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de Souto Barreto P, Gonzalez-Bautista E, Bischoff-Ferrari HA, Pelegrim de Oliveira V, Gorga Bandeira de Mello R, Andrieu S, Berbon C, Tavassoli N, Beard JR, Rolland Y, Soto Martín ME, Vellas B. Real-life intrinsic capacity screening data from the ICOPE-Care program. NATURE AGING 2024:10.1038/s43587-024-00684-2. [PMID: 39122839 DOI: 10.1038/s43587-024-00684-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 07/15/2024] [Indexed: 08/12/2024]
Abstract
The Integrated Care for Older People (ICOPE) program is a healthcare pathway that uses a screening test for intrinsic capacity (IC) as its entry point. However, real-life data informing on how IC domains cluster and change over time, as well as their clinical utility, are lacking. Using primary healthcare screening data from more than 20,000 French adults 60 years of age or older, this study identified four clusters of IC impairment: 'Low impairment' (most prevalent), 'Cognition+Locomotion+Hearing+Vision', 'All IC impaired' and 'Psychology+Vitality+Vision'. Compared to individuals with 'Low impairment', those in the other clusters had higher likelihood of having frailty and limitations in both activities of daily living (ADL) and instrumental activities of daily living (IADL), with the strongest associations being observed for 'All IC impaired'. This study found that ICOPE screening might be a useful tool for patient risk stratification in clinical practice, with a higher number of IC domains impaired at screening indicating a higher probability of functional decline.
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Affiliation(s)
- Philipe de Souto Barreto
- IHU HealthAge, Toulouse, France.
- CERPOP UMR 1295, University of Toulouse III, INSERM, UPS, Toulouse, France.
- Institute on Aging of the Toulouse University Hospital (CHU Toulouse), Toulouse, France.
| | - Emmanuel Gonzalez-Bautista
- IHU HealthAge, Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, INSERM, UPS, Toulouse, France
- Institute on Aging of the Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Heike A Bischoff-Ferrari
- IHU HealthAge, Toulouse, France
- Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland
| | - Vitor Pelegrim de Oliveira
- Institute on Aging of the Toulouse University Hospital (CHU Toulouse), Toulouse, France
- Geriatric Unit - Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Sandrine Andrieu
- IHU HealthAge, Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, INSERM, UPS, Toulouse, France
| | | | | | - John R Beard
- International Longevity Center - USA, Columbia University, New York, NY, USA
| | - Yves Rolland
- IHU HealthAge, Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, INSERM, UPS, Toulouse, France
- Institute on Aging of the Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Maria Eugenia Soto Martín
- IHU HealthAge, Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, INSERM, UPS, Toulouse, France
- Institute on Aging of the Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Bruno Vellas
- IHU HealthAge, Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, INSERM, UPS, Toulouse, France
- Institute on Aging of the Toulouse University Hospital (CHU Toulouse), Toulouse, France
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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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Taylor KA, Carroll MK, Short SA, Celestin BE, Gilbertson A, Olivier CB, Haddad F, Cauwenberghs N. Factors associated with lower quarter performance-based balance and strength tests: a cross-sectional analysis from the project baseline health study. Front Sports Act Living 2024; 6:1393332. [PMID: 39081837 PMCID: PMC11287662 DOI: 10.3389/fspor.2024.1393332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/27/2024] [Indexed: 08/02/2024] Open
Abstract
Objectives Physical performance tests are predictive of mortality and may screen for certain health conditions (e.g., sarcopenia); however, their diagnostic and/or prognostic value has primarily been studied in age-limited or disease-specific cohorts. Our objective was to identify the most salient characteristics associated with three lower quarter balance and strength tests in a cohort of community-dwelling adults. Methods We applied a stacked elastic net approach on detailed data on sociodemographic, health and health-related behaviors, and biomarker data from the first visit of the Project Baseline Health Study (N = 2,502) to determine which variables were most associated with three physical performance measures: single-legged balance test (SLBT), sitting-rising test (SRT), and 30-second chair-stand test (30CST). Analyses were stratified by age (<65 and ≥65). Results Female sex, Black or African American race, lower educational attainment, and health conditions such as non-alcoholic fatty liver disease and cardiovascular conditions (e.g., hypertension) were consistently associated with worse performance across all three tests. Several other health conditions were associated with either better or worse test performance, depending on age group and test. C-reactive protein was the only laboratory value associated with performance across age and test groups with some consistency. Conclusions Our results highlighted previously identified and several novel salient factors associated with performance on the SLBT, SRT, and 30CST. These tests could represent affordable, noninvasive biomarkers of prevalent and/or future disease in adult individuals; future research should validate these findings. Clinical Trial Registration ClinicalTrials.gov, identifier NCT03154346, registered on May 15, 2017.
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Affiliation(s)
- Kenneth A. Taylor
- Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | | | | | - Bettia E. Celestin
- Allergy and Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Adam Gilbertson
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, United States
| | - Christoph B. Olivier
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States
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Yong K, Chew J, Low K, Yeo A, Tan CN, Lim JP, Ding YY, Lim WS. Predictive Validity of Intrinsic Capacity Composite Scores for Risk of Frailty at 2 Years: A Comparison of 4 Scales. J Am Med Dir Assoc 2024; 25:105146. [PMID: 39002555 DOI: 10.1016/j.jamda.2024.105146] [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: 01/20/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE Intrinsic capacity (IC) and frailty are complementary constructs that encapsulate functional capacities of older adults. Although earlier studies suggest the utility of composite IC scores in predicting risk of frailty, key gaps remain with the lack of direct comparative studies between different IC scales and lack of a composite score based on the World Health Organization Integrated Care for Older People (ICOPE) tool. We aimed to compare different IC scales, including an ICOPE-based scale, in their predictive ability for risk of frailty at 2 years in healthy community-dwelling older adults. DESIGN Cohort study. SETTING AND PARTICIPANTS A total of 230 participants (age: 67.2 ± 7.4 years) from the GeriLABS-2 cohort study. METHODS We derived composite scores by summing 4 IC domains (locomotion, cognition, vitality, and psychological). We compared composite scores of 4 scales: IC1-Chew 2021, range: 0-8; IC2-Liu 2021, range: 0-4; IC3-ICOPE, range: 0-4; IC4-modified ICOPE, range: 0-8. The primary outcome was risk of frailty using the modified Fried Frailty Phenotype. We performed logistic regression to examine the association of baseline composite IC with risk of frailty. We also examined the impact of individual domains and number of impaired domains on risk of frailty. RESULTS Among 193 (83.9%) older adults who completed 2-year follow-up, 20 (10.4%) met criteria for risk of frailty. When adjusted for covariates, 2-point per domain scales (IC1/IC4) predicted increased risk of frailty (OR, 4.31; 95% CI, 1.55-11.96; OR, 5.00; 95% CI, 1.75-14.26). When further adjusted for baseline frailty, only IC4 remained significant (OR, 4.28; 95% CI, 1.45-12.60). Among the domains, impaired locomotion and vitality were associated with risk of frailty. Greater number of impaired domains predicted increased risk of frailty (IC1/IC2: β = 0.18-0.19, P < .05). CONCLUSIONS AND IMPLICATIONS Baseline composite IC score using 2-point per domain scales better predicted risk of frailty at 2 years, predicated on impaired locomotion/vitality and greater number of impaired domains. For early identification of healthy older adults at risk of frailty, an ICOPE-based scale should be considered, as it is effective and accessible.
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Affiliation(s)
- Kenneth Yong
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Justin Chew
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kristabella Low
- Department of Geriatric Medicine, Woodlands Health, Singapore, Singapore
| | - Audrey Yeo
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Cai Ning Tan
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jun Pei Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yew Yoong Ding
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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Sánchez-Sánchez JL, Lu WH, Gallardo-Gómez D, Del Pozo Cruz B, de Souto Barreto P, Lucia A, Valenzuela PL. Association of intrinsic capacity with functional decline and mortality in older adults: a systematic review and meta-analysis of longitudinal studies. THE LANCET. HEALTHY LONGEVITY 2024; 5:e480-e492. [PMID: 38945130 DOI: 10.1016/s2666-7568(24)00092-8] [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] [Received: 03/05/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Together with environmental factors, intrinsic capacity (the composite of all the physical and mental capacities of an individual) has been proposed as a marker of healthy ageing. However, whether intrinsic capacity predicts major clinical outcomes is unclear. We aimed to explore the association of intrinsic capacity with functional decline and mortality in older adults. METHODS In this systematic review and meta-analysis, we conducted a systematic search in MEDLINE (via PubMed), Scopus, and Web of Science from database inception to Feb 14, 2024, of observational longitudinal studies conducted in older adults (age ≥60 years) assessing the association of intrinsic capacity with impairment in basic activities of daily living (BADL) or instrumental activities of daily living (IADL) or risk of mortality. Estimates were extracted by two reviewers (JLS-S and W-HL) and were pooled using three-level meta-analytic models. The quality of each study was independently assessed by two authors (JLS-S and PLV) using the Newcastle-Ottawa Scale for longitudinal studies. Heterogeneity was evaluated using the I2 indicator at two levels: within-study (level 2) and between-study (level 3) variation. For associations between intrinsic capacity and IADL and BADL, we transformed data (standardised β coefficients and odds ratios [ORs]) into Pearson product moment correlation coefficients (r) using Pearson and Digby formulas to allow comparability across studies. For associations between intrinsic capacity and risk of mortality, hazard ratios (HRs) with 95% CIs were extracted from survival analyses. This study is registered with PROSPERO, CRD42023460482. FINDINGS We included 37 studies (206 693 participants; average age range 65·3-85·9 years) in the systematic review, of which 31 were included in the meta-analysis on the association between intrinsic capacity and outcomes; three studies (2935 participants) were included in the meta-analysis on the association between intrinsic capacity trajectories and longitudinal changes in BADL or IADL. Intrinsic capacity was inversely associated with longitudinal impairments in BADL (Pearson's r -0·12 [95% CI -0·19 to -0·04]) and IADL (-0·24 [-0·35 to -0·13]), as well as with mortality risk (hazard ratio 0·57 [95% CI 0·51 to 0·63]). An association was also found between intrinsic capacity trajectories and impairment in IADL (but not in BADL), with maintained or improved intrinsic capacity over time associated with a lower impairment in IADL (odds ratio 0·37 [95% CI 0·19 to 0·71]). There was no evidence of publication bias (Egger's test p>0·05) and there was low between-study heterogeneity (I2=18·4%), though within-study (I2=63·2%) heterogeneity was substantial. INTERPRETATION Intrinsic capacity is inversely associated with functional decline and mortality risk in older adults. These findings could support the use of intrinsic capacity as a marker of healthy ageing, although further research is needed to refine the structure and operationalisation of this construct across settings and populations. FUNDING None. TRANSLATIONS For the Spanish and French translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Juan Luis Sánchez-Sánchez
- Institute of Aging, Toulouse University Hospital, Toulouse, France; Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; IHU HealthAge, Toulouse, France.
| | - Wan-Hsuan Lu
- Institute of Aging, Toulouse University Hospital, Toulouse, France; IHU HealthAge, Toulouse, France
| | - Daniel Gallardo-Gómez
- Epidemiology of Physical Activity and Fitness Across Lifespan Research Group, Department of Physical Education and Sports, Faculty of Education, University of Seville, Seville, Spain
| | - Borja Del Pozo Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain; Faculty of Education, Department of Physical Education, University of Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz Research Unit, University of Cádiz, Spain; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Philipe de Souto Barreto
- Institute of Aging, Toulouse University Hospital, Toulouse, France; IHU HealthAge, Toulouse, France; CERPOP UMR 1295, Inserm, Paul Sabatier University, Toulouse, France
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; Physical Activity and Health Research Group, Research Institute of 12 de Octubre University Hospital, Madrid, Spain
| | - Pedro L Valenzuela
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; Physical Activity and Health Research Group, Research Institute of 12 de Octubre University Hospital, Madrid, Spain; Department of Systems Biology, University of Alcalá, Madrid, Spain
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Hsiao FY, Chen LK. Intrinsic capacity assessment works-let's move on actions. THE LANCET. HEALTHY LONGEVITY 2024; 5:e448-e449. [PMID: 38945125 DOI: 10.1016/s2666-7568(24)00110-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Affiliation(s)
- Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy and School of Pharmacy, College of Medicine, National Taiwan University, Taipei 10050, Taiwan; Department of Pharmacy, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital managed by Taipei Veterans General Hospital, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Zhai S, Zhang Z, Zhang R, Peng Y, Zhang J, Zhang Y, Jin Q, Zhou J, Chen J. Community-dwelling older adults' perspectives on health risks: a qualitative study exploring anxieties, priorities, and expectations in ageing. BMC Public Health 2024; 24:1657. [PMID: 38907192 PMCID: PMC11191137 DOI: 10.1186/s12889-024-18878-z] [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: 08/08/2023] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND With the conflict between the promise of ageing in health and longevity and the limited availability of health resources and social support, older adults in China inevitably experience anxieties surrounding health risks. This study aims to investigate how older adults perceive the health risks that come with getting older, explore the degree to which health risks affect older adults, and advocate for active engagement in practices for managing health risks. METHODS Using purposive sampling, three districts of Beijing (Xicheng District, Fengtai District, and Daxing District, respectively) were selected for the research. Qualitative semi-structured and in-depth interviews were conducted with 70 community-dwelling older adults who participated in the study. Data were extracted and analyzed based on a thematic framework approach. RESULTS Three main themes were identified: (i) the anxieties of older adults concerning health risks in ageing; (ii) the priorities of older adults for health risk management in ageing; (iii) the expectations of older adults for health risk management in ageing. The primary health concerns among older adults included disease incidence and function decline. It was found that basic health management emerged as a critical need for older adults to mitigate health risks. Moreover, it was observed that healthcare support for older adults from familial, institutional, and governmental levels exhibited varying degrees of inadequacy. CONCLUSIONS The primary source of anxieties among older adults regarding health risks predominantly stems from a perceived sense of health deprivation. It is often compounded by persistent barriers to primary care of priorities in managing health risks among older adults. In addition, the expectations of older adults for health risk management emphasize the necessity for integrated care approaches. Therefore, further research should give priority to the prevention and management of health risks, aim to reduce anxieties, provide integrated care to meet the primary needs and expectations of older adults, and ultimately strive toward the overarching goal of promoting health and longevity.
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Affiliation(s)
- Shaoqi Zhai
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Zhiying Zhang
- Outpatient Office, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Ruyi Zhang
- Ethics Committee Office, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yingchun Peng
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China.
| | - Jiaying Zhang
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Yiyao Zhang
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Qilin Jin
- Cardiac Surgery Department, People's Hospital of Beijing Daxing District, No.26, Huangcun West Street, Daxing District, Beijing, 102600, China
| | - Jiaojiao Zhou
- Fengtai District Xiluoyuan Community Health Service Centre, Beijing, 100077, China
| | - Jingjing Chen
- Huairou District Liulimiao Community Health Service Centre, Beijing, 101499, China
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8
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Wang C, Bi S, Lu Y, Li Y, Han B, Xu M, Meng G, Zhou Q. Availability and stability of palliative care for family members of terminally ill patients in an integrated model of health and social care. BMC Palliat Care 2024; 23:140. [PMID: 38840255 PMCID: PMC11151625 DOI: 10.1186/s12904-024-01475-7] [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: 05/10/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Palliative care and the integration of health and social care have gradually become the key direction of development to address the aging of the population and the growing burden of multimorbidity at the end of life in the elderly. AIMS To explore the benefits/effectiveness of the availability and stability of palliative care for family members of terminally ill patients in an integrated institution for health and social care. METHODS This prospective observational study was conducted at an integrated institution for health and social care. 230 patients with terminal illness who received palliative care and their family members were included. Questionnaires and scales were administered to the family members of patients during the palliative care process, including quality-of-life (SF-8), family burden (FBSD, CBI), anxiety (HAMA), and distress (DT). We used paired t-tests and correlation analyses to analyze the data pertaining to our research questions. RESULTS In the integrated institution for health and social care, palliative care can effectively improve quality of life, reduce the family's burden and relieve psychological impact for family members of terminally ill patients. Palliative care was an independent influencing factor on the quality of life, family burden, and psychosocial status. Independently of patient-related and family-related factors, the results are stable and widely applicable. CONCLUSION The findings underline the availability and stability of palliative care and the popularization of an integrated service model of health and social care for elder adults.
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Affiliation(s)
- Chunyan Wang
- Department of Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Shaojie Bi
- Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Yuli Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Bing Han
- Department of Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Min Xu
- Department of Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Guiyue Meng
- Department of Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Qingbo Zhou
- Department of Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China.
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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9
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Tan F, Wei X, Zhang J, Zhao Y, Tong X, Michel JP, Shao R, Gong E. The assessment and detection rate of intrinsic capacity deficits among older adults: a systematic review and meta-analysis. BMC Geriatr 2024; 24:485. [PMID: 38831281 PMCID: PMC11149255 DOI: 10.1186/s12877-024-05088-w] [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: 03/24/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Assessing and monitoring intrinsic capacity (IC) is an effective strategy to promote healthy ageing by intervening early in high-risk populations. This review systematically analyzed the global detection rates of IC deficits and explored variations across diverse populations and data collection methods. METHODS This study was preregistered with PROSPERO, CRD42023477315. In this systematic review and meta-analysis, we systematically searched ten databases from January 2015 to October 2023, for peer-reviewed, observational studies or baseline survey of trials that assessed IC deficits among older adults aged 50 and above globally following the condition, context and population approach. The main outcome was intrinsic capacity deficits which could be assessed by any tools. Meta-analyses were performed by a random-effect model to pool the detection rates across studies and subgroup analyses were conducted by populations and data collection methods. RESULTS Fifty-six studies conducted in 13 countries were included in the review and 44 studies with detection rates of IC were included in the meta-analysis. The pooled detection rate of IC deficits was 72.0% (65.2%-78.8%) and deficits were most detected in sensory (49.3%), followed by locomotion (40.0%), cognition (33.1%), psychology (21.9%), and vitality (20.1%). Variations in detection rates of IC deficits were observed across studies, with higher rates observed in low- and middle-income countries (74.0%) and hyper-aged societies (85.0%). Study population and measurement tools also explained the high heterogeneity across studies. CONCLUSION IC deficits are common among older adults, while heterogeneity exists across populations and by measurement. Early monitoring with standardized tools and early intervention on specific subdomains of IC deficits are greatly needed for effective strategies to promote healthy ageing.
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Affiliation(s)
- Fangqin Tan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Xiaoxia Wei
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Ji Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Yihao Zhao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Xunliang Tong
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jean-Pierre Michel
- University of Geneva, Geneva, Switzerland
- French Academy of Medicine, Paris, France
| | - Ruitai Shao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
| | - Enying Gong
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
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10
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Collette-Robert S, Guerville F, Novais T, Pongan E, Morelon E, Vernaudon J, Francq E, Couzi L, Bourdel-Marchasson I, Caillard S, Pszczolinski R, Heitz D, Gilbert T, Garnier-Crussard A. Intrinsic capacity and frailty in older adults with end-stage kidney disease undergoing pre-kidney transplant comprehensive geriatric assessment. J Nutr Health Aging 2024; 28:100236. [PMID: 38643611 DOI: 10.1016/j.jnha.2024.100236] [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: 03/06/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE Frailty has been extensively studied in end-stage kidney disease (ESKD) and kidney transplant (KT) patients. The identification of frailty is useful to predict adverse outcomes among ESKD and KT patients. The recent concept of intrinsic capacity (IC) appears as a good and easy-to-understand tool to screen for and monitor frailty in older adults with ESKD. This study aims to assess the relationships between frailty and IC in older adults with ESKD awaiting KT. DESIGN Cross-sectional study SETTING AND PARTICIPANTS: 236 patients from a day-care geriatric unit undergoing pre-KT geriatric assessment between 2017 and 2022 were included in the main sample, and 151 patients in an independent multicentric replication sample. MEASUREMENTS Frailty was evaluated using the physical frailty phenotype (PFP) and IC measures using the World Health Organization's screening (step 1) and diagnostic (step 2) tools for five IC domains (vitality, locomotion, audition, cognition, psychology). Multivariate regressions were run to assess relationships between PFP and IC domains, adjusted for age, sex, and comorbidities. Analyses were replicated using another independent multicenter cohort including 151 patients with ESKD to confirm the results. RESULTS Impairments in the locomotion, psychology, and vitality IC domains according to WHO screening tools were associated with frailty (odds ratio 9.62 [95% CI 4.09-24.99], 3.19 [95% CI 1.11-8.88], and 3.11 [95% CI 1.32-7.29], respectively). When IC were measured linearly with z-scores, all IC domains except hearing were inversely associated with frailty. In the replication cohort, results were overall similar, with a greater association between psychology domain and frailty. CONCLUSION This study highlights the relationship between frailty and IC in ESKD patients. We assume that IC may be assessed and monitored in ESKD patients, to predict and prevent future frailty, and post-KT adverse outcomes.
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Affiliation(s)
- Sarah Collette-Robert
- Clinical and Research Memory Centre of Lyon, Lyon Institute For Aging, Hospices Civils de Lyon, 69100 Villeurbanne, France
| | - Florent Guerville
- Clinical Gerontology Department, Bordeaux University Hospital, F-33000 Bordeaux, France; UMR 5536 CNRS/University of Bordeaux, Bordeaux, France; ImmunoConcEpT Lab UMR 5164 CNRS, INSERM ERL 1303, F-33000/University of Bordeaux, Bordeaux, France
| | - Teddy Novais
- Clinical and Research Memory Centre of Lyon, Lyon Institute For Aging, Hospices Civils de Lyon, 69100 Villeurbanne, France; Pharmaceutical Unit, Charpennes Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Elodie Pongan
- Clinical and Research Memory Centre of Lyon, Lyon Institute For Aging, Hospices Civils de Lyon, 69100 Villeurbanne, France; Memory Clinical and Research Center of Saint Etienne, Neurology Unit, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Emmanuel Morelon
- Department of Transplantation, Nephrology and Immunology, Hospices Civils de Lyon, Lyon, France
| | - Julien Vernaudon
- Clinical and Research Memory Centre of Lyon, Lyon Institute For Aging, Hospices Civils de Lyon, 69100 Villeurbanne, France; Geriatric Medicine Department, Villefranche-Sur-Saône Hospital, 69400 Villefranche-Sur-Saône, France
| | - Eloïse Francq
- Clinical Gerontology Department, Bordeaux University Hospital, F-33000 Bordeaux, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France
| | - Isabelle Bourdel-Marchasson
- Clinical Gerontology Department, Bordeaux University Hospital, F-33000 Bordeaux, France; UMR 5536 CNRS/University of Bordeaux, Bordeaux, France
| | - Sophie Caillard
- Nephrology-Transplantation Department, University Hospital, 2 Rheumatology Department, University Hospital, Strasbourg, France
| | - Romain Pszczolinski
- Nephrology-Transplantation Department, University Hospital, 2 Rheumatology Department, University Hospital, Strasbourg, France
| | - Damien Heitz
- Unité d'OncoGériatrie, Institut de Cancérologie de Strasbourg Europe, 67033 Strasbourg France
| | - Thomas Gilbert
- Research on Healthcare Professionals and Performance RESHAPE, Inserm U1290, Université Claude Bernard Lyon 1, 69008 Lyon, France; Geriatric Medicine Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, CEDEX, 69495 Pierre-Bénite, France.
| | - Antoine Garnier-Crussard
- Clinical and Research Memory Centre of Lyon, Lyon Institute For Aging, Hospices Civils de Lyon, 69100 Villeurbanne, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Neuropresage Team, Cyceron, 14000 Caen, France.
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11
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Rolland Y, Fielding R, Landi F, Vellas B. Implementing clinical operationalization of sarcopenia: the contribution of WHO ICOPE program. J Nutr Health Aging 2024; 28:100257. [PMID: 38714090 DOI: 10.1016/j.jnha.2024.100257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Yves Rolland
- IHU HealthAge, CERPOP UMR 1295, CHU Toulouse, France.
| | - Roger Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, USA
| | - Francesco Landi
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
| | - Bruno Vellas
- IHU HealthAge, CERPOP UMR 1295, CHU Toulouse, France
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12
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Hsu PS, Lee WJ, Peng LN, Lu WH, Meng LC, Hsiao FY, Chen LK. Safeguarding vitality and cognition: The role of sarcopenia in intrinsic capacity decline among octogenarians from multiple cohorts. J Nutr Health Aging 2024; 28:100268. [PMID: 38810513 DOI: 10.1016/j.jnha.2024.100268] [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: 04/29/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Sarcopenia and intrinsic capacity (IC) declines pose significant challenges to healthy aging, particularly in the rapidly growing octogenarian population. This study aimed to elucidate the relationship between sarcopenia and declines in IC across multiple cohorts of community-dwelling older adults. METHODS Data from four Taiwanese cohorts were analyzed. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria (algorithm 1: categorized as either having possible sarcopenia or not (robust); algorithm 2: categorized as robust, possible sarcopenia or sarcopenia). IC was operationalized using the World Health Organization's Integrated Care for Older People (ICOPE) framework (step 1 and step 2), encompassing six domains: locomotion, vitality, vision, hearing, cognition, and psychological well-being. Multivariable logistic regression models were adopted to assess the association between sarcopenia and IC decline. RESULTS Among 599 octogenarians (median age 82.2 years, 54.8% male), the prevalence of possible sarcopenia (algorithm 1) was 64.6%. When adopting algorithm 2, the prevalence of possible sarcopenia and sarcopenia was 46,2% and 32.1%, respectively. After adjusting for covariates, participants with possible sarcopenia or sarcopenia (algorithm 2) were more likely to exhibit declines in vitality (ICOPE Step 1: possible sarcopenia aOR 3.65, sarcopenia aOR 4.74; ICOPE Step 2: possible sarcopenia aOR 5.11, sarcopenia aOR 14.77) and cognition (ICOPE Step 1: possible sarcopenia aOR 2.40, sarcopenia aOR 2.12; ICOPE Step 2: possible sarcopenia aOR 2.02, sarcopenia aOR 2.51) compared to robust individuals. CONCLUSIONS This study underscores the robust association between sarcopenia and declines in vitality and cognition among octogenarians, highlighting the importance of sarcopenia screening and management in promoting healthy longevity in this vulnerable population.
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Affiliation(s)
- Pi-Shan Hsu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Ju Lee
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan County, Taiwan
| | - Li-Ning Peng
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Hsuan Lu
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France; Maintain Aging Research team, Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), Inserm, Université Paul Sabatier, Toulouse, France
| | - Lin-Chieh Meng
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
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13
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Pérez-Castejón JM, Formiga F. [Frailty and intrinsic capacity; from theoretical concept to clinical applicability]. Rev Esp Geriatr Gerontol 2024; 59:101483. [PMID: 38554457 DOI: 10.1016/j.regg.2024.101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 04/01/2024]
Affiliation(s)
- Juan Manuel Pérez-Castejón
- Unidad Docente, Hospital Municipal de Badalona y Centre Sociosanitari El Carme, Badalona Serveis Assistencials. Badalona, Barcelona, España.
| | - Francesc Formiga
- Sección de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
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14
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Briguglio M, Wainwright TW, Latella M, Ninfa A, Cordani C, Colombo C, Banfi G, Francetti L, Corbella S. A Proposal for a Multidisciplinary Integrated Oral Health Network for Patients Undergoing Major Orthopaedic Surgery (IOHN-OS). Geriatrics (Basel) 2024; 9:39. [PMID: 38525756 PMCID: PMC10961760 DOI: 10.3390/geriatrics9020039] [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: 02/20/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
The passing of the years of life physiologically leads to the accumulation of changes in tissues in the oral cavity, influencing dentition, chewing and swallowing mechanisms, and the oral microbiota. Some diseases and medications can aggravate oral symptoms and negatively influence eating behaviours, increasing the likelihood of becoming malnourished. This could make older individuals more vulnerable to complications when undergoing major orthopaedic surgery. Hidden infection foci in the oral cavity are a recognised cause of post-operative periprosthetic joint infections. Dysfunctional oral problems might also compromise feeding after surgery when good nutrition represents a fundamental aspect of a proper recovery. To manage these shortcomings, in this article, the authors hypothesise a multidisciplinary path of care named the Integrated Oral Health Network applied to major Orthopaedic Surgery (IOHN-OS). This peri-operative initiative would include pre-operative oral health screening and risk management by a dental team, patient education programmes before and after surgery, and bedside gerodontology actions like oral care and meal and eating support for fragile individuals. The IOHN-OS has the potential to reshape the concept of suitability for major orthopaedic surgery and generate momentum for designing community-based surveillance programmes that can keep the mouths of older subjects healthy for a long time.
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Affiliation(s)
- Matteo Briguglio
- Laboratory of Nutritional Sciences, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8FT, UK
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, UK
| | - Marialetizia Latella
- Laboratory of Nutritional Sciences, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Aurora Ninfa
- Operational Unit of Phoniatry, ASST Fatebenefratelli-Sacco, 20154 Milan, Italy
| | - Claudio Cordani
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
- Scientific Direction, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Cecilia Colombo
- Orthopaedic Biotechnology Laboratory, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Giuseppe Banfi
- Scientific Direction, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Luca Francetti
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
- Operational Unit of Odontostomatology, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Stefano Corbella
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
- Operational Unit of Odontostomatology, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
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15
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Merchant RA, Chan YH, Anbarasan D, Vellas B. Association of intrinsic capacity with functional ability, sarcopenia and systemic inflammation in pre-frail older adults. Front Med (Lausanne) 2024; 11:1374197. [PMID: 38510450 PMCID: PMC10953915 DOI: 10.3389/fmed.2024.1374197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
Background Decline in intrinsic capacity (IC) has been shown to accelerate progression to disability. The study aims to explore association of IC composite score with functional ability, sarcopenia and systemic inflammation in pre-frail older adults. Methods Cross-sectional study of pre-frail older adults ≥60 years old recruited from the community and primary care centers. Composite scores of four domains of IC were measured: locomotion, vitality, cognition and psychological. FRAIL scale was used to define pre-frailty. Muscle mass was measured using the bioelectrical impedance analysis. Systemic inflammation biomarkers [Interleukin-6 (IL-6), Interleukin-10 (IL-10), Tumor Necrosis Factor Alpha (TNF-α), and Growth differentiated factor 15 (GDF-15)] were measured. Participants in the lowest tertile (T1) exhibited greater decline in IC. Results A total of 398 pre-frail older adults were recruited, mean age was 72.7 ± 5.8 years, 60.1% female, education level 7.8 years, and 85.2% were of Chinese ethnicity. A total of 75.1% had decline in locomotion, 40.5% in vitality, 53.2% in cognition and 41.7% in psychological domain. A total of 95% had decline in at least one domain. T1 was significantly associated with ADL impairment (aOR 3.36, 95% CI 1.78-6.32), IADL impairment (aOR 2.37, 95% CI 1.36-4.13), poor perceived health (aOR 0.96, 95% CI 0.95-0.98), fall (aOR 1.63, 95% CI 1.05-2.84), cognitive impairment (aOR 8.21, 95% CI 4.69-14.39), depression (aOR 101.82, 95% CI 33.62-308.37), and sarcopenia (aOR 2.40, 95% CI 1.60-5.45). T1 had significant associations with GDF-15, IL-10, and IL-10 to TNF-α ratio. Conclusion Decline in IC composite score among pre-frail older adults was associated with functional limitation, sarcopenia, and systemic inflammation.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Denishkrshna Anbarasan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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López-Ortiz S, Caruso G, Emanuele E, Menéndez H, Peñín-Grandes S, Guerrera CS, Caraci F, Nisticò R, Lucia A, Santos-Lozano A, Lista S. Digging into the intrinsic capacity concept: Can it be applied to Alzheimer's disease? Prog Neurobiol 2024; 234:102574. [PMID: 38266702 DOI: 10.1016/j.pneurobio.2024.102574] [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: 06/06/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
Historically, aging research has largely centered on disease pathology rather than promoting healthy aging. The World Health Organization's (WHO) policy framework (2015-2030) underscores the significance of fostering the contributions of older individuals to their families, communities, and economies. The WHO has introduced the concept of intrinsic capacity (IC) as a key metric for healthy aging, encompassing five primary domains: locomotion, vitality, sensory, cognitive, and psychological. Past AD research, constrained by methodological limitations, has focused on single outcome measures, sidelining the complexity of the disease. Our current scientific milieu, however, is primed to adopt the IC concept. This is due to three critical considerations: (I) the decline in IC is linked to neurocognitive disorders, including AD, (II) cognition, a key component of IC, is deeply affected in AD, and (III) the cognitive decline associated with AD involves multiple factors and pathophysiological pathways. Our study explores the application of the IC concept to AD patients, offering a comprehensive model that could revolutionize the disease's diagnosis and prognosis. There is a dearth of information on the biological characteristics of IC, which are a result of complex interactions within biological systems. Employing a systems biology approach, integrating omics technologies, could aid in unraveling these interactions and understanding IC from a holistic viewpoint. This comprehensive analysis of IC could be leveraged in clinical settings, equipping healthcare providers to assess AD patients' health status more effectively and devise personalized therapeutic interventions in accordance with the precision medicine paradigm. We aimed to determine whether the IC concept could be extended from older individuals to patients with AD, thereby presenting a model that could significantly enhance the diagnosis and prognosis of this disease.
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Affiliation(s)
- Susana López-Ortiz
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Giuseppe Caruso
- Department of Drug and Health Sciences, University of Catania, 95125 Catania, Italy; Neuropharmacology and Translational Neurosciences Research Unit, Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | | | - Héctor Menéndez
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Saúl Peñín-Grandes
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Claudia Savia Guerrera
- Department of Educational Sciences, University of Catania, 95125 Catania, Italy; Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy
| | - Filippo Caraci
- Department of Drug and Health Sciences, University of Catania, 95125 Catania, Italy; Neuropharmacology and Translational Neurosciences Research Unit, Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Robert Nisticò
- School of Pharmacy, University of Rome "Tor Vergata", 00133 Rome, Italy; Laboratory of Pharmacology of Synaptic Plasticity, EBRI Rita Levi-Montalcini Foundation, 00143 Rome, Italy
| | - Alejandro Lucia
- Research Institute of the Hospital 12 de Octubre ('imas12'), 28041 Madrid, Spain; Faculty of Sport Sciences, European University of Madrid, 28670 Villaviciosa de Odón, Madrid, Spain; CIBER of Frailty and Healthy Ageing (CIBERFES), 28029 Madrid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain; Research Institute of the Hospital 12 de Octubre ('imas12'), 28041 Madrid, Spain
| | - Simone Lista
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain.
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17
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Ji S, Jung HW, Baek JY, Jang IY, Lee E. Sarcopenia as the Mobility Phenotype of Aging: Clinical Implications. J Bone Metab 2024; 31:1-12. [PMID: 38485236 PMCID: PMC10940105 DOI: 10.11005/jbm.2024.31.1.1] [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: 11/08/2023] [Revised: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 03/17/2024] Open
Abstract
Sarcopenia, which is characterized by an age-related decline in muscle mass and function, poses significant challenges to geriatric care. Its definition has evolved from muscle-specific criteria to include muscle mass, muscle function, and physical performance, recognizing sarcopenia as a physical frailty. Sarcopenia is associated with adverse outcomes, including mortality, falls, fractures, cognitive decline, and admission to long-term care facilities. Neuromechanical factors, protein-energy balance, and muscle protein synthesis-breakdown mechanisms contribute to its pathophysiology. The identification of sarcopenia involves screening tests and a comprehensive assessment of muscle mass, strength, and physical function. Clinical approaches aligned with the principles of comprehensive geriatric assessment prioritize patient-centered care. This assessment aids in identifying issues related to activities of daily living, cognition, mood, nutrition, and social support, alongside other aspects. The general approach to factors underlying muscle loss and functional decline in patients with sarcopenia includes managing chronic diseases and evaluating administered medications, with interventions including exercise and nutrition, as well as evolving pharmacological options. Ongoing research targeting pathways, such as myostatin-activin and exercise mimetics, holds promise for pharmacological interventions. In summary, sarcopenia requires a multifaceted approach, acknowledging its complex etiology and tailoring interventions to individual patient needs.
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Affiliation(s)
- Sunghwan Ji
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Angelsen A, Nakrem S, Zotcheva E, Strand BH, Strand LB. Health-promoting behaviors in older adulthood and intrinsic capacity 10 years later: the HUNT study. BMC Public Health 2024; 24:284. [PMID: 38267907 PMCID: PMC10809656 DOI: 10.1186/s12889-024-17840-3] [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: 11/03/2023] [Accepted: 01/22/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND With the global population growing older, there is a need for more knowledge of how to improve and/or maintain functional capacities to promote healthy ageing. In this study we aimed to assess the effect of several known health-promoting behaviors in old age with intrinsic capacity ten years later. METHODS This was a prospective cohort study looking at participants that were ≥ 65 years at the time of the third wave of the Trøndelag Health Study (HUNT3, 2006-2008) who also took part in the 70 + sub-study of the fourth wave (HUNT4 70+, 2017-2019). Self-reported behavior data from short questionnaires, including diet and physical activity, were collected in HUNT3, and data on the five domains of intrinsic capacity defined by the World Health Organization were collected in HUNT4 70+. A composite index was created for both healthy life and intrinsic capacity, awarding points for how well participants adhered to guidelines for healthy living and their level of functional impairment, respectively. Ordinal logistic regression was used to assess the relationship between health-promoting behaviors and intrinsic capacity. RESULTS Of 12,361 participants in HUNT3 ≥ 65 years, 4699 (56.5% women) also participated in HUNT4 70+. On the health-promoting behaviors, lowest adherence to healthy living guidelines were seen for fruit and vegetables intake (47.2%), milk intake (46.7%) and physical activity (31.1%). On intrinsic capacity domains, highest impairment was seen in the domains of locomotion (29.7%), hearing (11.1%) and vitality (8.3%). A higher adherence to guidelines for healthy living was associated with higher intrinsic capacity 10 years later. A one-point increase in the healthy life index was associated with a 1.15 (95% confidence interval 1.10-1.21) times increased odds of being in a higher intrinsic capacity category. CONCLUSION Health-promoting behaviors in old age are associated with better intrinsic capacity ten years later. In clinical settings assessment of health-promoting behaviors could potentially be done using short questionnaires.
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Affiliation(s)
- Aslaug Angelsen
- Norwegian University of Science and Technology, Trondheim, Norway.
| | - Sigrid Nakrem
- Norwegian University of Science and Technology, Trondheim, Norway
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Yan Wang N, Liu X, Kong X, Sumi Y, Chhetri JK, Hu L, Zhu M, Kang L, Liang Z, Ellis JW, Shi L. Implementation and impact of the World Health Organization integrated care for older people (ICOPE) program in China: a randomised controlled trial. Age Ageing 2024; 53:afad249. [PMID: 38251736 DOI: 10.1093/ageing/afad249] [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: 10/04/2023] [Revised: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Fragmentation of services increases health and social care burden as people live longer with higher prevalence of diseases, frailty and dependency. Local evidence for implementing person-centred integrated care is urgently needed to advance practice and policies to achieve healthy ageing. OBJECTIVE To test the feasibility and impact of World Health Organization's (WHO) Integrated Care for Older People (ICOPE) approach in China. DESIGN A randomised controlled trial examining the feasibility of implementing ICOPE approach, evaluating its impact on health outcomes and health resource utilisation. SETTING Primary care setting in urban and suburban communities of Chaoyang District, Beijing, China. SUBJECTS Community-dwelling older adults screened as at-risk of functional declines and randomised into intervention (537) and control (1611) groups between September 2020 and February 2021. METHODS A 6-month intervention program following WHO's ICOPE care pathways implemented by integrated care managers compared to standard available care. RESULTS After 1 to 1 propensity score matching, participants in intervention and control groups (totally 938) had comparable baseline characteristics, demonstrated feasibility of implementing ICOPE with satisfaction by participants (97-99%) and providers (92-93%). All outcomes showed improvements after a 6-month intervention, while statistically significant least-squares mean differences (control-intervention) in vitality (Mini-Nutritional Assessment Short Form to measure vitality, -0.21, 95% CI, -0.40-0.02), mobility (Short Physical Performance Battery to measure mobility, -0.29, 95% CI, -0.44-0.14) and psychological health (Geriatric Depression Scale five items to measure psychological health, 0.09, 95% CI, 0.03-0.14) were observed (P < 0.05). CONCLUSIONS It is feasible to localise and implement WHO's ICOPE approach in regions with fragmented resources such as China. Preliminary evidence supports its acceptance among key stakeholders and impact on health outcomes.
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Affiliation(s)
- Ninie Yan Wang
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiaohong Liu
- Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangrong Kong
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yuka Sumi
- Ageing and Health (AAH), Department of Maternal, Newborn, Child & Adolescent Health & Ageing (MCA), World Health Organization, Geneva, Switzerland
| | - Jagadish K Chhetri
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linlin Hu
- School of Health Policy and Management, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Minglei Zhu
- Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhen Liang
- Shenzhen People's Hospital, Shenzhen, China
| | - John W Ellis
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Leiyu Shi
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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20
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de Souto Barreto P, Rolland Y, Ferrucci L, Arai H, Bischoff-Ferrari H, Duque G, Fielding RA, Beard JR, Muscedere J, Sierra F, Vellas B, LeBrasseur NK. Looking at frailty and intrinsic capacity through a geroscience lens: the ICFSR & Geroscience Task Force. NATURE AGING 2023; 3:1474-1479. [PMID: 37985720 DOI: 10.1038/s43587-023-00531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Philipe de Souto Barreto
- IHU HealthAge, Toulouse, France.
- CERPOP, Inserm 1295, Université de Toulouse, UPS, Toulouse, France.
- Institute on Aging of the Toulouse University Hospital (CHU-Toulouse), Toulouse, France.
| | - Yves Rolland
- IHU HealthAge, Toulouse, France
- CERPOP, Inserm 1295, Université de Toulouse, UPS, Toulouse, France
- Institute on Aging of the Toulouse University Hospital (CHU-Toulouse), Toulouse, France
| | - Luigi Ferrucci
- Intramural Research Program of the National Institute on Aging
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Heike Bischoff-Ferrari
- IHU HealthAge, Toulouse, France
- Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland
| | - Gustavo Duque
- Bone, Muscle & Geroscience Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - John R Beard
- International Longevity Center-USA, Columbia University, New York, NY, USA
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Bruno Vellas
- IHU HealthAge, Toulouse, France
- CERPOP, Inserm 1295, Université de Toulouse, UPS, Toulouse, France
- Institute on Aging of the Toulouse University Hospital (CHU-Toulouse), Toulouse, France
| | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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21
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Affiliation(s)
- Jean-Pierre Michel
- Medical University of Geneva, Geneva, Switzerland
- French Academy of Medicine, Paris, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, Boulevard Fleming, 25000, Besancon, France.
- EA3920, University of Franche-Comté, Besancon, France.
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22
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Briguglio M, Sirtori P, Mangiavini L, Buzzi S, Cordani C, Zerni MF, Wainwright TW, Ursino N, Peretti GM, Banfi G. How Do Older Patients with End-Stage Osteoarthritis of the Hip Eat Prior to Hip Replacement? A Preliminary Snapshot That Highlights a Poor Diet. Nutrients 2023; 15:4868. [PMID: 38068726 PMCID: PMC10708412 DOI: 10.3390/nu15234868] [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: 10/31/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Diet quantity and quality in older adults is critical for the proper functioning of the musculoskeletal system. In view of hip surgery, old patients should consume 1.2-1.5 g of proteins and 27-30 kcal per kilo of body weight daily, and adhere to healthy eating habits. In this analytical study, we studied diet quantity and quality in relation to the clinical chemistry and functional status of 57 older adults undergoing elective hip replacement. Nine in ten patients did not meet suggested protein and energy intakes and only one in ten patients exhibited high adherence to the Mediterranean diet. Legume consumption adjusted for sex, age, body mass index, and health status successfully forecasted haemoglobin levels (p < 0.05), and patients regularly consuming olive oil reported minor hip disability compared to those using it less frequently (p < 0.05). Patients who reported daily ingestion of <1 serving of meat versus those consuming >1.5 servings had greater cumulative comorbidity (p < 0.05), with meat consumption independently predicting walking ability, mobility, and balance in the fully adjusted model (p < 0.01). In conclusion, our patients seem to eat poorly. There is room for improvement in pre-operative pathways to make older adults eat better, but there is a need to plan an interventional study to fully understand the cause-effect of a dietary pattern or specific food in enhancing recovery after surgery.
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Affiliation(s)
- Matteo Briguglio
- Laboratory of Nutritional Sciences, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Paolo Sirtori
- E.U.O.R.R. Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (G.M.P.)
| | - Laura Mangiavini
- E.U.O.R.R. Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (G.M.P.)
- Department of Biomedical Sciences for Health, University “La Statale” of Milan, 20133 Milan, Italy
| | - Sara Buzzi
- Department of Biomedical Sciences for Health, University “La Statale” of Milan, 20133 Milan, Italy
| | - Claudio Cordani
- Department of Biomedical, Surgical, and Dental Sciences, University “La Statale” of Milan, 20141 Milan, Italy;
- IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Maria Francesca Zerni
- Laboratory of Nutritional Sciences, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8FT, UK
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, UK
| | - Nicola Ursino
- C.A.S.C.O. Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Giuseppe M. Peretti
- E.U.O.R.R. Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (G.M.P.)
- Department of Biomedical Sciences for Health, University “La Statale” of Milan, 20133 Milan, Italy
| | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
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23
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Chen LK. Age, happiness, and health: Exploring the synergy of positive emotions in healthy aging. Arch Gerontol Geriatr 2023; 114:105167. [PMID: 37657407 DOI: 10.1016/j.archger.2023.105167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Affiliation(s)
- Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan.
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24
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de Oliveira VP, Ferriolli E, Lourenço RA, González-Bautista E, de Souto Barreto P, de Mello RGB. The sensitivity and specificity of the WHO's ICOPE screening tool, and the prevalence of loss of intrinsic capacity in older adults: A scoping review. Maturitas 2023; 177:107818. [PMID: 37542782 DOI: 10.1016/j.maturitas.2023.107818] [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: 02/14/2023] [Revised: 05/26/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND The World Health Organization has developed the Integrated Care for Older People (ICOPE) program, a public health strategy to maintain older adults' functional abilities and promote healthier aging. The approach comprises a 5-step pathway. Step 1 is the screening for impairment in functions, and Step 2 is an in-depth evaluation to confirm the presence and severity of functional impairment. These initial two steps are crucial to determine the subsequent plan of care (Step 3) and follow-up (Step 4). The fifth step encompasses actions to support families and caregivers and to engage communities. This review gathers data from the literature on the prevalence of positive screenings regarding intrinsic capacity detected by the program's first-step screening tool, and on currently available results regarding the instrument's sensitivity and specificity. METHODS AND FINDINGS Electronic searches were conducted in the PubMed, Cochrane, Embase, and SciElo databases, the medRxiv platform, and recent human aging scientific events, looking for research analyzing the ICOPE screening instrument. Studies reporting data on the prevalence of positive screenings for loss of intrinsic capacity using the proposed screening tool and/or findings on the instrument's sensitivity and specificity were included. A total of 7 publications with participants aged 50 years or more were selected. The prevalence of at least one impairment in intrinsic capacity detected by the instrument varied among the studies from 17.1 % to 94.3 %. Sensitivity ranged from 26.4 % to 100 % and specificity from 22 % to 96 %, depending on the setting and the assessed domain. CONCLUSION Currently available data are heterogeneous, and different results were found among the studies due to diverse settings and methodologies. The evidence on the ICOPE screening tool's performance in different populations is still scarce and reinforces the need for further research worldwide.
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Affiliation(s)
- Vitor Pelegrim de Oliveira
- Geriatric Unit - Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 5° andar, sala C 5006, Bloco C, Porto Alegre, RS CEP 90035-903, Brazil; Post Graduation Program in Medical Sciences: Endocrinology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2° andar, Porto Alegre, RS CEP 90035-000, Brazil; Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalier-Universitaire de Toulouse, 37 Allés Jules Guesdes, Toulouse, CP 31000, France.
| | - Eduardo Ferriolli
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), Av. Dr. Enéas de Carvalho Aguiar, 155, 8° andar, Bloco 8A, Setor Azul, São Paulo, SP CEP 05003-900, Brazil.
| | - Roberto Alves Lourenço
- Faculty of Health Sciences, Internal Medicine Department, Human Aging Research Laboratory, Universidade do Estado do Rio de Janeiro, Av. Mal. Rondon, 381, Rio de Janeiro, RJ CEP 20950-003, Brazil.
| | - Emmanuel González-Bautista
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalier-Universitaire de Toulouse, 37 Allés Jules Guesdes, Toulouse, CP 31000, France
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalier-Universitaire de Toulouse, 37 Allés Jules Guesdes, Toulouse, CP 31000, France
| | - Renato Gorga Bandeira de Mello
- Geriatric Unit - Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 5° andar, sala C 5006, Bloco C, Porto Alegre, RS CEP 90035-903, Brazil; Post Graduation Program in Medical Sciences: Endocrinology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2° andar, Porto Alegre, RS CEP 90035-000, Brazil.
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25
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Briguglio M, Cordani C, Langella F, Perazzo P, Pregliasco FE, Banfi G, Wainwright TW. Why Treat Patients with a Major Orthopaedic Surgery Only to Send Them Back to the Vulnerable Conditions That Made Them Sick in the First Place? A Conceptual Scenario to Improve Patient's Journey. Int J Gen Med 2023; 16:4729-4735. [PMID: 37881478 PMCID: PMC10593966 DOI: 10.2147/ijgm.s431055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/22/2023] [Indexed: 10/27/2023] Open
Abstract
Individuals with severe cartilage degeneration of the hip or knee or collapsed vertebrae that cause spine deformities can suffer from joint and neuropathic pain in the back, disuse of the affected limb, and restriction of movements. Surgical intervention is the most widespread and successful solution to date. There is a general belief that eating healthy and staying physically and mentally active might have a preventive role against musculoskeletal disease occurrence, while instead, we are more certain of the benefits deriving from a healthy diet and exercise therapy after major orthopaedic procedures. These aspects are in fact vital components in enhanced recovery after surgery programmes. However, they are applied in hospital settings, are often centre-dependent, and lack primary and tertiary preventive efficacy since end once the patient is discharged. There is the lack of initiatives at the territorial level that ensure a continuum in the patient's journey towards orthopaedic surgery, home transition, and a healthy and long-lasting life. The expert panel advocates the integration of an intermediate lifestyle clinic that promotes healthy eating, physical activity, and sleep hygiene. In this facility directed by professionals in enhancing recovery after surgery, patients can be referred after the surgical indication and before home discharge. Surgery is in fact a moment when individuals are more curious to do their best to heal and stay healthy, representing a timepoint and opportunity for educating patients on how lifestyle changes may optimise not only their surgical recovery but also long-term future health state.
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Affiliation(s)
- Matteo Briguglio
- Laboratory of Nutritional Sciences, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Claudio Cordani
- Department of Biomedical, Surgical, and Dental Sciences, University “La Statale”, Milan, Italy
- Scientific Direction, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | | | - Paolo Perazzo
- Intensive Care Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Fabrizio Ernesto Pregliasco
- Health Management, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe Banfi
- Scientific Direction, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Thomas W Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
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26
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Hoogendijk EO, Dent E, Koivunen K. Intrinsic capacity: an under-researched concept in geriatrics. Age Ageing 2023; 52:afad183. [PMID: 37782890 DOI: 10.1093/ageing/afad183] [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: 07/10/2023] [Indexed: 10/04/2023] Open
Abstract
In 2015, the World Health Organisation (WHO) introduced the concept of intrinsic capacity (IC) as part of a new public health model for healthy ageing. IC refers to the overall combination of an individual's physical and mental capacities, and is promoted as a new positive approach to the health and wellbeing of older adults. However, there is still insufficient evidence that implementing IC leads to better care for older adults. Moreover, the current operationalisations of IC lead to confusion and redundant research. In this commentary, we discuss whether the concept of IC has added value for geriatrics, and describe the main issues related to its conceptualisation, measurement, and application. We argue that there is a need to clarify and validate the concept of IC, including independent evidence regarding its feasibility and acceptance in clinical practice.
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Affiliation(s)
- Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - location VU University medical center, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC - location VU University medical center, Amsterdam, the Netherlands
| | - Elsa Dent
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kaisa Koivunen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, 40014, Jyväskylä, Finland
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27
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Gonzalez-Bautista E, Beard J. The Challenge of Measuring Intrinsic Capacity. J Nutr Health Aging 2023; 27:806-807. [PMID: 38216222 DOI: 10.1007/s12603-023-2012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 01/14/2024]
Affiliation(s)
- E Gonzalez-Bautista
- Gerontopole of Toulouse University Hospital, Institute on Aging. Research and Clinical Alzheimer's Disease Center, CMRR, Toulouse, France; Maintain Aging Research team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - JohnR Beard
- Butler Columbia Aging Center. Mailman School of Public Health, Columbia University, New York, USA.
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Wu N, Xie X, Cai M, Han Y, Wu S. Trends in health service needs, utilization, and non-communicable chronic diseases burden of older adults in China: evidence from the 1993 to 2018 National Health Service Survey. Int J Equity Health 2023; 22:169. [PMID: 37649033 PMCID: PMC10466757 DOI: 10.1186/s12939-023-01983-7] [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: 12/01/2022] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Aging is associated with an increased prevalence of non-communicable chronic diseases (NCDs), functional impairments, and diverse demands for health services. This study analyzed the trends in older adults' needs and utilization of health services from 1993 to 2018 in China, as well as chronic disease-related economic burdens. METHODS The research data were collected from the six cross-sectional National Health Service Survey (NHSS), implemented every 5 years from 1993 to 2018. A multi-stage stratified random cluster sampling method has been adopted in the NHSS. The data on the older population's socio-economic characteristics, health service needs, and utilization were collected from the 6 waves National Health Service Survey (NHSS) 1993-2018. In the 2013 and 2018 NHSSs, EQ-5D-3L and visual analogue scale were used to evaluate the health condition. And the prevalence of NCDs and related Out-of-pocket (OOP) expenditures were collected. Functional dependency and impairment were collected in 2018. The Katz Activities of Daily Living scale was used to evaluate six functions, including self-feeding, dressing, bathing, transferring, toilet hygiene, and controlling bowel movements. RESULTS The two-week morbidity rate and prevalence of NCDs showed a rapid upward trend in older adults. With the development of health system reform and universal health insurance coverage, older adults' two-week medical consultation rate increased from 25.6% in 1993 to 40.1% in 2018, and the hospitalization rate rose from 6.1% to 24.9%. The difference in health service needs and utilization between urban and rural areas decreased, and the hospitalization rate in rural areas (26.3%) exceeded that in urban areas (23.6%) for the first time in 2018. Functional independence become more severe as aged. The proportion of severe functional impairment was 6.9% and 2% in the group aged 80 or over and group 70-79 years, respectively. Regarding disability status, 32.5% had hearing problems and 31.4% had visual impairment. The highest prevalence rates of NCDs in older adults were found in hypertension (36.9%), followed by diabetes (10.6%), cerebrovascular disease (5.4%), ischemic heart disease (4.5%), and intervertebral disc disease (4.2%). The average annual OOP expenditures attributed to NCDs increased from ¥2481.8 RMB in 2013 to ¥8255.9 RMB in 2018 for older adults. About 90.7% of older adults prefer to live in the residential community, leading to the demands for preventive healthcare (30.4%), medical treatment (14.1%), and elderly education (8.6%). CONCLUSION The elevated risks of age-related impairments and chronic morbidities, and increased demands for preventive healthcare are critical public health issues. Policymakers should strengthen primary healthcare and move towards integrated delivery to improve access and quality of care for older adults. The integration of healthcare and social security constitutes an adaptive trend in meeting the multi-level demands of an aging society.
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Affiliation(s)
- Nina Wu
- Department of Health Management and Policy, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China
| | - Xueqin Xie
- Centre for Health Statistics Information, National Health Commission of the People's Republic of China, No. 1, Xizhimenwai South Road, Xicheng District, Beijing, 100044, China
| | - Min Cai
- Centre for Health Statistics Information, National Health Commission of the People's Republic of China, No. 1, Xizhimenwai South Road, Xicheng District, Beijing, 100044, China
| | - Youli Han
- Department of Health Management and Policy, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
| | - Shiyong Wu
- Centre for Health Statistics Information, National Health Commission of the People's Republic of China, No. 1, Xizhimenwai South Road, Xicheng District, Beijing, 100044, China.
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29
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Rolland Y, Sierra F, Ferrucci L, Barzilai N, De Cabo R, Mannick J, Oliva A, Evans W, Angioni D, De Souto Barreto P, Raffin J, Vellas B, Kirkland JL. Challenges in developing Geroscience trials. Nat Commun 2023; 14:5038. [PMID: 37598227 PMCID: PMC10439920 DOI: 10.1038/s41467-023-39786-7] [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: 02/20/2023] [Accepted: 06/29/2023] [Indexed: 08/21/2023] Open
Abstract
Geroscience is becoming a major hope for preventing age-related diseases and loss of function by targeting biological mechanisms of aging. This unprecedented paradigm shift requires optimizing the design of future clinical studies related to aging in humans. Researchers will face a number of challenges, including ideal populations to study, which lifestyle and Gerotherapeutic interventions to test initially, selecting key primary and secondary outcomes of such clinical trials, and which age-related biomarkers are most valuable for both selecting interventions and predicting or monitoring clinical responses ("Gerodiagnostics"). This article reports the main results of a Task Force of experts in Geroscience.
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Affiliation(s)
- Yves Rolland
- Gérontopôle de Toulouse, IHU HealthAge, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.
- CERPOP UMR 1295, University of Toulouse III, Inserm, UPS, Toulouse, France.
| | | | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Nir Barzilai
- Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rafael De Cabo
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | | | | | - William Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA
| | - Davide Angioni
- Gérontopôle de Toulouse, IHU HealthAge, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Philipe De Souto Barreto
- Gérontopôle de Toulouse, IHU HealthAge, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, Inserm, UPS, Toulouse, France
| | - Jeremy Raffin
- Gérontopôle de Toulouse, IHU HealthAge, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, Inserm, UPS, Toulouse, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, IHU HealthAge, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, Inserm, UPS, Toulouse, France
| | - James L Kirkland
- Noaber Foundation Professor of Aging Research, Mayo Clinic, Principal Investigator, NIH R33 Translational Geroscience Network, President, American Federation for Aging Research, Rochester, NY, USA
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Gonzalez-Bautista E, Morsch P, Gonzalez C, Vega E. A short list of high-priority indicators of health system responsiveness for aging: an eDelphi consensus study. Rev Panam Salud Publica 2023; 47:e103. [PMID: 37534053 PMCID: PMC10392236 DOI: 10.26633/rpsp.2023.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/06/2023] [Indexed: 08/04/2023] Open
Abstract
The objective of this article was to provide a consensus-based short list of effective indicators to measure health system responsiveness to the needs of older adults which would be relevant to informing public policy. An e-Delphi study was done with no direct interaction between respondents. Virtual surveys were sent to 141 participants with experience in analysis and monitoring of health indicators, management of health systems, and health care of older adults. A baseline list of 24 previously published indicators was used. The criteria for selection as high priority indicators were: usefulness as a tracer of health system responsiveness and usefulness to inform policy. Consensus was defined as: ≥70% agreement among the participants that the indicator was very high or high priority; plus being benchmarked by ≥50% of respondents as having a higher relative weight than other indicators; plus being in the top 10 in the ranking list. The first round of the process included 38 participants with varied professional backgrounds. Consensus was reached for seven indicators after two rounds. Five indicators were related to distal outcomes (mortality, disability, or healthy life expectancy), one to monitoring functional assessments, and one to poverty levels. Health systems professionals should consider these comprehensive priority indicators in their efforts to provide a better health system for older people.
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Affiliation(s)
- Emmanuel Gonzalez-Bautista
- GerontopoleToulouse University HospitalToulouseFranceGerontopole, Toulouse University Hospital, Toulouse, France.
| | - Patricia Morsch
- Health Systems and ServicesPan American Health OrganizationWashington, D.C.United States of AmericaHealth Systems and Services, Pan American Health Organization, Washington, D.C., United States of America.
| | | | - Enrique Vega
- Health Systems and ServicesPan American Health OrganizationWashington, D.C.United States of AmericaHealth Systems and Services, Pan American Health Organization, Washington, D.C., United States of America.
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Gutiérrez-Barreto SE, Sosa-Tinoco E, Rojas-Calixto O, Deniss-Navarro Z, Avila-Avila A, Gutierrez JP. Evaluating the design of the Integrated Care for Older People: a theory of change approach. Front Med (Lausanne) 2023; 10:1166196. [PMID: 37502365 PMCID: PMC10368864 DOI: 10.3389/fmed.2023.1166196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Given the progressive aging of the population, there is an urgent need at the health system level to implement effective models to care for older people (OP). Healthy aging is imperative to reach the Sustainable Development Goals. The World Health Organization (WHO) developed the Integrated Care for Older People (ICOPE) strategy to address this challenge. Implementing ICOPE requires its adaption to a specific context. We propose a pathway for such adaptation through an evaluation of the design of ICOPE; thus, we aim to describe the Theory of Change (ToC) of ICOPE and evaluate it for its implementation in Mexico City. Methods Based on the WHO and published literature documentation, we drafted an initial ToC for ICOPE. Then, we validated the ToC with experts in ICOPE, after which we evaluated and refined it by discussing the causal pathway, intervention required to activate it, rationale, and assumptions in consecutive workshops with 91 stakeholders and healthcare workers, using the nominal group technique to reach a consensus. Results The resulting ToC has the potential to contribute to healthy aging by three expected impacts: (1) prevention, reversal, or delaying of the decline of intrinsic capacity (IC) in OP; (2) improvement of the quality of life of OP; and (3) increase of disability-free life expectancy. The ICOPE causal pathway had ten preconditions, including the availability of resources, identifying at-risk individuals, available treatments, and evaluating results. Discussion We adapted ICOPE to a specific implementation context by evaluating its ToC in a participatory process that allows us to identify challenges and address them, at least in terms of the guidelines to operate the strategy. As ICOPE is an approach for a primary healthcare system, its adoption in a community healthcare program is promising and feasible. Evaluation as a tool could contribute to the design of effective interventions. The evaluation of the design of ICOPE for its implementation contributes to the strength of its potential to improve care for OP. This design for implementing ICOPE has the potential to be applied to similar contexts, for example, in other lower-middle-income countries.
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Affiliation(s)
- Samuel E. Gutiérrez-Barreto
- Master’s and Doctorate Programs in Medical, Dental, and Health Sciences, National Autonomous University of Mexico, Mexico City, Mexico
| | | | | | | | | | - Juan Pablo Gutierrez
- Center for Policy, Population and Health Research, National Autonomous University of Mexico, Mexico City, Mexico
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El-Osta A, Sasco ER, Barbanti E, Webber I, Alaa A, Karki M, Asmar MLE, Idriss H, Almadi M, Massoud F, Alboksmaty A, Majeed A. Tools for measuring individual self-care capability: a scoping review. BMC Public Health 2023; 23:1312. [PMID: 37422637 PMCID: PMC10329804 DOI: 10.1186/s12889-023-16194-6] [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: 02/07/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Our ability to self-care can play a crucial role in the prevention, management and rehabilitation of diverse conditions, including chronic non-communicable diseases. Various tools have been developed to support the measurement of self-care capabilities of healthy individuals, those experiencing everyday self-limiting conditions, or one or more multiple long-term conditions. We sought to characterise the various non-mono-disease specific self-care measurement tools for adults as such a review was lacking. OBJECTIVE The aim of the review was to identify and characterise the various non-mono-disease specific self-care measurement tools for adults. Secondary objectives were to characterise these tools in terms of their content, structure and psychometric properties. DESIGN Scoping review with content assessment. METHODS The search was conducted in Embase, PubMed, PsycINFO and CINAHL databases using a variety of MeSH terms and keywords covering 1 January 1950 to 30 November 2022. Inclusion criteria included tools assessing health literacy, capability and/or performance of general health self-care practices and targeting adults. We excluded tools targeting self-care in the context of disease management only or indicated to a specific medical setting or theme. We used the Seven Pillars of Self-Care framework to inform the qualitative content assessment of each tool. RESULTS We screened 26,304 reports to identify 38 relevant tools which were described in 42 primary reference studies. Descriptive analysis highlighted a temporal shift in the overall emphasis from rehabilitation-focused to prevention-focused tools. The intended method of administration also transitioned from observe-and-interview style methods to the utilisation of self-reporting tools. Only five tools incorporated questions relevant to the seven pillars of self-care. CONCLUSIONS Various tools exist to measure individual self-care capability, but few consider assessing capability against all seven pillars of self-care. There is a need to develop a comprehensive, validated tool and easily accessible tool to measure individual self-care capability including the assessment of a wide range of self-care practices. Such a tool could be used to inform targeted health and social care interventions.
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Affiliation(s)
- Austen El-Osta
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Eva Riboli Sasco
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Evelina Barbanti
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Iman Webber
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Aos Alaa
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Manisha Karki
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Marie line El Asmar
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Haitham Idriss
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Mashael Almadi
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Farah Massoud
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Ahmed Alboksmaty
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Azeem Majeed
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
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Gonzalez-Bautista E, Llibre-Guerra JJ, Sosa AL, Acosta I, Andrieu S, Acosta D, Llibre-Rodríguez JDJ, Prina M. Exploring the natural history of intrinsic capacity impairments: longitudinal patterns in the 10/66 study. Age Ageing 2023; 52:afad137. [PMID: 37517058 PMCID: PMC10387229 DOI: 10.1093/ageing/afad137] [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: 12/18/2022] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND intrinsic capacity (IC) is a construct encompassing people's physical and mental abilities. There is an implicit link amongst IC domains: cognition, locomotion, nutrition, sensory and psychological. However, little is known about the integration of the domains. OBJECTIVES to investigate patterns in the presentation and evolution of IC domain impairments in low-and-middle-income countries and if such patterns were associated with adverse outcomes. METHODS secondary analyses of the first two waves of the 10/66 study (population-based surveys conducted in eight urban and four rural catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico and China). We applied latent transition analysis on IC to find latent statuses (latent clusters) of IC domain impairments. We evaluated the longitudinal association of the latent statuses with the risk of frailty, disability and mortality, and tested concurrent and predictive validity. RESULTS amongst 14,923 participants included, the four latent statuses were: high IC (43%), low deterioration with impaired locomotion (17%), high deterioration without cognitive impairment (22%), and high deterioration with cognitive impairment (18%). A total of 61% of the participants worsened over time, 35% were stable, and 3% improved to a healthier status.Participants with deteriorated IC had a significantly higher risk of frailty, disability and dementia than people with high IC. There was strong concurrent and predictive validity. (Mortality Hazard Ratio = 4.60, 95%CI 4.16; 5.09; Harrel's C = 0.73 (95%CI 0.72;0.74)). CONCLUSIONS half of the study population had high IC at baseline, and most participants followed a worsening trend. Four qualitatively different IC statuses or statuses were characterised by low and high levels of deterioration associated with their risk of disability and frailty. Locomotion and cognition impairments showed other trends than psychological and nutrition domains across the latent statuses.
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Affiliation(s)
- Emmanuel Gonzalez-Bautista
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Institute on Aging, Toulouse University Hospital (CHU), Gerontopole, Toulouse, France
- Department of Health Service & Population Research, King’s College London, Institute of Psychiatry, Psychology &Neuroscience, London, UK
| | | | - Ana L Sosa
- National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Isaac Acosta
- Internal Medicine Department, Geriatric Section, Universidad Nacional Pedro Henriquez Ureña, Santo Domingo, Dominican Republic
| | - Sandrine Andrieu
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Daisy Acosta
- Internal Medicine Department, Geriatric Section, Universidad Nacional Pedro Henriquez Ureña, Santo Domingo, Dominican Republic
| | | | - Matthew Prina
- Department of Health Service & Population Research, King’s College London, Institute of Psychiatry, Psychology &Neuroscience, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Gaussens L, González-Bautista E, Bonnefoy M, Briand M, Tavassoli N, De Souto Barreto P, Rolland Y. Associations between Vitality/Nutrition and the Other Domains of Intrinsic Capacity Based on Data from the INSPIRE ICOPE-Care Program. Nutrients 2023; 15:nu15071567. [PMID: 37049408 PMCID: PMC10096560 DOI: 10.3390/nu15071567] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The vitality domain of intrinsic capacity (IC) represents the synthesis of biological interactions and metabolism. As part of the Integrated Care for Older People (ICOPE) program developed by the World Health Organization (WHO), vitality focuses on the nutritional status of older adults. The objective of this work was to describe the vitality domain of IC in community-dwelling older people and to examine the associations of the vitality components (appetite loss and weight loss) with the other IC domains assessed within the framework of ICOPE. METHODS Cross-sectional data were obtained between January 2020 and February 2022 through the INSPIRE-ICOPE-Care program, a real-life ICOPE implementation initiative developed in the Occitania region of France. Participants were men and women aged 60 and older, looking for primary care services within the French healthcare system. RESULTS Appetite loss was reported by 14.0% (2013) of the participants, and weight loss by 12.4% (1788). A total of 863 participants (6.01%) declaring weight loss also suffered from appetite loss. In total, 2910 participants (20.27%) screened positive for the domain of vitality. Appetite loss was significantly associated with positive screenings for the domains of cognition (OR = 2.14 [1.84;2.48]), vision (OR = 1.51 [1.28;1.79]), hearing (OR = 1.18 [1.01;1.37]), psychology (OR = 3.95 [3.46;4.52]), and locomotion 'OR = 2.19 [1.91;2.51]). We found significant associations of weight loss with the IC domains of cognition (OR = 1.65 [1.42;1.93]), psychology (OR = 1.80 [1.56;2.07]), locomotion (OR = 1.64 [1.41;1.91]), vision (OR = 1.24 [1.04;1.47]), and hearing (OR = 1.32 [1.12;1.55]). People reporting simultaneous appetite and weight loss showed higher odds of screening positive for psychological (OR = 5.33 [4.53;6.27]) and locomotion impairments (OR = 3.38 [2.88;3.98]). CONCLUSIONS Appetite and weight loss are common among older people and are related to other potential IC impairments, especially psychological and locomotion. Further studies are needed to explore the longitudinal associations of vitality with the incidence of clinically meaningful declines in the other IC domains.
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Affiliation(s)
- Luc Gaussens
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, 31300 Toulouse, France
| | - Emmanuel González-Bautista
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, 31300 Toulouse, France
| | - Marc Bonnefoy
- Service de Médecine Gériatrique, CHU Lyon, Groupement Hospitalier Sud, 69495 Pierre-Bénite, France
| | - Marguerite Briand
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, 31300 Toulouse, France
| | - Neda Tavassoli
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, 31300 Toulouse, France
| | - Philipe De Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, 31300 Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, Inserm, UPS, 31062 Toulouse, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, 31300 Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, Inserm, UPS, 31062 Toulouse, France
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Rojano i Luque X, Blancafort-Alias S, Prat Casanovas S, Forné S, Martín Vergara N, Fabregat Povill P, Vila Royo M, Serrano R, Sanchez-Rodriguez D, Vílchez Saldaña M, Martínez I, Domínguez López M, Riba Porquet F, Intxaurrondo González A, Salvà Casanovas A. Identification of decreased intrinsic capacity: Performance of diagnostic measures of the ICOPE Screening tool in community dwelling older people in the VIMCI study. BMC Geriatr 2023; 23:106. [PMID: 36809987 PMCID: PMC9945724 DOI: 10.1186/s12877-023-03799-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) has developed the Integrated Care for Older People (ICOPE) strategy to face the challenges of ageing societies. This strategy is focused on person centered care and the assessment intrinsic capacity (IC). Early identification of five domains of IC (cognition, locomotion, vitality, sensory (hearing and vision), and psychological) has been shown to be related with adverse outcomes and can guide actions towards primary prevention and healthy ageing. IC assessment proposed by the WHO ICOPE guidelines is composed by two steps: First, Screening for decreased IC by the ICOPE Screening tool; second, by the reference standard methods. The aim was to assess the performance of diagnostic measures (sensibility, specificity, diagnostic accuracy, and agreement of the ICOPE Screening tool) compared to the reference standard methods in European community-dwelling older adults. METHODS Cross-sectional analysis of the baseline of the ongoing VIMCI (Validity of an Instrument to Measure Intrinsic Capacity) cohort study, which was carried out in Primary Care centers and outpatient clinics from 5 rural and urban territories in Catalonia (Spain). Participants were 207community dwelling persons ≥ 70-year-old with Barthel ≥ 90, without dementia or advanced chronic conditions who provided their consent to participate. The 5 IC domains were assessed by the ICOPE Screening tool and the reference methods (SPPB, gait speed, MNA, Snellen chart, audiometry, MMSE, GDS5) during patients' visit. Agreement was assessed with the Gwet AC1 index. RESULTS ICOPE Screening tool sensitivity was higher for cognition (0.889) and ranged between 0.438 and 0.569 for most domains. Specificity ranged from 0.682 to 0.96, diagnostic accuracy from 0.627 to 0.879, Youden index from 0.12 to 0.619, and Gwet AC1 from 0.275 to 0.842. CONCLUSION The ICOPE screening tool showed fair performance of diagnostic measures; it was helpful to identify those participants with satisfactory IC and showed a modest ability to identify decreased IC in older people with high degree of autonomy. Since low sensitivities were found, a process of external validation would be recommended to reach better discrimination. Further studies about the ICOPE Screening tool and its performance of diagnostic measures in different populations are urgently required.
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Affiliation(s)
- Xavier Rojano i Luque
- grid.477257.40000 0004 4904 4581Fundació Salut i Envelliment UAB (FSIE-UAB), Barcelona, Spain ,grid.413396.a0000 0004 1768 8905Sant Pau Institute for Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - Sergi Blancafort-Alias
- Fundació Salut i Envelliment UAB (FSIE-UAB), Barcelona, Spain. .,Sant Pau Institute for Biomedical Research (IIB Sant Pau), Barcelona, Spain.
| | - Susanna Prat Casanovas
- grid.22061.370000 0000 9127 6969ABS Ripoll-Sant Joan de les Abadesses, Institut Català de la Salut (ICS), Ripoll, Spain
| | - Susanna Forné
- Fundació Sant Hospital, La Seu d’Urgell, Lleida, Spain
| | - Nuria Martín Vergara
- grid.22061.370000 0000 9127 6969EAP Horts de Miró, Institut Català de la Salut (ICS), Reus, Spain
| | | | - Maria Vila Royo
- grid.432291.f0000 0004 1755 8959Badalona Serveis Assistencials (BSA), Badalona, Spain
| | | | - Dolores Sanchez-Rodriguez
- grid.411371.10000 0004 0469 8354Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium ,grid.4861.b0000 0001 0805 7253 Health Organization Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium ,grid.20522.370000 0004 1767 9005Geriatrics Department, Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | | | - Iris Martínez
- Fundació Sant Hospital, La Seu d’Urgell, Lleida, Spain
| | | | | | - Aimar Intxaurrondo González
- grid.477257.40000 0004 4904 4581Fundació Salut i Envelliment UAB (FSIE-UAB), Barcelona, Spain ,grid.413396.a0000 0004 1768 8905Sant Pau Institute for Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - Antoni Salvà Casanovas
- grid.477257.40000 0004 4904 4581Fundació Salut i Envelliment UAB (FSIE-UAB), Barcelona, Spain ,grid.413396.a0000 0004 1768 8905Sant Pau Institute for Biomedical Research (IIB Sant Pau), Barcelona, Spain
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Rodríguez-Laso Á, García-García FJ, Rodríguez-Mañas L. The icope Intrinsic Capacity Screening Tool: Measurement Structure and Predictive Validity of Dependence and Hospitalization. J Nutr Health Aging 2023; 27:808-816. [PMID: 37960903 DOI: 10.1007/s12603-023-1985-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/03/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES To evaluate the measurement structure of the ICOPE screening tool (IST) of intrinsic capacity and to find out whether the IST as a global measure adds explanatory power over and above its domains in isolation to predict the occurrence of adverse health outcomes such as dependence and hospitalization in community-dwelling older people. DESIGN Secondary analysis of a cohort study, the Toledo Study of Healthy Ageing. SETTING Province of Toledo, Spain. PARTICIPANTS Community-dwelling older people. MEASUREMENTS Items equal or similar to those of the IST were introduced as a reflective-formative construct in a Structural Equation Model to evaluate its measurement structure and its association with dependence for basic and instrumental activities and hospitalization over a three-year period. RESULTS A total of 1032 individuals were analyzed. Mean age was 73.5 years (sd 5.4). The least preserved indicators were ability to recall three words (18%) and to perform chair stands (54%). Vision and hearing items did not form a single sensory domain, so six domains were considered. Several cognition items did not show sufficiently strong and univocal associations with the domain. After pruning the ill-behaved items, the measurement model fit was excellent (Satorra-Bentler scaled chi-square: 10.3, degrees of freedom: 11, p=0.501; CFI: 1.000; RMSEA: 0.000, 90% CI: 0.000-0.031, p value RMSEA<=0.05: 1; SRMR: 0.055). In the structural model, the cognition domain items were not associated as expected with age (p values 0.158 and 0.293), education (p values 0.190 and 0.432) and dependence (p values 0.654 and 0.813). The IST included as a composite in a model with the individual domains showed no statistically significant associations with any of the outcomes (dependence for basic activities: 0.162, p=0.167; instrumental: -0.052, p=0.546; hospitalization: 0.145, p=0.167), while only the mobility domain did so for dependence (basic: -0.266, p=0.005; instrumental: -0.138, p=0.019). The model fit of the last version was good (Satorra-Bentler scaled chi-square: 52.1, degrees of freedom: 52, p=0.469; CFI: 1.000; TLI: 1.000; RMSEA: 0.01, 90% CI: 0.000-0.02, p value RMSEA<=0.05: 1; SRMR: 0.071). The IST operationalized as the sum of non-impaired domains was not associated after covariate adjustment (dependence for basic activities: -0.065, p=0.356; instrumental: -0.08, p=0.05; hospitalization: -0.003, p=0.949) either. CONCLUSION The cognitive domain of the IST, and probably other of its items, may need a reformulation. A global measure of intrinsic capacity such as the IST does not add explanatory power to the individual domains that constitute it. So far, our results confirm the importance of checking the findings of the IST with a second confirmatory step, as described in the WHO's ICOPE strategy.
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Affiliation(s)
- Á Rodríguez-Laso
- Leocadio Rodríguez-Mañas, Geriatric Department, Hospital Universitario de Getafe, Ctra de Toledo Km12,5. 28905 Getafe. Madrid, Spain, Phone number: (34) 916839360 (ext. 6412),
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Zhang S, Peng LN, Otsuka R, Liang CK, Nishita Y, Arai H, Chen LK. Comparative Analysis of Intrinsic Capacity Impairments, Determinants, and Clinical Consequences in Older Community-Dwellers in Japan and Taiwan: Longitudinal Studies Showing Shared Traits and Distinct Presentations. J Nutr Health Aging 2023; 27:1038-1046. [PMID: 37997726 DOI: 10.1007/s12603-023-2020-z] [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: 08/13/2023] [Accepted: 10/19/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES Despite the recognized impact of intrinsic capacity (IC) impairment on healthy aging, international comparisons in different sociocultural contexts are scarce. This study aimed to compare IC impairment among community-dwelling older adults in Japan and Taiwan to explore the context of healthy aging in different countries. DESIGN Comparative observational study. SETTING National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) in Japan and Longitudinal Aging Study of Taipei (LAST) in Taiwan. PARTICIPANTS 794 individuals (age range, 60.0-86.5 years) from NILS-LSA and 1,358 (60.0-96.7 years) from LAST. MEASUREMENTS IC impairment was evaluated across the domains of locomotion, cognition, vitality, sensory capacity, and psychological well-being. Participants were categorized as having impaired IC or healthy. We investigated associations between IC impairment, falls, and all-cause mortality. RESULTS IC impairment was present in 54.9% and 37.3% of participants in the NILS-LSA and LAST cohorts, respectively. Male NILS-LSA participants with impaired IC (odds ratio [OR]:1.50, 95% confidence interval [CI]:1.03-2.20), with hearing loss (OR:1.98, 95% CI:1.00-3.90) were more likely to fall. In LAST, impaired locomotion (OR:2.14, 95% CI:1.46-3.14) increased the risk of falls. Men with impaired IC (hazard ratio [HR]; 2.14, 95% CI:1.10-4.15) and visual impairment (HR:2.21, 95% CI:1.15-4.25) and women with impaired psychological well-being (HR:4.94, 95% CI:1.28-18.97) in the NILS-LSA cohort had greater risk for all-cause mortality; however, this was not shown for LAST participants. CONCLUSION The prevalence and distribution of IC impairment and associated biomarkers differed significantly between participants in Japan and Taiwan. However, the associations with adverse outcomes remained similar, emphasizing the need for tailored interventions for healthy aging.
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Affiliation(s)
- S Zhang
- Liang-Kung Chen, MD, PhD, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, Taiwan 11217, , Tel: +886-2-28757830, Fax: +886-2-28757711
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Tan LF, Chan YH, Seetharaman S, Denishkrshna A, Au L, Kwek SC, Chen MZ, Ng SE, Hui RJY, Merchant RA. Impact of Exercise and Cognitive Stimulation Therapy on Physical Function, Cognition and Muscle Mass in Pre-Frail Older Adults in the Primary Care Setting: A Cluster Randomized Controlled Trial. J Nutr Health Aging 2023; 27:438-447. [PMID: 37357328 PMCID: PMC10230140 DOI: 10.1007/s12603-023-1928-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/13/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES Multicomponent exercise program have shown to improve function and cognition in older adults but studies on pre-frail older adults in the primary care setting are limited. This study aimed i) to evaluate impact of 6 months exercise (Ex) versus complementary effect of 3 months of cognitive stimulation therapy (CST) to 6 months of Ex (Ex+CST) on physical function, muscle mass and cognition versus control group at 3, 6 and 12 months ii) inflammatory biomarkers such as Interleukin-6 (IL-6) and Tumor Necrosis Factor Alpha (TNF-α). DESIGN Cluster randomised control trial. SETTING AND INTERVENTION Pre-frail older adults ≥ 65 years attending primary care clinic. Two intervention groups i) Ex 6 months ii) CST 3 months with Ex 6 months. MEASUREMENTS At 0, 3, 6 and 12 months, questionnaires (on demographics, physical function, cognition, and depression) were administered and physical function assessment (gait speed, short physical performance battery (SPPB) test, handgrip strength, five times sit-to-stand (5x-STS)) was conducted. Muscle mass and its surrogates such as phase angle and body cell mass were measured using bioelectrical impedance analysis machine. Inflammatory biomarkers were measured at 0 and 3 months. RESULTS Data from 190 participants was analysed at 3 months (111 control, 37 Ex and 41 Ex+CST). At 3 months, significant improvement in cognition was seen only in the Ex+CST group whereas improvements in depression, gait speed, SPPB and 5x-STS were seen in both the Ex and Ex+CST groups. At 6 months, the Ex+CST group improved in cognition and depression whereas improvement in frailty and muscle mass indices were seen in both the interventions groups. At 12 months, both the interventions groups had better perceived health, gait speed and less decline in muscle mass compared with control groups. Both the Ex and Ex+CST had significant association with TNF-α at 3 months (β -2.71 (95% CI -4.80 - -0.62); p = 0.012 and β -1.74 (95% CI -3.43 - -0.06); p = 0.043 respectively). CONCLUSION Combined Ex+CST had significant improvement in cognition whereas the intervention groups improved in depression, physical function, muscle mass, frailty, perceived health and TNF-α levels. With growing evidence of the benefits of multicomponent interventions at primary care level, incorporating it into mainstream care with action plans on long-term sustainability and scalability should be a priority for every country.
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Affiliation(s)
- L F Tan
- Associate Professor Reshma A Merchant, Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228,
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Merchant RA, Izquierdo M, Woo J, Morley JE. Resilience and the Future. J Frailty Aging 2022; 11:339-341. [PMCID: PMC9589833 DOI: 10.14283/jfa.2022.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Reshma A. Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228 Singapore ,Department of Medicine, Yong Loo Lin School of Medicine, 1E Kent Ridge Rd., NUHS Tower Block Level 10, Singapore, 19228 Singapore
| | - M. Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)- Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain ,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - J. Woo
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, SAR, China ,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - J. E. Morley
- Department of Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1008 S. Spring Ave., 2nd Floor, St. Louis, Missouri 63110 USA
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Hampel H, Au R, Mattke S, van der Flier WM, Aisen P, Apostolova L, Chen C, Cho M, De Santi S, Gao P, Iwata A, Kurzman R, Saykin AJ, Teipel S, Vellas B, Vergallo A, Wang H, Cummings J. Designing the next-generation clinical care pathway for Alzheimer's disease. NATURE AGING 2022; 2:692-703. [PMID: 37118137 PMCID: PMC10148953 DOI: 10.1038/s43587-022-00269-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/07/2022] [Indexed: 04/30/2023]
Abstract
The reconceptualization of Alzheimer's disease (AD) as a clinical and biological construct has facilitated the development of biomarker-guided, pathway-based targeted therapies, many of which have reached late-stage development with the near-term potential to enter global clinical practice. These medical advances mark an unprecedented paradigm shift and requires an optimized global framework for clinical care pathways for AD. In this Perspective, we describe the blueprint for transitioning from the current, clinical symptom-focused and inherently late-stage diagnosis and management of AD to the next-generation pathway that incorporates biomarker-guided and digitally facilitated decision-making algorithms for risk stratification, early detection, timely diagnosis, and preventative or therapeutic interventions. We address critical and high-priority challenges, propose evidence-based strategic solutions, and emphasize that the perspectives of affected individuals and care partners need to be considered and integrated.
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Affiliation(s)
| | - Rhoda Au
- Depts of Anatomy & Neurobiology, Neurology and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, MA, USA
| | - Soeren Mattke
- Center for Improving Chronic Illness Care, University of Southern California, San Diego, San Diego, CA, USA
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Depts of Neurology and Epidemiology and Data Science, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Paul Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, San Diego, CA, USA
| | - Liana Apostolova
- Departments of Neurology, Radiology, Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Min Cho
- Neurology Business Group, Eisai, Nutley, NJ, USA
| | | | - Peng Gao
- Neurology Business Group, Eisai, Nutley, NJ, USA
| | | | | | - Andrew J Saykin
- Indiana Alzheimer's Disease Research Center and the Departments of Radiology and Imaging Sciences, Medical and Molecular Genetics, and Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, University Medical Center Rostock, Rostock, Germany
| | - Bruno Vellas
- University Paul Sabatier, Gerontopole, Toulouse University Hospital, UMR INSERM 1285, Toulouse, France
| | | | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, Beijing, China
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas (UNLV), Las Vegas, NV, USA
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