemotherapy (n = 209). CONCLUSION In newly diagnosed supratentorial glioblastoma, IDH-wildtype patients treated at the standard combined radiochemotherapy era, frailty, defined using a 5-mFI score ≥ 2 was an independent predictor of overall survival.
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Affiliation(s)
- Benoît Hudelist
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Angela Elia
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Alexandre Roux
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Luca Paun
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Xavier Schumacher
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Meissa Hamza
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Marco Demasi
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Alessandro Moiraghi
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Edouard Dezamis
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
| | - Fabrice Chrétien
- Service de Neuropathologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, F-75014, France
| | - Joseph Benzakoun
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
- Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, F-75014, France
| | - Catherine Oppenheim
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
- Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, F-75014, France
| | - Marc Zanello
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Johan Pallud
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France.
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France.
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13
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Volkert D, Delzenne N, Demirkan K, Schneider S, Abbasoglu O, Bahat G, Barazzoni R, Bauer J, Cuerda C, de van der Schueren M, Doganay M, Halil M, Lehtisalo J, Piccoli GB, Rolland Y, Sengul Aycicek G, Visser M, Wickramasinghe K, Wirth R, Wunderle C, Zanetti M, Cederholm T. Nutrition for the older adult - Current concepts. Report from an ESPEN symposium. Clin Nutr 2024; 43:1815-1824. [PMID: 38970937 DOI: 10.1016/j.clnu.2024.06.020] [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: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND & AIMS In view of the global demographic shift, a scientific symposium was organised by the European Society for Clinical Nutrition and Metabolism (ESPEN) to address nutrition-related challenges of the older population and provide an overview of the current state of knowledge. METHODS Eighteen nutrition-related issues of the ageing global society were presented by international experts during the symposium and summarised in this report. RESULTS Anorexia of ageing, dysphagia, malnutrition, frailty, sarcopenia, sarcopenic obesity, and the metabolic syndrome were highlighted as major nutrition-related geriatric syndromes. Great progress has been made in recent years through standardised definitions of some but not all syndromes. Regarding malnutrition, the GLIM approach has shown to be suitable also in older adults, justifying its continuous implementation. For anorexia of ageing, a consensus definition is still required. Intervention approaches should be integrated and person-centered with the aim of optimizing intrinsic capacity and maintaining functional capacity. Landmark studies like EFFORT and FINGER have impressively documented the potential of individualised and multifactorial interventions for functional and health benefits. Combining nutritional intervention with physical training seems particularly important whereas restrictive diets and drug treatment should generally be used with caution because of undesirable risks. Obesity management in older adults should take into account the risk of promoting sarcopenia. CONCLUSIONS In the future, even more individualised approaches like precision nutrition may enable better nutritional care. Meanwhile all stakeholders should focus on a better implementation of currently available strategies and work closely together to improve nutritional care for older adults.
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Affiliation(s)
- D Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - N Delzenne
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium.
| | - K Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkiye.
| | - S Schneider
- Gastroenterology and Nutrition, CHU de Nice, Université Côte d'Azur, Nice, France.
| | - O Abbasoglu
- Department of Clinical Nutrition, Hacettepe University, Ankara, Turkiye.
| | - G Bahat
- Department of Internal Medicine, Division of Geriatrics, Medical Faculty, Istanbul University, Istanbul, Turkiye.
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
| | - J Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Germany.
| | - C Cuerda
- Department of Medicine, Universidad Complutense, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - M de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
| | - M Doganay
- Department of Surgery and Surgical Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkiye.
| | - M Halil
- Department of Internal Medicine, Division of Geriatrics, Medical Faculty, Hacettepe University, Ankara, Turkiye.
| | - J Lehtisalo
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - G B Piccoli
- Nephrologie, Centre Hospitalier Le Mans, Le Mans, France.
| | - Y Rolland
- IHU HealthAge, Centre Hospitalo-Universitaire de Toulouse, France; Centre for Epidemiology and Research in POPulation Health, CERPOP UMR 1295, Toulouse, France.
| | | | - M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - K Wickramasinghe
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - R Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
| | - C Wunderle
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
| | - M Zanetti
- Geriatric Clinic, Department of Medical Sciences, University of Trieste, Italy.
| | - T Cederholm
- Department of Clinical Nutrition & Metabolism, Uppsala University and Theme Inflammation & Aging, Karolinska University Hospital, Stockholm, Sweden.
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14
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Fletcher K, Cortellini A, Ganta T, Kankaria R, Song H, Ye F, Irlmeier R, Debnath N, Saeed A, Radford M, Alahmadi A, Diamond A, Hoimes C, Presley CJ, Owen DH, Abou Alaiwi S, Nassar AH, Lamberti G, Perrone F, Buti S, Giusti R, Filetti M, Vanella V, Mallardo D, Sussman TA, Galetta D, Kalofonou F, Daniels E, Ascierto PA, Pinato DJ, Nebhan C, Berg S, Choueiri TK, Marron TU, Wang Y, Naqash AR, Johnson DB. Safety and efficacy outcomes of early cessation of anti-PD1 therapy in patients 80 years or older: A retrospective cohort study. Cancer Lett 2024; 596:217001. [PMID: 38838764 DOI: 10.1016/j.canlet.2024.217001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024]
Abstract
Older patients have similar immune checkpoint inhibitor efficacy and rates of adverse events as younger patients, but appear to have decreased tolerability, particularly in the oldest patient cohort (>80 years), often leading to early cessation of therapy. We aimed to determine whether early discontinuation impacts efficacy of anti-PD-1 therapy in patients ≥80 years old. In this retrospective, multicenter, international cohort study, we examined 773 patients with 4 tumor types who were at least 80 years old and treated with anti-PD-1 therapy. We determined response rate, overall survival (OS), and progression-free survival (PFS) in patients who discontinued therapy early (<12 months) for reasons other than progression or death. We used descriptive statistics for demographics, response, and toxicity rates. Survival statistics were described using Kaplan Meier curves. Median (range) age at anti-PD-1 initiation was 83.0 (75.8-97.0) years. The cancer types included were melanoma (n = 286), non-small cell lung cancer (NSCLC) (n = 345), urothelial cell carcinoma (UCC) (n = 108), and renal cell carcinoma (RCC) (n = 34). Of these, 102 met the primary endpoint of <12 months to discontinuation for reasons other than death or progression. Median PFS and OS, respectively, for these patients were 34.4 months and 46.6 months for melanoma, 15.8 months and 23.4 months for NSCLC, and 10.4 months and 15.8 months for UCC. This study suggests geriatric patients who have demonstrated therapeutic benefit and discontinued anti-PD-1 therapy at less than 12 months of duration for reasons other than progression may have durable clinical benefit without additional therapy.
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Affiliation(s)
- Kylie Fletcher
- Vanderbilt University School of Medicine, Nashville, USA.
| | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Roma, Italy; Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
| | - Teja Ganta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roma Kankaria
- Vanderbilt University School of Medicine, Nashville, USA
| | - Haocan Song
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rebecca Irlmeier
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Neha Debnath
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anwaar Saeed
- Division of Hematology & Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Asrar Alahmadi
- Case Western Reserve University, Division of Hematology & Oncology, Cleveland, OH, USA; Ohio State University, The James Comprehensive Cancer Center, Columbus
| | - Akiva Diamond
- Case Western Reserve University, Division of Hematology & Oncology, Cleveland, OH, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Christopher Hoimes
- Case Western Reserve University, Division of Hematology & Oncology, Cleveland, OH, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Carolyn J Presley
- Ohio State University, The James Comprehensive Cancer Center, Columbus
| | - Dwight H Owen
- Ohio State University, The James Comprehensive Cancer Center, Columbus
| | - Sarah Abou Alaiwi
- Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Amin H Nassar
- Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Giuseppe Lamberti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma and Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma and Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant'Andrea, Rome, Italy
| | - Marco Filetti
- Phase 1 Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Vito Vanella
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | - Tamara A Sussman
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Domenico Galetta
- IRCCS Istituto Tumori Giovanni Paolo II, Medical Thoracic Oncology Unit, Bari, Italy
| | - Foteini Kalofonou
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ella Daniels
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Department of Translational Medicine, University of Piemonte Orientale "A. Avogadro", Novara, Italy
| | | | | | | | | | - Yinghong Wang
- The University of Texas MD Anderson Cancer Center, Houston
| | - Abdul Rafeh Naqash
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, USA
| | - Douglas B Johnson
- Department of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
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15
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Navarro CDC, Francisco A, Costa EFD, Dalla Costa AP, Sartori MR, Bizerra PFV, Salgado AR, Figueira TR, Vercesi AE, Castilho RF. Aging-dependent mitochondrial bioenergetic impairment in the skeletal muscle of NNT-deficient mice. Exp Gerontol 2024; 193:112465. [PMID: 38795789 DOI: 10.1016/j.exger.2024.112465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/02/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
Overall health relies on features of skeletal muscle that generally decline with age, partly due to mechanisms associated with mitochondrial redox imbalance and bioenergetic dysfunction. Previously, aged mice genetically devoid of the mitochondrial NAD(P)+ transhydrogenase (NNT, encoded by the nicotinamide nucleotide transhydrogenase gene), an enzyme involved in mitochondrial NADPH supply, were shown to exhibit deficits in locomotor behavior. Here, by using young, middle-aged, and older NNT-deficient (Nnt-/-) mice and age-matched controls (Nnt+/+), we aimed to investigate how muscle bioenergetic function and motor performance are affected by NNT expression and aging. Mice were subjected to the wire-hang test to assess locomotor performance, while mitochondrial bioenergetics was evaluated in fiber bundles from the soleus, vastus lateralis and plantaris muscles. An age-related decrease in the average wire-hang score was observed in middle-aged and older Nnt-/- mice compared to age-matched controls. Although respiratory rates in the soleus, vastus lateralis and plantaris muscles did not significantly differ between the genotypes in young mice, the rates of oxygen consumption did decrease in the soleus and vastus lateralis muscles of middle-aged and older Nnt-/- mice. Notably, the soleus, which exhibited the highest NNT expression level, was the muscle most affected by aging, and NNT loss. Additionally, histology of the soleus fibers revealed increased numbers of centralized nuclei in older Nnt-/- mice, indicating abnormal morphology. In summary, our findings suggest that NNT expression deficiency causes locomotor impairments and muscle dysfunction during aging in mice.
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Affiliation(s)
- Claudia D C Navarro
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), 13083 887 Campinas, SP, Brazil
| | - Annelise Francisco
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), 13083 887 Campinas, SP, Brazil; Department of Experimental Medical Science, Faculty of Medicine, Lund University, 221 84 Lund, Sweden
| | - Ericka F D Costa
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), 13083 887 Campinas, SP, Brazil
| | - Ana P Dalla Costa
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), 13083 887 Campinas, SP, Brazil
| | - Marina R Sartori
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), 13083 887 Campinas, SP, Brazil
| | - Paulo F V Bizerra
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), 13083 887 Campinas, SP, Brazil
| | - Andréia R Salgado
- Multidisciplinary Center for Biological Investigation on Laboratory Animals Science, University of Campinas, Campinas, SP, Brazil
| | - Tiago R Figueira
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, 14040 900 Ribeirão Preto, SP, Brazil
| | - Anibal E Vercesi
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), 13083 887 Campinas, SP, Brazil
| | - Roger F Castilho
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), 13083 887 Campinas, SP, Brazil.
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16
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Koehler FC, Späth MR, Meyer AM, Müller RU. Fueling the success of transplantation through nutrition: recent insights into nutritional interventions, their interplay with gut microbiota and cellular mechanisms. Curr Opin Organ Transplant 2024; 29:284-293. [PMID: 38861189 DOI: 10.1097/mot.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
PURPOSE OF REVIEW The role of nutrition in organ health including solid organ transplantation is broadly accepted, but robust data on nutritional regimens remains scarce calling for further investigation of specific dietary approaches at the different stages of organ transplantation. This review gives an update on the latest insights into nutritional interventions highlighting the potential of specific dietary regimens prior to transplantation aiming for organ protection and the interplay between dietary intake and gut microbiota. RECENT FINDINGS Nutrition holds the potential to optimize patients' health prior to and after surgery, it may enhance patients' ability to cope with the procedure-associated stress and it may accelerate their recovery from surgery. Nutrition helps to reduce morbidity and mortality in addition to preserve graft function. In the case of living organ donation, dietary preconditioning strategies promise novel approaches to limit ischemic organ damage during transplantation and to identify the underlying molecular mechanisms of diet-induced organ protection. Functioning gut microbiota are required to limit systemic inflammation and to generate protective metabolites such as short-chain fatty acids or hydrogen sulfide. SUMMARY Nutritional intervention is a promising therapeutic concept including the pre- and rehabilitation stage in order to improve the recipients' outcome after solid organ transplantation.
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Affiliation(s)
- Felix C Koehler
- Department II of Internal Medicine and Center for Molecular Medicine Cologne
- CECAD Research Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin R Späth
- Department II of Internal Medicine and Center for Molecular Medicine Cologne
- CECAD Research Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna M Meyer
- Department II of Internal Medicine and Center for Molecular Medicine Cologne
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne
- CECAD Research Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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17
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Yu J, Khamzina Y, Kennedy J, Liang NL, Hall DE, Arya S, Tzeng E, Reitz KM. The association between frailty and outcomes following ruptured abdominal aortic aneurysm repair. J Vasc Surg 2024; 80:379-388.e3. [PMID: 38614142 DOI: 10.1016/j.jvs.2024.04.021] [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: 02/06/2024] [Revised: 03/28/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE Endovascular aortic repair (EVAR) is a less invasive method than the more physiologically stressful open surgical repair (OSR) for patients with anatomically appropriate abdominal aortic aneurysms (AAAs). Early postoperative outcomes are associated with both patients; physiologic reserve and the physiologic stresses of the surgical intervention. Among frail patients with reduced physiologic reserve, the stress of an aortic rupture in combination with the stress of an operative repair are less well tolerated, raising the risk of complications and mortality. This study aims to evaluate the difference in association between frailty and outcomes among patients undergoing minimally invasive EVAR and the physiologically more stressful OSR for ruptured AAAs (rAAAs). METHODS Our retrospective cohort study included adults undergoing rAAA repair in the Vascular Quality Initiative from 2010 to 2022. The validated Risk Analysis Index (RAI) (robust, ≤20; normal, 21-29; frail, 30-39; very frail, ≥40) quantified frailty. The association between the primary outcome of 1-year mortality and frailty status as well as repair type were compared using multivariable Cox models generating adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). Interaction terms evaluated the association's moderation. RESULTS We identified 5806 patients (age, 72 ± 9 years; 77% male; EVAR, 65%; robust, 6%; normal, 48%; frail, 36%; very, frail 10%) with a 53% observed 1-year mortality rate following rAAA repair. OSR (aHR, 1.43; 95% CI, 1.19-1.73) was associated with increased 1-year mortality when compared with EVAR. Increasing frailty status (frail aHR, 1.26; 95% CI, 1.00-1.59; very frail aHR, 1.64; 95% CI, 1.26-2.13) was associated with increased 1-year mortality, which was moderated by repair type (P-interaction < .05). OSR was associated with increased 1-year mortality in normal (aHR, 1.49; 95% CI, 1.20-1.87) and frail (aHR, 1.51; 95% CI, 1.20-1.89), but not among robust (aHR, 0.88; 95% CI, 0.59-1.32) and very frail (aHR, 1.29; 95% CI, 0.97-1.72) patients. CONCLUSIONS Frailty and OSR were associated with increased adjusted risk of 1-year mortality following rAAA repair. Among normal and frail patients, OSR was associated with an increased adjusted risk of 1-year mortality when compared with EVAR. However, there was no difference between OSR and EVAR among robust patients who can well tolerate the stress of OSR and among very frail patients who are unable to withstand the surgical stress from rAAA regardless of repair type.
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Affiliation(s)
- Jia Yu
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Jason Kennedy
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Nathan L Liang
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Vascular Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Daniel E Hall
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Surgery Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Shipra Arya
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, PA
| | - Edith Tzeng
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Vascular Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Katherine M Reitz
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Vascular Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
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Handforth C, Paggiosi MA, Jacques R, Gossiel F, Eastell R, Walsh JS, Brown JE. The impact of androgen deprivation therapy on bone microarchitecture in men with prostate cancer: A longitudinal observational study (The ANTELOPE Study). J Bone Oncol 2024; 47:100611. [PMID: 39021590 PMCID: PMC11253680 DOI: 10.1016/j.jbo.2024.100611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Androgen Deprivation Therapy (ADT) for prostate cancer (PC) has substantial negative impacts on the musculoskeletal system and body composition. Many studies have focused on the effects of ADT on areal bone mineral density (aBMD), but aBMD does not capture key determinants of bone strength and fracture risk, for example volumetric bone density (vBMD), geometry, cortical thickness and porosity, trabecular parameters and rate of remodelling. More specialist imaging techniques such as high-resolution peripheral quantitative computed tomography (HR-pQCT) have become available to evaluate these parameters. Although it has previously been demonstrated that bone microarchitectural deterioration occurs in men undergoing ADT, the aim of the ANTELOPE study was to examine longitudinal changes in bone microstructure alongside a range of musculoskeletal parameters and frailty, comparing men with PC receiving ADT alone or ADT plus chemotherapy for metastatic disease, with a healthy age-matched population. Methods We used HR-pQCT to investigate effects of 12 months of ADT on vBMD and microstructural parameters, complemented by assessment of changes in aBMD, serum bone turnover markers, sex hormones, body composition, grip strength, physical and muscle function, frailty and fracture risk. We studied three groups: Group A - men with localised/locally advanced PC due to commence ADT; Group B - men with newly diagnosed hormone-sensitive, metastatic PC, starting ADT alongside docetaxel chemotherapy and steroids; Group C - healthy, age-matched men. The primary endpoint was change in vBMD (Group A vs Group C) at the distal radius. Results Ninety-nine participants underwent baseline study assessments (Group A: n = 38, Group B: n = 30 and Group C: n = 31). Seventy-five participants completed all study assessments (Group A (29), Group B (18), Group C (28). At baseline, there were no significant differences between Groups A and C in any of the BMD or bone microstructure outcomes of interest. After 12 months of ADT treatment, there was a significantly greater decrease in vBMD (p < 0.001) in Group A (mean 12-month change = -13.7 mg HA/cm3, -4.1 %) compared to Group C (mean 12-month change = -1.3 mg HA/cm3, -0.4 %), demonstrating achievement of primary outcome. Similar effects were observed when comparing the change in vBMD between Group B (mean 12-month change = -13.5 mg HA/cm3, -4.3 %) and Group C. These changes were mirrored in aBMD. ADT resulted in microstructural deterioration, a reduction in estimated bone strength and an increase in bone turnover. There was evidence of increase in total fat mass and trunkal fat mass in ADT-treated patients, with marked loss in upper limb mass, along with BMI gain. Frailty increased and physical performance and strength deteriorated in both ADT groups, relative to the healthy control group. Conclusion The study showed that ADT has profound effects on vBMD, aBMD, bone microstructure and strength and body composition, and important impacts on frailty and physical performance. Whilst DXA remains a valuable tool (changes in aBMD are of the same magnitude as those observed for vBMD), HR-pQCT should be considered for assessing the effects of anti-androgens and other newer PC therapies on bone, as well as potential mitigation by bone-targeted agents.
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Affiliation(s)
- Catherine Handforth
- Leeds Teaching Hospitals NHS Trust, UK
- Division of Clinical Medicine, Faculty of Health, University of Sheffield, UK
| | | | - Richard Jacques
- Sheffield Centre for Health and Related Research, University of Sheffield, UK
| | - Fatma Gossiel
- Division of Clinical Medicine, Faculty of Health, University of Sheffield, UK
| | - Richard Eastell
- Division of Clinical Medicine, Faculty of Health, University of Sheffield, UK
| | - Jennifer S. Walsh
- Division of Clinical Medicine, Faculty of Health, University of Sheffield, UK
| | - Janet E. Brown
- Division of Clinical Medicine, Faculty of Health, University of Sheffield, UK
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Félix J, Martínez de Toda I, Díaz-Del Cerro E, González-Sánchez M, De la Fuente M. Frailty and biological age. Which best describes our aging and longevity? Mol Aspects Med 2024; 98:101291. [PMID: 38954948 DOI: 10.1016/j.mam.2024.101291] [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: 11/09/2023] [Revised: 05/01/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
Frailty and Biological Age are two closely related concepts; however, frailty is a multisystem geriatric syndrome that applies to elderly subjects, whereas biological age is a gerontologic way to describe the rate of aging of each individual, which can be used from the beginning of the aging process, in adulthood. If frailty reaches less consensus on the definition, it is a term much more widely used than this of biological age, which shows a clearer definition but is scarcely employed in social and medical fields. In this review, we suggest that this Biological Age is the best to describe how we are aging and determine our longevity, and several examples support our proposal.
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Affiliation(s)
- Judith Félix
- Department of Genetics, Physiology, and Microbiology (Unit of Animal Physiology), Faculty of Biological Sciences, Complutense University of Madrid, 28040 Madrid, Spain; Institute of Investigation Hospital 12 Octubre (imas12), 28041 Madrid, Spain.
| | - Irene Martínez de Toda
- Department of Genetics, Physiology, and Microbiology (Unit of Animal Physiology), Faculty of Biological Sciences, Complutense University of Madrid, 28040 Madrid, Spain; Institute of Investigation Hospital 12 Octubre (imas12), 28041 Madrid, Spain.
| | - Estefanía Díaz-Del Cerro
- Department of Genetics, Physiology, and Microbiology (Unit of Animal Physiology), Faculty of Biological Sciences, Complutense University of Madrid, 28040 Madrid, Spain; Institute of Investigation Hospital 12 Octubre (imas12), 28041 Madrid, Spain.
| | - Mónica González-Sánchez
- Department of Genetics, Physiology, and Microbiology (Unit of Genetics), Faculty of Biological Sciences, Complutense University of Madrid, 28040 Madrid, Spain; Institute of Investigation Hospital 12 Octubre (imas12), 28041 Madrid, Spain.
| | - Mónica De la Fuente
- Department of Genetics, Physiology, and Microbiology (Unit of Animal Physiology), Faculty of Biological Sciences, Complutense University of Madrid, 28040 Madrid, Spain; Institute of Investigation Hospital 12 Octubre (imas12), 28041 Madrid, Spain.
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Taithongchai A, Mohamed-Ahmed R, Sinha S, Gibson W, Giarenis I, Robinson D, Abrams P. Should hormone replacement therapy (any route of administration) be considered in all postmenopausal women with lower urinary tract symptoms? Report from the ICI-RS 2023. Neurourol Urodyn 2024; 43:1321-1327. [PMID: 38289324 DOI: 10.1002/nau.25384] [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: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
AIMS This International Consultation on Incontinence-Research Society report aims to summarize the evidence and uncertainties regarding the use of hormone replacement therapy by any route in the management of lower urinary tract symptoms (LUTS) including recurrent urinary tract infections (rUTI), with a review of special considerations for the elderly. Research question proposals to further this field have been highlighted. METHODS An overview of the existing evidence, guidelines, and consensus regarding the use of topical or systemic estrogens in the management of LUTS. RESULTS There are currently evidence and recommendations to offer topical estrogens to postmenopausal women with overactive bladder symptoms as well as postmenopausal women with rUTIs. Systemic estrogens however have been shown in a meta-analysis to have a negative effect on LUTS and, therefore are not currently recommended. CONCLUSIONS Although available evidence and recommendations exist for the use of topical estrogens, few women are commenced on these in primary care. There remain large gaps still within our knowledge of the use of estrogens within the management of LUTS, particularly on when it should be commenced, the length of time treatment should be continued for, and barriers to prescribing.
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Affiliation(s)
| | | | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | - William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ilias Giarenis
- Department of Urogynaecology, Norfolk and Norwich Hospital, Norwich, UK
| | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London, UK
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21
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Hu FH, Feng LP, Jia YJ, Ge MW, Shen LT, Liu P, Chen HL. Frailty and all-cause and cancer-related mortality in cancer patients: A prospective cohort study. Eur J Oncol Nurs 2024; 71:102667. [PMID: 39003843 DOI: 10.1016/j.ejon.2024.102667] [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: 05/30/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To evaluate the associations between frailty and all-cause and cancer-related mortality. Additionally, the objective is to compare the magnitude of these associations between older adults and younger adults. METHODS We gathered baseline data from NHANES (1999-2018) and developed a cumulative index consisting of 39 items to evaluate frailty. The National Death Index database was utilized to track the survival status of individuals. The Cox regression model was employed to estimate the associations between frailty status and all-cause and cancer-related mortality. RESULTS Ultimately, 3398 cancer patients were included in the analysis, comprising 910 younger adults and 2488 older adults. Compared to non-frail patients, the elevated all-cause and cancer-related mortality among pre-frail patients was not statistically significant (HRs = 1.312, 95%CI: 0.956-1.800, P = 0.092; HRs = 1.462, 0.811-2.635, P = 0.207). However, a significant elevation of both all-cause and cancer-related mortality risk was observed among frail patients (HRs = 2.213, 1.617-3.030, P < 0.001; HRs = 2.463, 95%CI = 1.370-4.429, P = 0.003). Frailty individuals demonstrated a more pronounced association with the prediction of all-cause mortality in younger (HRs = 2.230, 1.073-4.634, P = 0.032) than in older adults (HRs = 2.090, 1.475-2.960, P < 0.001). Sensitivity analysis consistently revealed robust results. RCS plots suggested a progressively escalating dose-response correlation between frailty and both all-cause and cancer-related mortality risk. CONCLUSIONS Pre-frailty did not result in an increase in mortality risks compared to non-frailty. However, frailty caused a higher all-cause and cancer-related mortality risk than non-frailty. Identifying those at risk and implementing targeted interventions may contribute to extending healthy life expectancy, regardless of age.
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Affiliation(s)
- Fei-Hong Hu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Li-Ping Feng
- Family-Centered Maternity Ward, Affiliated Hospital of Nantong University, Nantong University, Nantong, Jiangsu, China
| | - Yi-Jie Jia
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Meng-Wei Ge
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Lu-Ting Shen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Peng Liu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China.
| | - Hong-Lin Chen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China.
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22
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Brennan TH, Lewis LK, Gordon SJ, Prichard I. Effectiveness of interventions to prevent or reverse pre-frailty and frailty in middle-aged community dwelling adults: A systematic review. Prev Med 2024; 185:108008. [PMID: 38797264 DOI: 10.1016/j.ypmed.2024.108008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/06/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Frailty, marked by diminished physiological capacity and higher health risks, is less understood in middle-aged individuals (40-65 years) than older adults. This review synthesises intervention studies for pre-frailty and frailty in this demographic, assessing effectiveness, feasibility, and implementation factors including participant experience and cost-effectiveness. METHOD Registered on the Open Science Framework and adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the template for intervention description and replication (TIDieR) guidelines, this review searched six databases for interventions targeting middle-aged adults. Dual screening, data extraction, risk assessment, and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) certainty evaluation were conducted. Findings were narratively synthesized due to heterogeneity. RESULTS Eight studies (2018-2023) with 2838 participants were included. Resistance training and multicomponent exercise reduced frailty; though, not always significantly. Low-intensity exercises and education-based interventions yielded mixed results, suggesting a need for further research. Positive participant experiences and cost-effectiveness of interventions such as resistance training and educational interventions supports their feasibility. Varying quality, methodologies and levels of bias indicated a need for more rigorous future research. DISCUSSION This review reveals an evidence gap in middle-aged frailty interventions. Multicomponent interventions and resistance training showed promise, but their comparative effectiveness remains uncertain. Educational and low-intensity interventions need further research to establish their effectiveness. The findings diverge from those in older adults, emphasising the need for age-specific approaches. Future studies should employ higher-quality methods and explore emerging technologies to enhance intervention effectiveness for pre-frailty and frailty in middle-aged adults.
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Affiliation(s)
- Tom H Brennan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South Australia, Australia.
| | - Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South Australia, Australia
| | - Susan J Gordon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South Australia, Australia; Aged Care Research & Industry Innovation Australia (ARIIA), Flinders University, Tonsley, South Australia, Australia
| | - Ivanka Prichard
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South Australia, Australia
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Trevisi G, Scerrati A, Rustemi O, Ricciardi L, Raneri F, Tomatis A, Piazza A, Auricchio AM, Stifano V, Dughiero M, DE Bonis P, Mangiola A, Sturiale CL. The role of the craniotomy size in the surgical evacuation of acute subdural hematomas in elderly patients: a retrospective multicentric study. J Neurosurg Sci 2024; 68:403-411. [PMID: 35380204 DOI: 10.23736/s0390-5616.22.05648-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Elderly patients operated for an acute subdural hematoma (ASDH) frequently have a poor outcome, with a high frequency of death, vegetative status, or severe disability (Glasgow Outcome Score [GOS] 1-3). Minicraniotomy has been proposed as a minimally invasive surgical treatment to reduce the impact of surgery in the elderly population. The present study aimed to compare the influence of the size of the craniotomy on the functional outcome in patients undergoing surgical treatment for ASDH. METHODS We selected patients ≥70 years old admitted to 5 Italian tertiary referral neurosurgical for the treatment of a post-traumatic ASDH between January 1, 2016, and December 31, 2019. We collected demographic data, clinical data (GCS, GOS, Charlson Comorbidity Index [CCI], antiplatelet/anticoagulant therapy, neurological deficits, seizure, pupillary size, length of stay), surgical data (craniotomy size, dividing the patients into 3 groups based on the corresponding tertile, and surgery duration), radiological data (ASDH side and thickness, midline shift, other post-traumatic lesions, extent of ASDH evacuation) and we assessed the functional outcome at hospital discharge and 6-month follow-up considering GOS=1-3 as a poor outcome. ANOVA and χ2 Tests and logistic regression models were used to assess differences in and associations between clinical-radiological characteristics and functional outcomes. RESULTS We included 136 patients (76 males) with a mean age of 78±6 years. Forty-five patients underwent a small craniotomy, 47 a medium size, and 44 a large craniotomy. Among the different craniotomy size groups, there were no differences in gender, anticoagulant/antithrombotic therapy, CCI, side of ASDH, ASDH thickness, preoperative GCS, focal deficits, seizures, and presence of other post-traumatic lesions. Patients undergoing small craniotomies were older than patients undergoing medium-large craniotomies; ASDH treated with medium size craniotomy were thinner than the others; patients undergoing large craniotomies showed greater midline shift and a higher rate of anisocoria. The three groups did not differ for functional outcome and postoperative midline shift, but the length of surgery and the rate of >50% of ASDH evacuation were lower in the small craniotomy group. CONCLUSIONS A small craniotomy was not inferior to larger craniotomies in determining functional outcomes in the treatment of ASDH in the elderly.
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Affiliation(s)
| | - Alba Scerrati
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Oriela Rustemi
- Unit of Neurosurgery1, San Bortolo Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Luca Ricciardi
- Unit of Neurosurgery, NESMOS Department, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Fabio Raneri
- Unit of Neurosurgery1, San Bortolo Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Alberto Tomatis
- Unit of Neurosurgery, Santo Spirito Hospital, Pescara, Italy
| | - Amedeo Piazza
- Unit of Neurosurgery, NESMOS Department, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Anna M Auricchio
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vito Stifano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Dughiero
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Pasquale DE Bonis
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Annunziato Mangiola
- Unit of Neurosurgery, Santo Spirito Hospital, Pescara, Italy
- Department of Neurosciences, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
| | - Carmelo L Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy -
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Padovan BV, Bijl MAJ, Langendijk JA, van der Laan HP, Van Dijk BAC, Festen S, Halmos GB. Evaluation of a new two-step frailty assessment of head and neck patients in a prospective cohort. Eur Arch Otorhinolaryngol 2024; 281:4291-4304. [PMID: 38653824 PMCID: PMC11266264 DOI: 10.1007/s00405-024-08651-8] [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: 02/10/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Assessing frailty, in head and neck cancer (HNC) patients is key when choosing appropriate treatment. Optimal screening is challenging, as it should be feasible and should avoid over-referral for comprehensive geriatric assessment (CGA) This study aims to evaluate the association between geriatric assessment using a new two-step care pathway, referral to geriatrician and adverse outcomes. METHODS This institutional retrospective analysis on a prospective cohort analysed the multimodal geriatric assessment (GA) of newly diagnosed HNC patients. Uni- and multivariable logistic regression was performed to study the association between the screening tests, and referral to the geriatrician for complete geriatric screening, and adverse outcomes. RESULTS This study included 539 patients, of whom 276 were screened. Patients who underwent the GA, were significantly older and more often had advanced tumour stages compared to non-screened patients. Referral to the geriatrician was done for 30.8% of patients. Of the 130 patients who underwent surgery, 26/130 (20%) experienced clinically relevant postoperative complications. Of the 184 patients who underwent (radio)chemotherapy, 50/184 (27.2%) had clinically relevant treatment-related toxicity. Age, treatment intensity, polypharmacy and cognitive deficits, were independently associated with referral to geriatrician. A medium to high risk of malnutrition was independently associated with acute radiation induced toxicity and adverse outcomes in general. CONCLUSION The current study showed a 30.8% referral rate for CGA by a geriatrician. Age, treatment intensity, cognitive deficits and polypharmacy were associated with higher rates of referral. Furthermore, nutritional status was found to be an important negative factor for adverse treatment outcomes, that requires attention.
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Affiliation(s)
- Beniamino Vincenzoni Padovan
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - M A J Bijl
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H P van der Laan
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B A C Van Dijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S Festen
- University Medical Center Groningen, University Medical Center for Geriatric Medicine, Groningen, The Netherlands
| | - G B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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von Renteln-Kruse W, Püschel K. [Mobility, driving, and functional competence in older people-selected results from the Longitudinal Urban Cohort Ageing Study (LUCAS)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:877-883. [PMID: 39017711 PMCID: PMC11281963 DOI: 10.1007/s00103-024-03921-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/18/2024] [Indexed: 07/18/2024]
Abstract
Mobility is crucial for independent living in old age. Older people with reduced physical ability (frailty) begin to limit their personal range of activities to their immediate living environment and ultimately to their immediate home. Diseases of the musculoskeletal system as well as neurological, psychological, cognitive, sensory, and circulatory disorders can limit functional competence (ability to live independently).In the Longitudinal Urban Cohort Ageing Study (LUCAS), from which selected results are reported in this article, participants were categorized into different functional classes (Robust, postRobust, preFrail, Frail) using the LUCAS functional index. The results show that losses in functional competence were associated with impaired mobility and reduced car driving. Impaired mobility led to restricted radius of action.The aim of healthcare in old age is to preserve independence and quality of life as long as possible. Car driving is an important part of older peoples' activities of daily living. Therefore, primary care physicians should address car driving regularly because preventive measures to strengthen functional health also strengthen car driving ability in older persons.
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Affiliation(s)
| | - Klaus Püschel
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Butenfeld 34, 22529, Hamburg, Deutschland.
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Jiang L, Yang L, Hong Z, Yao X. Association between frailty status and falling in older adults with hip fracture: a cross-sectional study. Postgrad Med 2024:1-8. [PMID: 39046320 DOI: 10.1080/00325481.2024.2384827] [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: 03/28/2024] [Revised: 06/17/2024] [Accepted: 07/23/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES There is limited research on the relationship between frailty status and falls in hip fractures in older participants. This study aimed to investigate the relationship between frailty and falls in older adults who had experienced a hip fracture. METHODS From June 2023 to January 2024, the study population comprised 253 hip fracture patients aged 60 years and over. They were admitted to the orthopedic department of a tertiary care hospital. We excluded participants with incomplete information. The 5-item FRAIL scale (Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight) was used to assess frailty status and the patient's self-reported falls. We analyzed the relationship between frailty and falls in older hip fracture patients using logistic regression models, subgroup analyses, and stratified analyses. RESULTS Finally, 174 older participants with hip fractures were identified in this study, where 155 (89.1%) had falls. Among 155 falls, 39 (78.0%) were in the robust group, 65 (91.5%) were in the pre-frail group, and 51 (96.2%) were in the frail group. An analysis revealed that among more than 60 years old hip fracture patients, each additional point in frailty score was significantly linked to a higher likelihood of experiencing a fall (OR: 1.97, 95% CI: 1.10-3.52, p < 0.05). While frailty appeared as a categorical variable, this association was stronger with an OR of 2.68 (95% CI: 0.71-10.21) in the pre-frailty group and 7.95 (95% CI: 1.11-57.08), compared to the robust group (p for trend < 0.005). In subgroup analyses, an interaction was observed between frailty and falling according to sex. In stratified analyses, the relationship between frailty status and fall significantly differed between the male and female groups (male OR: 1.49, 95% CI: 0.71 -3.13; female OR: 7.54, 95% CI: 1.13 - 50.32, p for interaction = 0.035). CONCLUSIONS The study revealed a notable correlation between frailty and falls, with gender and frailty showing an interaction impact on the increased occurrence of falls. Therefore, further research across diverse disease populations is needed to explore the link between frailty status and falls. Large-scale prospective studies are necessary to clarify the causality of this relationship. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2300073031).
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Affiliation(s)
- Lan Jiang
- Department of Trauma and Orthopedic Surgery, The Huangshan People's City Hospital, Huangshan, China
| | - Lili Yang
- Department of Trauma and Orthopedic Surgery, The Huangshan People's City Hospital, Huangshan, China
| | - Ziyuan Hong
- Department of Trauma and Orthopedic Surgery, The Huangshan People's City Hospital, Huangshan, China
| | - Xuewei Yao
- Department of Trauma and Orthopedic Surgery, The Huangshan People's City Hospital, Huangshan, China
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van Oppen JD, Coats T, Conroy S, Hayden S, Heeren P, Hullick C, Liu S, Lucke J, Lukin B, McNamara R, Melady D, Mooijaart SP, Rosen T, Banerjee J. Person-centred decisions in emergency care for older people living with frailty: principles and practice. Emerg Med J 2024:emermed-2024-213898. [PMID: 39060102 DOI: 10.1136/emermed-2024-213898] [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: 01/09/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
Older people living with frailty are frequent users of emergency care and have multiple and complex problems. Typical evidence-based guidelines and protocols provide guidance for the management of single and simple acute issues. Meanwhile, person-centred care orientates interventions around the perspectives of the individual. Using a case vignette, we illustrate the potential pitfalls of applying exclusively either evidence-based or person-centred care in isolation, as this may trigger inappropriate clinical processes or place undue onus on patients and families. We instead advocate for delivering a combined evidence-based, person-centred approach to healthcare which considers the person's situation and values, apparent problem and available options.
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Affiliation(s)
- James David van Oppen
- Centre for Urgent and Emergency Care Research, The University of Sheffield, Sheffield, UK
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Tim Coats
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Sarah Hayden
- Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pieter Heeren
- Faculty of Medicine and Life Sciences, Healthcare & Ethics Research Group, UHasselt, Hasselt, Belgium
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Flanders, Belgium
| | - Carolyn Hullick
- Australian Commission on Safety and Quality in Healthcare, Sydney, New South Wales, Australia
- The University of Newcastle Australia, Callaghan, New South Wales, Australia
| | - Shan Liu
- Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jacinta Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, Netherlands
| | - Bill Lukin
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Rosa McNamara
- Emergency Department, St Vincent's University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Don Melady
- Department of Family and Community Medicine, Schwartz Reisman Emergency Medicine Institute, Toronto, Ontario, Canada
| | - Simon P Mooijaart
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Jay Banerjee
- College of Life Sciences, University of Leicester, Leicester, UK
- Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Theodorakis N, Feretzakis G, Vamvakou G, Verykios VS, Polymeris A, Nikolaou M. Testosterone therapy for functional hypogonadism in middle-aged and elderly males: current evidence and future perspectives. Hormones (Athens) 2024:10.1007/s42000-024-00587-2. [PMID: 39060901 DOI: 10.1007/s42000-024-00587-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
Population aging is a global phenomenon driving research focus toward preventing and managing age-related disorders. Functional hypogonadism (FH) has been defined as the combination of low testosterone levels, typically serum total testosterone below 300-350 ng/dL, together with manifestations of hypogonadism, in the absence of an intrinsic pathology of the hypothalamic-pituitary-testicular (HPT) axis. It is usually seen in middle-aged or elderly males as a product of aging and multimorbidity. This age-related decline in testosterone levels has been associated with numerous adverse outcomes. Testosterone therapy (TTh) is the mainstay of treatment for organic hypogonadism with an identifiable intrinsic pathology of the HPT axis. Current guidelines generally make weak recommendations for TTh in patients with FH, mostly in the presence of sexual dysfunction. Concerns about long-term safety have historically limited TTh use in middle-aged and elderly males with FH. However, recent randomized controlled trials and meta-analyses have demonstrated safe long-term outcomes regarding prostatic and cardiovascular health, together with decreases in all-cause mortality and improvements in various domains, including sexual function, body composition, physical strength, bone density, and hematopoiesis. Furthermore, there are numerous insightful studies suggesting additional benefits of TTh, for instance in cardio-renal-metabolic conditions. Specifically, future trials should investigate the role of TTh in improving symptoms and prognosis in various clinical contexts, including sarcopenia, frailty, dyslipidemia, arterial hypertension, diabetes mellitus, fracture risk, heart failure, stable angina, chronic kidney disease, mood disorders, and cognitive dysfunction.
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Affiliation(s)
- Nikolaos Theodorakis
- Department of Cardiology & 65+ Clinic, Sismanogleio-Amalia Fleming General Hospital, 14, 25th Martiou Str, Melissia, 15127, Greece
- School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, Athens, 11527, Greece
| | - Georgios Feretzakis
- School of Science and Technology, Hellenic Open University, 18 Aristotelous Str, Patras, 26335, Greece.
| | - Georgia Vamvakou
- Department of Cardiology & 65+ Clinic, Sismanogleio-Amalia Fleming General Hospital, 14, 25th Martiou Str, Melissia, 15127, Greece
| | - Vassilios S Verykios
- School of Science and Technology, Hellenic Open University, 18 Aristotelous Str, Patras, 26335, Greece
| | - Antonis Polymeris
- Department of Endocrinology, Metabolism and Diabetes Mellitus, Sismanogleio-Amalia Fleming General Hospital, 14, 25th Martiou Str, Melissia, 15127, Greece
| | - Maria Nikolaou
- Department of Cardiology & 65+ Clinic, Sismanogleio-Amalia Fleming General Hospital, 14, 25th Martiou Str, Melissia, 15127, Greece
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James K, Jamil Y, Kumar M, Kwak MJ, Nanna MG, Qazi S, Troy AL, Butt JH, Damluji AA, Forman DE, Orkaby AR. Frailty and Cardiovascular Health. J Am Heart Assoc 2024:e031736. [PMID: 39056350 DOI: 10.1161/jaha.123.031736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
The incidence of frailty and cardiovascular disease (CVD) increases as the population ages. There is a bidirectional relationship between frailty and CVD, and both conditions share several risk factors and underlying biological mechanisms. Frailty has been established as an independent prognostic marker in patients with CVD. Moreover, its presence significantly influences both primary and secondary prevention strategies for adults with CVD while also posing a barrier to the inclusion of these patients in pivotal clinical trials and advanced cardiac interventions. This review discusses the current knowledge base on the relationship between frailty and CVD, how managing CVD risk factors can modify frailty, the influence of frailty on CVD management, and future directions for frailty detection and modification in patients with CVD.
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Affiliation(s)
- Kirstyn James
- Department of Geriatric Medicine Cork University Hospital Cork Ireland
| | - Yasser Jamil
- Department of Internal Medicine Yale University School of Medicine New Haven CT USA
| | | | - Min J Kwak
- University of Texas Health Science Center at Houston TX USA
| | - Michael G Nanna
- Department of Internal Medicine Yale University School of Medicine New Haven CT USA
| | | | - Aaron L Troy
- Department of Medicine Beth Israel Deaconess Medical Center Boston MA USA
| | - Jawad H Butt
- British Heart Foundation Cardiovascular Research Centre University of Glasgow UK
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Department of Cardiology Zealand University Hospital Roskilde Denmark
| | - Abdulla A Damluji
- Johns Hopkins University School of Medicine Baltimore MD USA
- The Inova Center of Outcomes Research Inova Heart and Vascular Institute Baltimore MD USA
| | - Daniel E Forman
- Department of Medicine (Geriatrics and Cardiology) University of Pittsburgh PA USA
- Pittsburgh GRECC (Geriatrics Research, Education and Clinical Center) VA Pittsburgh Healthcare System Pittsburgh PA USA
| | - Ariela R Orkaby
- VA Boston Healthcare System Boston MA USA
- Division of Aging, Brigham and Women's Hospital Harvard Medical School Boston MA USA
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30
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Shamsalinia A, Hosseini SR, Bijani A, Ghadimi R, Kordbageri MR, Saadati K, Ghaffari F. Effects of Frailty Syndrome on Osteoporosis, Focusing on the Mediating Effect of Muscle Strength and Balance in Community-Dwelling Older Adults (≥60 years) in Iran: Results From the Amirkola Health and Aging Project Cohort Study. Geriatr Orthop Surg Rehabil 2024; 15:21514593241264647. [PMID: 39070931 PMCID: PMC11273585 DOI: 10.1177/21514593241264647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/21/2024] [Accepted: 06/09/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction For older adults, maintaining muscle strength and balance is crucial to preserve an upright posture and independently manage their basic activities of daily living (ADL). This study aimed to examine whether muscle strength and balance mediate the relationship between frailty syndrome (FS) and osteoporosis in a large sample of community-dwelling older adults. Material and Methods This cross-sectional study is part of the second phase (2016-2017) of the Amirkola Health and Ageing Project (AHAP), a cohort study conducted on all elderly aged 60 and over in Amirkola, Northern Iran, since 2011. Data from 2018 older adults were collected by a trained person using bone mineral density (BMD), frailty index, activities of daily living (ADL), instrumental activities of daily living (IADL), handgrip strength (HGS), quadriceps muscle strength (QMS), Berg Balance Scale (BBS), and Timed Up and Go test (TUG test) and analyzed using analysis of variance, chi-square, and path analysis tests. Results The mean indices of femoral neck BMD and lumbar spine BMD, HGS, QMS, BBS, ADL, and IADL were lower in the frail older adults than in the pre-frail and non-frail older adults. In addition, the mean TUG test level was higher in the frail older adults than in the non-frail and pre-frail older adults. The results of the present study have indicated that frailty is significantly related to osteoporosis, and that balance and muscle strength can predict osteoporosis; these variables play a mediating role in the relationship between frailty and osteoporosis. Conclusion From the results of the present study, it can be concluded that frailty may increase the odds of osteoporosis. The results of the current study have indicated that balance (BBS and TUG test) and muscle strength (HGS and QMS) are associated with osteoporosis and these variables play a mediating role in the relationship between frailty and osteoporosis.
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Affiliation(s)
- Abbas Shamsalinia
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Science, Babol, Iran
| | - Seyed Reza Hosseini
- Social Determinants of Health (SDH) Research Centre, Health Research Institute, Babol University of Medical Science, Babol, Iran
| | - Ali Bijani
- Social Determinants of Health (SDH) Research Centre, Health Research Institute, Babol University of Medical Science, Babol, Iran
| | - Reza Ghadimi
- Social Determinants of Health (SDH) Research Centre, Health Research Institute, Babol University of Medical Science, Babol, Iran
| | | | - Kiyana Saadati
- Student Research Committee, Ramsar Campus, Mazandaran University of Medical Sciences, Ramsar, Iran
| | - Fatemeh Ghaffari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Science, Babol, Iran
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31
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Pu Y, Sun Z, Zhang H, Huang Q, Wang Z, Mei Z, Wang P, Kong M, Yang W, Lin C, Zhou X, Lin S, Huang Q, Huang L, Sun L, Yuan C, Xu Q, Tang H, Wang X, Zheng Y. Gut microbial features and circulating metabolomic signatures of frailty in older adults. NATURE AGING 2024:10.1038/s43587-024-00678-0. [PMID: 39054372 DOI: 10.1038/s43587-024-00678-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/03/2024] [Indexed: 07/27/2024]
Abstract
Frailty, a multidimensional indicator of suboptimal aging, reflects cumulative declines across multiple physiological systems. Although age-related changes have been reported in gut microbiota, their role in healthy aging remains unclear. In this study, we calculated frailty index (FI) from 33 health-related items to reflect the overall health status of 1,821 older adults (62-96 years, 55% female) and conducted multi-omics analysis using gut metagenomic sequencing data and plasma metabolomic data. We identified 18 microbial species and 17 metabolites shifted along with frailty severity, with stronger links observed in females. The associations of nine species, including various Clostridium species and Faecalibacterium prausnitzii, with FI were reproducible in two external populations. Plasma glycerol levels, white blood cell count and kidney function partially mediated these associations. A composite microbial score derived from FI significantly predicted 2-year mortality (adjusted hazard ratio across extreme quartiles, 2.86; 95% confidence interval, 1.38-5.93), highlighting the potential of microbiota-based strategies for risk stratification in older adults.
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Affiliation(s)
- Yanni Pu
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhonghan Sun
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Zhang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai, China
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingxia Huang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhengdong Wang
- Department of Gastroenterology, Rugao People's Hospital, Rugao, China
| | - Zhendong Mei
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peilu Wang
- Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China
| | - Mengmeng Kong
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenjun Yang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chenhao Lin
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaofeng Zhou
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuchun Lin
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiumin Huang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lili Huang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Sun
- Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China
| | - Changzheng Yuan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Qian Xu
- Institute of Gut Microbiota Research and Engineering Development, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huiru Tang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Xiaofeng Wang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai, China.
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
| | - Yan Zheng
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai, China.
- Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China.
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
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Tran A, Putnam LR, Lipham JC, Shiraga S. Utility of the mFI-5 as a predictor of post-operative outcomes following gastrectomy for gastric cancer: an ACS-NSQIP analysis. Surg Endosc 2024:10.1007/s00464-024-11103-3. [PMID: 39046494 DOI: 10.1007/s00464-024-11103-3] [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: 04/17/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Gastric cancer is the 5th most common malignancy worldwide. Surgical treatment for the disease can often be highly morbid, especially in elderly patients. The modified 5-item frailty index (mFI-5), a recently developed tool for assessing patient frailty, has been shown to be an effective predictor of post-operative outcomes in various surgical fields. This study aims to assess the utility of the mFI-5 in predicting adverse postoperative outcomes following gastrectomy for gastric cancer. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent partial or total gastrectomy for gastric cancer between 2011 and 2021. The mFI-5 score was calculated based on the presence of hypertension, congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, and partially or fully dependent functional status. Patients were stratified into 3 groups according to mFI-5 score (mFI-5 = 0, mFI-5 = 1, mFI-5 ≥ 2). Univariate analysis and multivariate logistic regression were used to evaluate the association between mFI-5 score and post-operative outcomes. RESULTS 7438 patients were identified (mFI-5 = 0: 3032, mFI-5 = 1: 2805, mFI-5 ≥ 2: 1601). mFI-5 ≥ 2 was an independent predictor of overall complications (OR 1.43, p < 0.001), serious complications (OR 1.42, p < 0.001), pneumonia (OR 1.43, p = 0.010), MI (OR 2.91, p = 0.005), and readmission within 30 days (OR 1.33, p = 0.008). Patients with higher frailty were more likely to experience unplanned intubation (OR 2.06, p < 0.001; OR 2.47, p < 0.001), failure to wean from the ventilator (OR 1.68, p = 0.003; OR 2.00, p < 0.001), acute renal failure (OR 3.25, p = 0.003; OR 3.27, p = 0.005), 30-day mortality (OR 1.73, p = 0.009; OR 1.94, p = 0.004), and non-home discharge (OR 1.34, p = 0.001; OR 1.74, p < 0.001) relative to non-frail patients. CONCLUSION Higher frailty, as indicated by an increased mFI-5 score, raises the risk of serious post-operative complications in patients with gastric cancer undergoing gastrectomy. The mFI-5 has the potential to help identify high-risk patients and enhance pre-operative discussions and optimization.
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Affiliation(s)
- Ashley Tran
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA.
| | - Luke R Putnam
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - John C Lipham
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Sharon Shiraga
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
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Safarnavadeh M, Salehi L. Psychometric adequacy of the persian adapted version of the tilburg frailty indicator (P-TFI). BMC Geriatr 2024; 24:623. [PMID: 39034390 PMCID: PMC11265109 DOI: 10.1186/s12877-024-05161-4] [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: 08/04/2023] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Frailty is identified as the primary goal of preventing the various consequences. The present study aimed to assess validity and reliability of the Persian adapted version of the Tilburg frailty indicator (TFI) in Iran. METHOD This cross-sectional study included three phases of translating the indicator to Persian, assessing the face and content validity, completing the P-TFI by older people, who helped assess the reliability and construct validity. For construct validity, convergent and divergent validity were used. It was expected that the TFI domain scores would show the highest correlations with their related measures of frailty (convergent construct validity) and the lowest correlations with measures of the other domains (divergent construct validity). The study population consisted of 400 older people, selected from six health care centers. RESULTS The mean age of the participants was 69.05 ± 7.28 years and the majority of the participants were married woman with less than a high school education. The total mean score of TFI was 8.26 ± 1.80, and 42.75% was classified as frail. The test-retest reliability was 0.88 for the total scale, 0.80 for physical, 0.65 for psychological, and 0.81 for social domains. The mean score of frailty and its dimensions (physical, psychological, and social) varied from 4.35 ± 1.78, 1.81 ± 1.33, 1.69 ± 0.73, and 0.86 ± 0.61, respectively. The total score of the TFI was correlated with each alternative measure and the convergent validity was proved. Further, the kappa values ranging from 535 to 0.967 were significant and test- retest reliability for total, physical, psychological, and social dimension were 0.88, 080, 065, and 081, respectively. Further, the convergent or divergent validity is being discussed for clarity. CONCLUSION The Persian version of the TFI is valid and easy scored tools among Iranian's older people.
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Affiliation(s)
- Maryam Safarnavadeh
- Vice Chancellery for Education, Iran Ministry of Health and Medical Education, Tehran, Iran
| | - Leili Salehi
- Department of Health Education & Promotion, School of Public Health,Research center for health,safety and environment,Karaj, Iran, Alborz University of Medical Sciences, P.O. Box 3146-883811, Karaj, Iran.
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Courish MK, O'Brien MW, Maxwell SP, Mekari S, Kimmerly DS, Theou O. Relationship between frailty and executive function by age and sex in the Canadian Longitudinal Study on Aging. GeroScience 2024:10.1007/s11357-024-01256-3. [PMID: 39014131 DOI: 10.1007/s11357-024-01256-3] [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: 01/03/2024] [Accepted: 06/12/2024] [Indexed: 07/18/2024] Open
Abstract
Frailty reflects age-related damage to multiple physiological systems. Executive dysfunction is often a presenting symptom of diseases characterized by cognitive impairment. A decline in cardiovascular health is associated with worse executive function. We tested the hypothesis that higher frailty would be associated with executive dysfunction and that cardiovascular health would mediate this relationship. Middle- and older-aged adults at baseline (n = 29,591 [51% female]) and 3-year follow-up (n = 25,488 [49% females]) from the Canadian Longitudinal Study on Aging (comprehensive cohort) were included. Frailty was determined at baseline from a 61-item index, a cumulative cardiovascular health score was calculated from 30 variables at baseline, and participants completed a word-color Stroop task as an assessment of executive function. Multiple linear regressions and mediation analyses of cardiovascular health were conducted between frailty, Stroop interference-condition reaction time, and cardiovascular health in groups stratified by both age and sex (middle-aged males [MM], middle-aged females [MF], older-aged males [OM], older-aged females [OF]). Frailty (MM, 0.15 ± 0.05; MF, 0.16 ± 0.06; OM, 0.21 ± 0.06; OF, 0.23 ± 0.06) was negatively associated with cardiovascular health (MM, 0.12 ± 0.08; MF, 0.11 ± 0.07; OM, 0.20 ± 0.10; OF, 0.18 ± 0.09; β > 0.037, p < 0.001), as well as the Stroop reaction time at 3-year follow-up (MM, 23.7 ± 7.9; MF, 23.1 ± 7.3; OM, 32.9 ± 13.1; OF, 30.9 ± 12.0; β > 2.57, p < 0.001) across all groups when adjusted for covariates. Cardiovascular health was a partial (~ 10%) mediator between frailty and reaction time, aside from MFs. In conclusion, higher frailty levels are associated with executive dysfunction, which was partially mediated by cardiovascular health. Strategies to improve frailty and better cardiovascular health may be useful for combatting the age-related decline in executive function.
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Affiliation(s)
- Molly K Courish
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Myles W O'Brien
- Geriatric Medicine Research, Dalhousie University & Nova Scotia Health, Halifax, NS, Canada
- School of Physiotherapy (Faculty of Health) and Department of Medicine (Faculty of Medicine), Division of Geriatric Medicine, & Geriatric Medicine Research, Dalhousie University & Nova Scotia Health, Halifax, NS, B3H 4R2, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, Canada
| | - Selena P Maxwell
- Geriatric Medicine Research, Dalhousie University & Nova Scotia Health, Halifax, NS, Canada
| | - Said Mekari
- Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, Canada
| | - Derek S Kimmerly
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Olga Theou
- Geriatric Medicine Research, Dalhousie University & Nova Scotia Health, Halifax, NS, Canada.
- School of Physiotherapy (Faculty of Health) and Department of Medicine (Faculty of Medicine), Division of Geriatric Medicine, & Geriatric Medicine Research, Dalhousie University & Nova Scotia Health, Halifax, NS, B3H 4R2, Canada.
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Konomi T, Yoshikawa M, Kajikawa K, Kitagawa T, Kobayashi Y, Furukawa M, Fujiyoshi K, Yato Y. Impact of Frailty on Functional Improvement Following Traumatic Spinal Cord Injury: A Japanese Single-Center Experience. J Clin Med 2024; 13:4154. [PMID: 39064194 PMCID: PMC11278503 DOI: 10.3390/jcm13144154] [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: 05/28/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Study Design: This is a retrospective case series study. Objective: The aim of this study was to investigate whether frailty contributes to functional recovery in individuals with spinal cord injury (SCI). Methods: A total of 121 patients with SCI (106 cervical SCI, 15 thoracic SCI) discharged from our center over the past three years were studied. Moreover, 11-factor modified frailty index (mFI) scores, the length of hospital stays, the rate of returning home, and improvement in Spinal Cord Independence Measure (SCIM) scores were assessed retrospectively. Results: The average age at the time of injury for all 121 cases was 59.6 years. Based on pre-injury assessments, 24 cases were categorized as the Frail group, and 97 cases were categorized as the Robust group. The Frail group had SCIM improvement rates of 16.7% and a home discharge rate of 45.8%. In contrast, the Robust group had SCIM improvement rates of 33.5% and a home discharge rate of 68.0%, with statistically significant differences between the two groups. A significant negative correlation was observed between mFI scores and SCIM improvement rates (R = -0.231, p = 0.014). Conclusions: This study suggests that individuals with pre-existing frailty before SCI experience poorer SCIM improvement rates and face challenges in returning home.
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Affiliation(s)
- Tsunehiko Konomi
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, 2-37-1 Gakuen Musashimurayama, Tokyo 208-0011, Japan
| | - Minako Yoshikawa
- Nursing Department, Murayama Medical Center, National Hospital Organization, 2-37-1 Gakuen Musashimurayama, Tokyo 208-0011, Japan
| | - Keita Kajikawa
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, 2-37-1 Gakuen Musashimurayama, Tokyo 208-0011, Japan
- Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki Tokorozawa, Saitama 359-8513, Japan
| | - Takahiro Kitagawa
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, 2-37-1 Gakuen Musashimurayama, Tokyo 208-0011, Japan
| | - Yoshiomi Kobayashi
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, 2-37-1 Gakuen Musashimurayama, Tokyo 208-0011, Japan
| | - Mitsuru Furukawa
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, 2-37-1 Gakuen Musashimurayama, Tokyo 208-0011, Japan
| | - Kanehiro Fujiyoshi
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, 2-37-1 Gakuen Musashimurayama, Tokyo 208-0011, Japan
| | - Yoshiyuki Yato
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, 2-37-1 Gakuen Musashimurayama, Tokyo 208-0011, Japan
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Lewis M, Heymann A, Zacay G, Justo D. Frailty and its association with long-term mortality among community-dwelling older adults aged 75 years and over. Isr J Health Policy Res 2024; 13:26. [PMID: 39010194 PMCID: PMC11251321 DOI: 10.1186/s13584-024-00614-y] [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: 02/08/2024] [Accepted: 05/14/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Frailty, a significant risk factor for adverse outcomes and mortality, poses an emerging challenge with profound implications for public health and clinical practice. The measurement of frailty offers potential enhancements in healthcare services for older adults. The prevalence of frailty and its association with long-term mortality in a nationwide, unselected population of community-dwelling older adults, particularly those aged 75 and over, has not been previously studied on a large scale in Israel. METHODS A retrospective cohort study was conducted at Meuhedet Health Maintenance Organization, Israel's third largest healthcare service provider, serving 1,276,000 people (13.8% of Israelis). The prevalence of frailty and its association with all-cause mortality were studied among older adults aged 75 years and over who were followed for 2-8 years. Frailty, defined by the cumulative deficit method, utilized clinical data from the preceding 10-year period, comprising 28 chronic diseases and age-related health deficits. RESULTS The cohort included 43,737 older adults, with a median age of 77 years (IQR 75-82 years); among them, 19,300 (44.1%) were males. Overall, 19,396 (44.3%) older adults were frail: 12,260 (28.0%) mildly frail, 5,533 (12.7%) moderately frail and 1,603 (3.7%) severely frail. During the follow-up period 15,064 (34.4%) older adults died: 4,782 (39.0%) mildly frail, 3,016 (54.5%) moderately frail and 1,080 (67.4%) severely frail. Cox regression analysis demonstrated that mortality was associated with severe frailty (HR 2.63, 95%CI 2.45-2.80), moderate frailty (HR 2.05, 95%CI 1.96-2.14), and mild frailty (HR 1.45, 95%CI 1.39-1.51), independent of age, gender, and population sector. Among patients aged 90 years and over, no significant differences in cumulative survival were found between those with moderate and severe frailty (p = 0.408). CONCLUSIONS Frailty is prevalent among community-dwelling Israeli older adults aged 75 years and over, and it is associated with long-term mortality. Considering its association with long-term mortality across frailty levels until the age of 90, early identification and intervention for frailty are recommended within this population. Policymakers should consider the use of the cumulative deficit method for evaluating frailty at both the population health and clinical levels.
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Affiliation(s)
- Maor Lewis
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel-Aviv, Israel.
- Faculty of Medicine and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.
| | - Anthony Heymann
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel-Aviv, Israel
- Faculty of Medicine and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Galia Zacay
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel-Aviv, Israel
- Faculty of Medicine and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Justo
- Faculty of Medicine and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Division of Geriatrics, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
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Dabhi N, Kumar J, Kellogg RT, Park MS. Mechanical thrombectomy for treatment of acute ischemic stroke in frail patients: a systematic review of the literature. J Neurointerv Surg 2024; 16:788-793. [PMID: 37487691 DOI: 10.1136/jnis-2023-020476] [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: 04/21/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The overall safety and efficacy of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in frail patients is not well delineated. This systematic review aims to summarize and compare outcomes in frail and non-frail patients who underwent MT for AIS. METHODS A systematic review of the literature was performed using PubMed, Ovid Medline, and Web of Science to identify studies with outcomes-related data for frail patients with MT-treated AIS. The recanalization rate, procedural complications, and clinical outcome at 90-day follow-up were collected. RESULTS In the four included studies there were 642 frail patients and 499 non-frail patients. Frail patients had reduced rates of good functional outcomes (29% vs 42%; χ2=22, p<0.01) and increased 90-day mortality (51% vs 25%; χ2=38, p<0.01) compared with non-frail patients. CONCLUSION MT for treatment of AIS in frail patients may be associated with worse rates of morbidity and mortality along with reduced efficacy. Given that no studies to date directly compare conservative measures with endovascular management for AIS in frail patients, more studies are required to further evaluate and identify characteristics that may improve outcomes in these patients.
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Affiliation(s)
- Nisha Dabhi
- Department of Neurosurgery, Univerisity of Virginia, Charlottesville, Virginia, USA
| | - Jeyan Kumar
- Department of Neurosurgery, Univerisity of Virginia, Charlottesville, Virginia, USA
| | - Ryan T Kellogg
- Department of Neurosurgery, Univerisity of Virginia, Charlottesville, Virginia, USA
| | - Min S Park
- Department of Neurosurgery, Univerisity of Virginia, Charlottesville, Virginia, USA
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Hanlon P, Politis M, Wightman H, Kirkpatrick S, Jones C, Khan M, Bezzina C, Mackinnon S, Rennison H, Wei L, Vetrano DL, Blane DN, Dent E, Hoogendijk EO. Frailty and socioeconomic position: A systematic review of observational studies. Ageing Res Rev 2024; 100:102420. [PMID: 39025269 DOI: 10.1016/j.arr.2024.102420] [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: 01/02/2024] [Revised: 06/04/2024] [Accepted: 07/14/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Frailty, an age-related state of reduced physiological reserve, is often associated with lower socio-economic position (SEP). This systematic review synthesised observational studies assessing (i) the association between SEP and frailty prevalence; (ii) how changes in frailty status over time vary by SEP; and (iii) whether the association between frailty and clinical outcomes is modified by SEP. METHODS We searched three electronic databases from 2001 to 2023. We included observational studies measuring early-, mid-, and late-life indicators of SEP (education, income, wealth, housing, occupation, and area-based measures of multiple deprivation) and frailty (assessed using any validated measure). Screening and extraction were performed in duplicate. Findings were synthesised using narrative synthesis. RESULTS We included 383 studies reporting findings from 265 independent samples/cohorts across 64 countries. Lower SEP was associated with higher frailty prevalence across all indicators (childhood deprivation 7/8 studies, education 227/248, occupation 28/32, housing 8/9, income 98/108, wealth 39/44 and area-based deprivation 32/34). Lower SEP was also associated with higher frailty incidence (27/30), with greater odds of transitioning towards a more severe frailty state (35/43), lower odds of frailty reversion (7/11), and (in some studies) with more rapid accumulation of deficits (7/15). The relationship between frailty and mortality was not modified by SEP. INTERPRETATION Preventative measures across multiple levels of individual and structural inequality are likely to be required to reduce the rising levels of frailty. Resourcing of interventions and services to support people living with frailty should be proportionate to needs in the population to avoid widening existing health inequalities.
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Affiliation(s)
- Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, UK.
| | - Marina Politis
- School of Health and Wellbeing, University of Glasgow, UK
| | | | | | - Caitlin Jones
- School of Health and Wellbeing, University of Glasgow, UK
| | - Maryam Khan
- School of Health and Wellbeing, University of Glasgow, UK
| | - Cara Bezzina
- School of Health and Wellbeing, University of Glasgow, UK
| | | | - Heidi Rennison
- School of Health and Wellbeing, University of Glasgow, UK
| | - Lili Wei
- School of Health and Wellbeing, University of Glasgow, UK
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Tomtebodavägen 18 A, floors 9 and 10, Solna, Sweden; Stockholm Gerontology Research Center, Sveavägen 155, Stockholm, Sweden
| | - David N Blane
- School of Health and Wellbeing, University of Glasgow, UK
| | - Elsa Dent
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia; Adelaide Primary Health Network, Adelaide, SA, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
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Li L, Duan L, Xu Y, Ruan H, Zhang M, Zheng Y, He S. Hypertension in frail older adults: current perspectives. PeerJ 2024; 12:e17760. [PMID: 39006023 PMCID: PMC11246622 DOI: 10.7717/peerj.17760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Hypertension is one of the most common chronic diseases in older people, and the prevalence is on the rise as the global population ages. Hypertension is closely associated with many adverse health outcomes, including cardiovascular disease, chronic kidney disease and mortality, which poses a substantial threat to global public health. Reasonable blood pressure (BP) management is very important for reducing the occurrence of adverse events. Frailty is an age-related geriatric syndrome, characterized by decreased physiological reserves of multiple organs and systems and increased sensitivity to stressors, which increases the risk of falls, hospitalization, fractures, and mortality in older people. With the aging of the global population and the important impact of frailty on clinical practice, frailty has attracted increasing attention in recent years. In older people, frailty and hypertension often coexist. Frailty has a negative impact on BP management and the prognosis of older hypertensive patients, while hypertension may increase the risk of frailty in older people. However, the causal relationship between frailty and hypertension remains unclear, and there is a paucity of research regarding the efficacious management of hypertension in frail elderly patients. The management of hypertension in frail elderly patients still faces significant challenges. The benefits of treatment, the optimal BP target, and the choice of antihypertensive drugs for older hypertensive patients with frailty remain subjects of ongoing debate. This review provides a brief overview of hypertension in frail older adults, especially for the management of BP in this population, which may help in offering valuable ideas for future research in this field.
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Affiliation(s)
- Liying Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Linjia Duan
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Ying Xu
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Haiyan Ruan
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
- Department of Cardiology, Traditional Chinese Medicine Hospital of Shuangliu District, Chengdu, China
| | - Muxin Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
- Department of Cardiology, First People's Hospital, Longquanyi District, Chengdu, China
| | - Yi Zheng
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
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Collinge CW, Razzoli M, Mansk R, McGonigle S, Lamming DW, Pacak CA, van der Pluijm I, Niedernhofer L, Bartolomucci A. The mouse Social Frailty Index (mSFI): a novel behavioral assessment for impaired social functioning in aging mice. GeroScience 2024:10.1007/s11357-024-01263-4. [PMID: 38987495 DOI: 10.1007/s11357-024-01263-4] [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: 04/10/2024] [Accepted: 06/23/2024] [Indexed: 07/12/2024] Open
Abstract
Various approaches exist to quantify the aging process and estimate biological age on an individual level. Frailty indices based on an age-related accumulation of physical deficits have been developed for human use and translated into mouse models. However, declines observed in aging are not limited to physical functioning but also involve social capabilities. The concept of "social frailty" has been recently introduced into human literature, but no index of social frailty exists for laboratory mice yet. To fill this gap, we developed a mouse Social Frailty Index (mSFI) consisting of seven distinct assays designed to quantify social functioning which is relatively simple to execute and is minimally invasive. Application of the mSFI in group-housed male C57BL/6 mice demonstrated a progressively elevated levels of social frailty through the lifespan. Conversely, group-housed females C57BL/6 mice manifested social frailty only at a very old age. Female mice also showed significantly lower mSFI score from 10 months of age onward when compared to males. We also applied the mSFI in male C57BL/6 mice under chronic subordination stress and in chronic isolation, both of which induced larger increases in social frailty compared to age-matched group-housed males. Lastly, we show that the mSFI is enhanced in mouse models that show accelerated biological aging such as progeroid Ercc1-/Δ and Xpg-/- mice of both sexes compared to age matched littermate wild types. In summary, the mSFI represents a novel index to quantify trajectories of biological aging in mice and may help elucidate links between impaired social behavior and the aging process.
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Affiliation(s)
- Charles W Collinge
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Maria Razzoli
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Mansk
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Seth McGonigle
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Dudley W Lamming
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Christina A Pacak
- Greg Marzolf Jr. Muscular Dystrophy Center & Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Ingrid van der Pluijm
- Department of Molecular Genetics, and Department of Vascular Surgery, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Laura Niedernhofer
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
- Institute on the Biology of Aging and Metabolism, University of Minnesota, Minneapolis, MN, USA
| | - Alessandro Bartolomucci
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA.
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Yeo BSY, Chan JH, Tan BKJ, Liu X, Tay L, Teo NWY, Charn TC. Olfactory Impairment and Frailty: A Systematic Review and Meta-Analysis. JAMA Otolaryngol Head Neck Surg 2024:2821102. [PMID: 38990553 PMCID: PMC11240234 DOI: 10.1001/jamaoto.2024.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Importance Olfactory impairment (OI) and frailty are prevalent conditions associated with aging, but studies investigating their association with each other have been discordant. Objective To summarize current evidence surrounding the association between OI and frailty. Data Sources PubMed, Embase, Cochrane Library, SCOPUS, and CINAHL from inception to November 28, 2023. Study Selection This study included observational studies investigating the association between objectively or subjectively assessed OI and objectively evaluated frailty among adults. Data Extraction and Synthesis Two independent authors extracted data into a structured template. Maximally adjusted estimates were pooled using a random-effects model, and statistical heterogeneity was evaluated using I2 values. Additional prespecified subgroup and sensitivity analyses were performed. This study used the Newcastle-Ottawa Scale for bias assessment and the Grading of Recommendations Assessment, Development and Evaluation framework for overall evidence quality evaluation. Main Outcomes and Measures The primary outcome was the cross-sectional association between OI and frailty, for which the odds of frailty were compared between participants with and without OI. The secondary outcome was the cross-sectional association between frailty and OI, for which the odds of OI were compared between participants with and without frailty. Results This study included 10 studies with 10 624 patients (52.9% female; mean [SD] age, 62.9 [9.6] years). The Newcastle-Ottawa Scale score of studies ranged from low to moderate. Grading of Recommendations Assessment, Development and Evaluation scores ranged from low to moderate. OI was associated with a 2.32-fold (odds ratio [OR], 2.32; 95% CI, 1.63-3.31; I2 = 0%) greater odds of frailty compared with individuals with healthy olfactory function. The odds of OI was progressively greater with categorical frailty status, with a 1.55-fold (OR, 1.55; 95% CI, 1.32-1.82; I2 = 0%), 2.28-fold (OR, 2.28; 95% CI, 1.96-2.65; I2 = 0%), and 4.67-fold (OR, 4.67; 95% CI, 2.77-7.86; I2 = 0%) increase in odds for individuals with prefrailty, frailty, and the most frailty, respectively, compared with robust individuals. The results demonstrated stability in subgroup analyses (geographical continent of study, objective vs subjective olfactory assessment) and sensitivity tests. Conclusions and Relevance The results of this systematic review and meta-analysis suggest that there is an association between OI and frailty, with an increase in the odds of OI with worsening categorical frailty status among individuals with prefrailty, frailty, and the most frailty. OI may be a potential biomarker for frailty. Future studies could delve into whether OI may be a modifiable risk factor for frailty.
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Affiliation(s)
- Brian Sheng Yep Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jun He Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Xuandao Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Laura Tay
- Department of General Medicine, Sengkang General Hospital, Singapore
- SingHealth Duke-NUS Centre of Memory and Cognitive Disorders, Singapore
| | - Neville Wei Yang Teo
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
- Surgery Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Tze Choong Charn
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
- Surgery Academic Clinical Programme, Duke-NUS Medical School, Singapore
- Department of Otolaryngology-Head and Neck Surgery, Sengkang General Hospital, Singapore
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Ko Y, Choi K. Exploring the Role of Social Factors in Cognitive Frailty among South Korean Older Adults. Healthcare (Basel) 2024; 12:1394. [PMID: 39057536 PMCID: PMC11275848 DOI: 10.3390/healthcare12141394] [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: 05/07/2024] [Revised: 06/26/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Cognitive frailty, which is characterized by the co-occurrence of physical frailty and cognitive impairment, poses significant risks to the well-being and independence of elderly individuals. Previous research has established that demographic, health-related, and social factors contribute to both physical frailty and cognitive decline. However, the role of social factors in influencing cognitive frailty remains unclear. This study aims to identify the relationship between social factors and cognitive frailty among Korean older adults living in the community. We performed secondary analyses of data from the 2020 Survey on Older Adults. After entering demographic factors and health-related factors into the logistic model as covariates, this study explored the association between cognitive frailty and social factors, including living arrangements, social support, the frequency of engagement in social activities per week, and satisfaction with friends and community. Among participants, approximately 2.9% had cognitive frailty, 3.2% had only physical frailty, and 21.9% had only cognitive decline. Lower levels of satisfaction with friends and the community and infrequent participation in social activities were strongly correlated with cognitive frailty. These findings emphasize the necessity of public health programs that encourage older individuals' social involvement. A supportive social environment can be fostered through initiatives that promote community events, group activities, and volunteerism. Public health policies should prioritize the development and maintenance of social activity centers that offer various programs to prevent progression to cognitive frailty in older adults.
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Affiliation(s)
- Young Ko
- College of Nursing, Gachon University, Incheon 21936, Gyeonggi, Republic of Korea;
| | - Kyungwon Choi
- Department of Nursing, Korea National University of Transportation, Jeungpyeong-gun 27909, Chungbuk, Republic of Korea
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Komatsu J, Nishimura YK, Sugane H, Hosoda H, Imai RI, Nakaoka Y, Nishida K, Mito S, Seki SI, Kubo T, Kitaoka H, Kubokawa SI, Kawai K, Hamashige N, Doi YL. Early Invasive Strategy for Octogenarians and Nonagenarians With Acute Myocardial Infarction. Circ Rep 2024; 6:263-271. [PMID: 38989106 PMCID: PMC11233166 DOI: 10.1253/circrep.cr-24-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 07/12/2024] Open
Abstract
Background: Older adults with acute myocardial infarction (AMI) are currently a rapidly growing population. However, their clinical presentation and outcomes remain unresolved. Methods and Results: A total of 268 consecutive AMI patients were analyzed for clinical characteristics and outcomes with major adverse cardiovascular events (MACE) and all-cause mortality within 1 year. Patients aged ≥80 years (Over-80; n=100) were compared with those aged ≤79 years (Under-79; n=168). (1) Primary percutaneous coronary intervention (PCI) was frequently and similarly performed in both the Over-80 group and the Under-79 group (86% vs. 89%; P=0.52). (2) Killip class III-IV (P<0.01), in-hospital mortality (P<0.01), MACE (P=0.03) and all-cause mortality (P<0.01) were more prevalent in the Over-80 group than in the Under-79 group. (3) In the Over-80 group, frail patients showed a significantly worse clinical outcome compared with non-frail patients. (4) Multivariate analysis revealed Killip class III-IV was associated with MACE (odds ratio [OR]=3.51; P=0.02) and all-cause mortality (OR=9.49; P<0.01) in the Over-80 group. PCI was inversely associated with all-cause mortality (OR=0.13; P=0.02) in the Over-80 group. Conclusions: The rate of primary PCI did not decline with age. Although octogenarians/nonagenarians showed more severe clinical presentation and worse short-term outcomes compared with younger patients, particularly in those with frailty, the prognosis may be improved by early invasive strategy even in these very old patients.
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Affiliation(s)
- Junya Komatsu
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | | | - Hiroki Sugane
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Hayato Hosoda
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | | | - Yoko Nakaoka
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Koji Nishida
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Shinji Mito
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Shu-Ichi Seki
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medical School Kochi Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medical School Kochi Japan
| | | | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | | | - Yoshinori L Doi
- Department of Cardiology, Chikamori Hospital Kochi Japan
- Cardiomyopathy Institute, Chikamori Hospital Kochi Japan
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Le HT, Dang AK, Le LTT, Nguyen HTT, Nguyen GT, Nguyen HTT, Phan HBT, Nguyen TA, Robinson L. Nutritional status, dietary quality and eating disturbance issues among people with dementia in Vietnam: evidence of a cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:107. [PMID: 38987853 PMCID: PMC11238499 DOI: 10.1186/s41043-024-00570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/17/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Due to cognitive impairments, people with dementia (PWD) often have difficulties in eating and drinking. This study aimed to assess the nutritional status, dietary quality and eating disturbance issues among PWD in Vietnam. METHODS We conducted a cross-sectional study at the Vietnamese National Geriatric Hospital from April to December 2022. We used Mini-Mental State Exam (MMSE) to classify the severity levels of dementia. Mini Nutritional Assessment (MNA), 24-hour recall, eating disturbance questionnaires, and anthropometric indicators were used to evaluate the nutritional status, dietary quality, and eating disorders of study subjects. RESULTS Overall, among 63 study participants, 74.6 per cent of PWD were at risk of or having malnutrition. By dementia classification according to MMSE scale, people with moderate and severe dementia accounted for 53.3 per cent of those who met the recommended energy levels, compared to 42.4 per cent of people with mild dementia and normal people. In the above two groups, around three per cent of participants reached the recommended amount of fibre. Calcium (50-70%), vitamin A (80-90%), and D (90%) were found to be the most severe deficiency forms of minerals and vitamins in both male and female participants. The majority of participants (90.5%) had at least one form of eating disorders with the most frequent issue being appetite changes (76.2%) and swallowing issues (50.8%). CONCLUSIONS PWD in our sample frequently experienced malnutrition, a lack of essential nutrients, difficulties swallowing, changes in eating habits and appetite. It is neccesary to early screen and assess nutritional status and swallowing disturbance in PWD, and instruct their caregivers to prepare nutritious meals for them.
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Affiliation(s)
- Huong Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Anh Kim Dang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, Australia
| | - Linh Thao Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam.
| | - Ha Thu Thi Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Giang Thu Nguyen
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Hanh Bich Thi Phan
- Faculty of Dentistry, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK
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Hopkins SA, Hoare SE, Polak L, Lovick R, Simpson R, Chhetri JK, Kelly MP, Barclay S, Harwood RH. Does frailty need a new name? BMJ 2024; 386:e076862. [PMID: 38981648 DOI: 10.1136/bmj-2023-076862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Affiliation(s)
- Sarah A Hopkins
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah E Hoare
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Louisa Polak
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Rhian Simpson
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jagadish K Chhetri
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Michael P Kelly
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rowan H Harwood
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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Abdullah G, Akpan A, Phelan MM, Wright HL. New insights into healthy ageing, inflammageing and frailty using metabolomics. FRONTIERS IN AGING 2024; 5:1426436. [PMID: 39044748 PMCID: PMC11263002 DOI: 10.3389/fragi.2024.1426436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/24/2024] [Indexed: 07/25/2024]
Abstract
Human ageing is a normal process and does not necessarily result in the development of frailty. A mix of genetic, environmental, dietary, and lifestyle factors can have an impact on ageing, and whether an individual develops frailty. Frailty is defined as the loss of physiological reserve both at the physical and cellular levels, where systemic processes such as oxidative stress and inflammation contribute to physical decline. The newest "omics" technology and systems biology discipline, metabolomics, enables thorough characterisation of small-molecule metabolites in biological systems at a particular time and condition. In a biological system, metabolites-cellular intermediate products of metabolic reactions-reflect the system's final response to genomic, transcriptomic, proteomic, epigenetic, or environmental alterations. As a relatively newer technique to characterise metabolites and biomarkers in ageing and illness, metabolomics has gained popularity and has a wide range of applications. We will give a comprehensive summary of what is currently known about metabolomics in studies of ageing, with a focus on biomarkers for frailty. Metabolites related to amino acids, lipids, carbohydrates, and redox metabolism may function as biomarkers of ageing and/or frailty development, based on data obtained from human studies. However, there is a complexity that underpins biological ageing, due to both genetic and environmental factors that play a role in orchestrating the ageing process. Therefore, there is a critical need to identify pathways that contribute to functional decline in people with frailty.
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Affiliation(s)
- Genna Abdullah
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Asangaedem Akpan
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Division of Internal Medicine, University of Western Australia, Bunbury, WA, Australia
- Faculty of Health Sciences, Curtis University, Bunbury, WA, Australia
- Department of Geriatric Medicine, Bunbury Regional Hospital, Bunbury, WA, Australia
| | - Marie M. Phelan
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- High Field NMR Facility, Liverpool Shared Research Facilities University of Liverpool, Liverpool, United Kingdom
| | - Helen L. Wright
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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Mentzelopoulos SD. Resuscitation of frail cardiac arrest patients: A still unresolved conundrum? Resuscitation 2024:110304. [PMID: 38977239 DOI: 10.1016/j.resuscitation.2024.110304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Affiliation(s)
- Spyros D Mentzelopoulos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Greece.
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Mayo A, O'Brien MW, Godin J, Kehler DS, Kimmerly DS, Theou O. Can an active lifestyle offset the relationship that poor lifestyle behaviours have on frailty? Arch Gerontol Geriatr 2024; 127:105556. [PMID: 39032315 DOI: 10.1016/j.archger.2024.105556] [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: 02/13/2024] [Revised: 06/18/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To examine the association of lifestyle behaviours (LSB) with physical activity (PA) and frailty; also, to examine if associations differ by sex and age. METHODS 24,828 individuals [49.6 ± 17.6 years (range: 20-85), 51.6 % female] from the National Health and Nutrition Examination Survey (cycles 2009-2018) were included. Individuals were divided into Active (≥150 min/week of moderate-to-vigorous physical activity (MVPA)) and Inactive (<150 min/week MVPA) based on self-reported PA. Frailty was measured by a 46-item Frailty Index (FI). LSB consisted of stationary time, sleep, diet quality, and alcohol and smoking habits. LSB was summed into a score [0-5]. Linear regression models were used with each LSB in isolation and the summed LSB with frailty. RESULTS There were 7,495 (30.1 %) Active and 17,333 (69.8 %) Inactive individuals. The FI was lower in the Active participants (Active: 0.10 ± 0.08; Inactive: 0.15 ± 0.12; p < 0.01). A worse LSB score was associated with an increased FI in all behaviours but females who binge drink and smoke (p-all>0.14). For inactive individuals, all LSBs were associated with an increased FI except those who binge drink and male smokers (p = 0.08). There was a significant association between increased summed LSB and an increased FI (β range: Active, 0.024-0.037; Inactive, 0.028, 0.046. p-all<0.01); the Active group had a lower FI at every age group than the Inactive group (p < 0.001). CONCLUSION PA was associated with a lower FI even among those with a poor LSB score. This association is dependent on age, with older individuals reporting a stronger association.
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Affiliation(s)
- A Mayo
- Geriatric Medicine Research, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - M W O'Brien
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, New Brunswick, Canada
| | - J Godin
- Geriatric Medicine Research, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - D S Kehler
- School of Physiotherapy (Faculty of Health), Dalhousie University, Halifax, Nova Scotia, Canada
| | - D S Kimmerly
- Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - O Theou
- Geriatric Medicine Research, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada; School of Physiotherapy (Faculty of Health), Dalhousie University, Halifax, Nova Scotia, Canada.
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Rojas-Rivera AF, Alves de Oliveira Lucchesi P, Andrade Anziani M, Lillo P, Ferretti-Rebustini REDL. Psychometric Properties of the FRAIL Scale for Frailty Screening: A Scoping Review. J Am Med Dir Assoc 2024; 25:105133. [PMID: 38981581 DOI: 10.1016/j.jamda.2024.105133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES The aim of this study was to identify and map the available psychometric evidence of the FRAIL scale to screen frailty among older adults. DESIGN Scoping review of published articles on 9 databases (PubMed, Scopus, Web of Science, CINAHL, Cochrane, Embase, PsycINFO, VHL Regional Portal, and Epistemonikos) and 8 gray literature sources. SETTING AND PARTICIPANTS Studies in adults or older adults, in both inpatient and outpatient settings (without context restrictions). METHODS Cross-cultural adaptations, validity and reliability evidence studies, whose main objective was to develop and/or validate and/or culturally adapt the FRAIL Scale to assess frailty in adults or older adults, published since 2007 were included in this scoping review. The databases were searched between February and March 2023.The JBI methodology for scoping reviews was used to guide the process. The protocol of this study was registered on the Open Science Framework platform. RESULTS Of the 1031 records found during the search, 40 articles that met the established criteria for analysis were included. Nearly 1 in 10 countries worldwide (11.9%) have psychometric evidence regarding this scale. Ten studies were identified with the goal of cross-cultural adaptation and/or validation in a different cultural context for the first time. Twenty-one of 40 studies used Morley 2012 operationalization of FRAIL Scale criteria. Thirty-nine studies provided evidence of associations with other variables. The rest of the evidence for content, internal structure, response processes, and reliability was only evaluated in cross-cultural adaptation studies, with limitations. CONCLUSIONS AND IMPLICATIONS In conclusion, there is some evidence of validity for FRAIL Scale; nevertheless, studies are needed to adapt the scale to new cultures, using rigorous Cross-Cultural Adaptation processes, and to provide new evidence of validity and reliability, to strengthen and consolidate the body of knowledge for its application to various patient groups and context.
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Affiliation(s)
- Alejandra F Rojas-Rivera
- Universidad de los Andes, Santiago, Chile, Facultad de Enfermería y Obstetricia, Escuela de Enfermería; Escola de Enfermagem da Universidade São Paulo, Brasil.
| | | | | | - Patricia Lillo
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile; Centro de Gerociencia, Salud Mental y Metabolismo, GERO, Santiago, Chile; Clínica Universidad de los Andes, Santiago, Chile, Centro de Neurociencias
| | - Renata Eloah de Lucena Ferretti-Rebustini
- Escola de Enfermagem da Universidade São Paulo, Brasil; Laboratório de Fisiopatologia no Envelhecimento da Faculdade de Medicina da Universidade de São Paulo, Brasil
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Masutomi K, Bando M, Inagaki Y, Kido R, Uemura Y, Hatada Y, Kido JI, Fukui M, Hinode D, Yumoto H. Relationship between oral hypofunction and salivary biomarkers in older adults: a cross-sectional study. BMC Oral Health 2024; 24:766. [PMID: 38971720 PMCID: PMC11227702 DOI: 10.1186/s12903-024-04556-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Oral health problems have increased among older adults. Oral hypofunction is characterized by seven signs and symptoms: oral uncleanness, oral dryness, decline in occlusal force, decline in the movement function of the tongue and lips, decline in tongue pressure, decline in masticatory function, and decline in swallowing function, the latter being a significant risk factors for oral frailty. Recent research has suggested that salivary biomarkers can be used to assess not only oral diseases, including dental caries and periodontitis, but also systemic diseases, such as cancer and diabetes mellitus. This cross-sectional study investigated the relationship between oral hypofunction and the levels of salivary biomarkers. METHODS In total, 116 patients, aged 65 years or older, were included in this cross-sectional study. If three or more signs or symptoms in seven kinds of tests met the criteria of each test, oral hypofunction was diagnosed. The levels of biomarkers in the saliva collected from the patients were analyzed using an enzyme-linked immunosorbent assay. RESULTS In total, 63.8% of patients were diagnosed with oral hypofunction. Multivariable linear regression analysis showed that calprotectin levels in the saliva were significantly related to oral moisture and masticatory function. Furthermore, 8-OHdG levels in saliva were associated with the movement function of the tongue and lips and oral hygiene level, and salivary AGE correlated only with the movement function of the tongue and lips. Multiple logistic regression analysis revealed that calprotectin levels in the saliva were significantly correlated with the prevalence of oral hypofunction, even after adjusting for age, sex, and periodontal status. However, none of the biomarker levels in the saliva had a significant relationship with the number of examinations outside the reference range. CONCLUSIONS Calprotectin, 8-OHdG, and AGE levels are associated with oral hypofunction in older adults.
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Affiliation(s)
- Kenji Masutomi
- Department of Periodontology and Endodontology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - Mika Bando
- Department of Periodontology and Endodontology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-Cho, Tokushima, 770-8504, Japan.
| | - Yuji Inagaki
- Department of Periodontology and Endodontology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - Rie Kido
- Department of Periodontology and Endodontology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - Yuta Uemura
- Department of Periodontology and Endodontology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - Yukari Hatada
- Department of Periodontology and Endodontology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - Jun-Ichi Kido
- Department of Periodontology and Endodontology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - Makoto Fukui
- Department of Hygiene and Oral Health Science, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - Daisuke Hinode
- Department of Hygiene and Oral Health Science, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - Hiromichi Yumoto
- Department of Periodontology and Endodontology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-Cho, Tokushima, 770-8504, Japan
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