Anxiety, age, education and activities of daily living as predictive factors of the occurrence of frailty syndrome in patients with heart rhythm disorders

Adverse outcomes and health-ecological influencing factors of preoperative frailty among elderly patients with gastric cancer

PURPOSE

Frailty is defined as a state of decreased physiologic reserves arising from cumulative deficits in multiple homeostatic systems, which is important in the field of clinical oncology. We aimed to explore the relationship between preoperative frailty and adverse outcomes, and systematically analyze the factors influencing frailty based on the health ecology model among elderly gastric cancer patients.

METHODS

A observational study was conducted to select 406 elderly patients who would undergo gastric cancer surgery at a tertiary hospital. The logistic regression model was used to examine the relationship between preoperative frailty and adverse outcomes, including total complications, prolonged length of stay (PLOS), and 90-day hospital readmission. Based on the health ecology model, the factors which may influence frailty were collected from four levels. Univariate and multivariate analysis were utilized to determine the factors influencing preoperative frailty.

RESULTS

Preoperative frailty was associated with total complications (odds ratio [OR] 2.776, 95% confidence interval [CI] 1.588-4.852), PLOS (OR 2.338, 95%CI 1.342-4.073), and 90-day hospital readmission (OR 2.640, 95% CI 1.275-5.469). Besides, nutritional risk (OR 4.759, 95% CI 2.409-9.403), anemia (OR 3.160, 95% CI 1.751-5.701), number of comorbidity ≥ 2 (OR 2.318, 95% CI 1.253-4.291), low physical activity level (OR 3.069, 95% CI 1.164-8.092), apathetic attachment (OR 2.656, 95% CI 1.457-4.839), personal monthly income ≤ 1000 yuan (OR 2.033, 95% CI 1.137-3.635) and anxiety (OR 2.574, 95% CI 1.311-5.053) were independent risk factors for frailty. High physical activity level (OR 0.413, 95% CI 0.208-0.820) and improved objective support (OR 0.818, 95% CI 0.683-0.978) were independent protective factors for frailty.

CONCLUSIONS

Preoperative frailty was associated with multiple adverse outcomes and could be affected by factors of different dimensions from the health ecology perspective, including nutrition, anemia, comorbidity, physical activity, attachment style, objective support, anxiety, and income, which can guide the formation of a comprehensive prehabilitation for frailty among elderly gastric cancer patients.

A pandemic toll in frail older adults: Higher odds of incident and persistent common mental disorders in the ELSA-Brasil COVID-19 mental health cohort

INTRODUCTION

We aimed to investigate the association of frailty with persistent and incident common mental disorders (CMD) in older adults during the pandemic.

METHODS

We included 706 older adults who participated in the onsite wave of the ELSA-Brasil study (2017-2019) and the online COVID-19 assessment (May-July 2020). CMD were assessed in both waves by the Clinical Interview Schedule-Revised. Frailty was defined according to the physical phenotype and Frailty Index in the 2017-2019 wave. Logistic regression was used to investigate the association of frailty with persistent and incident CMD, adjusted for sociodemographics.

RESULTS

Frailty according to both definitions were associated with persistent CMD (Frailty Index: OR = 8.61, 95 % CI = 4.08-18.18; physical phenotype: OR = OR = 23.67, 95 % CI = 7.08-79.15), and incident CMD (Frailty Index: OR = 2.79, 95 % CI = 1.15-6.78; physical phenotype OR = 4.37, 95 % CI = 1.31-14.58). The exclusion of exhaustion (that overlaps with psychiatric symptoms) from the frailty constructs did not change the association between frailty and persistent CMD, although the associations with indent CMD were no longer significant.

LIMITATIONS

Fluctuations in CMD status were not captured between both assessments.

CONCLUSION

Frailty status before the COVID-19 outbreak was associated with higher odds of persistent and incident CMD in older adults during the pandemic first wave. Identifying individuals at higher risk of mental burden can help prioritize resources allocation and management.

Factors Predicting Frailty Among Postoperative Brain Tumor Patients

ABSTRACT

BACKGROUND: Surgical frailty is a condition in which patients are weak with varied recovery of various organ functions after surgery resulting in unpleasant outcomes. Frailty studies have been conducted in several populations with a limited knowledge on postoperative brain tumor patients. This study aimed to examine factors predicting frailty in brain tumor patients after craniotomy. METHODS: This study was a cross-sectional predictive study. The sample included 85 patients who were 18 years or older and underwent craniotomy with tumor removal from 1 university hospital in Bangkok, Thailand, between February and October 2021. Data were analyzed using descriptive statistic, Pearson correlation, and multiple linear regression, which determined significance level at .05. RESULTS: The prevalence of frailty among participants was 50.6%. Postoperative symptom and mood state were positively associated with frailty (r = 0.410 and r = 0.448, respectively; P < .01). Postoperative symptom, mood state, age, tumor type, and income could explain the variance of frailty in brain tumor patients after craniotomy by 40.3% (R2 = 0.403, P < .01). CONCLUSION: Healthcare providers should plan for discharge planning including assessment and develop the intervention for managing postoperative symptoms and psychological symptoms to promote recovery from frailty that generally occurs after brain tumor surgery.

Resident and Institutional-Level Factors, Frailty, and Nursing Homes Residents

BACKGROUND

Frailty is a major cause of adverse health outcomes such as hospitalization, falls, disability, and morbidity among older adults; the elucidation of factors affecting frailty trends over time may facilitate the development of effective interventions.

OBJECTIVES

This study aimed to examine the trend of frailty over time (at baseline, with 6-month and 12-month follow-ups) among Chinese nursing home residents and identify associated resident- and institutional-level factors.

METHODS

This longitudinal study included 353 residents who were admitted into 27 nursing homes in Jinan, China. Frailty was defined based on the seven self-reported components of the FRAIL-NH scale, which was designed for nursing home residents. Information was gathered using scales that assessed resident-level (sociodemographic characteristics and physical, psychological, and social factors) and institutional-level characteristics (hospital affiliation, fitness sites, green space, occupancy percentage, staff-resident ratio, staff turnover rate). These data were subjected to a multilevel linear analysis.

RESULTS

Frailty was identified in 49.7% of residents at baseline and exhibited a progressively worsening trend over 1 year. Among institutional-level characteristics, the provision of fitness sites in nursing homes was a protective factor for frailty. Among resident-level characteristics, undernutrition was a significant independent risk factor and played a key role in increasing frailty over time. Other risk factors for frailty included younger age, poorer self-rated health, lower physical function, chewing difficulty, loneliness, anxiety, and being less active in leisure activities.

DISCUSSION

Frailty was highly prevalent among Chinese nursing home residents and gradually increased over time. The results of this study could be used to inform the development of interventions targeted at modifiable risk factors and shape public health policies aimed at promoting healthy aging and delaying frailty and its adverse outcomes.

Attitude towards sexuality and sexual behaviors among men with heart rhythm disorders

AIM

Symptoms of cardiac arrhythmias and the perception of the implantation of a cardiac pacemaker can negatively affect mental health including sexuality and sexual behaviors. The aim of this study was to assess the attitude towards sexuality and sexual behaviors among men with cardiac arrhythmias.

METHODS

The study included 80 men (aged 58.6 ± 9.23 years) with heart rhythm disorders who had qualified for cardiac pacemaker implantation. The International Index of Erectile Function IIEF-15 was completed at least one day before cardiac pacemaker implantation by all of the patients.

RESULTS

The average results of the IIEF for all of the included patients was 41.87 ± 7.57 and were statistically worse in the population with atrioventricular blocks (39.60 ± 7.79) compared to those with sinus node dysfunction (44.15 ± 6.71) (p = .0110). The same relationships were found in the subcategory of orgasmic function (p = .0108) as well as intercourse satisfaction (p = .0111). Erectile dysfunction occurred in 88.75% of the patients with diagnosed arrhythmias. There was no statistically significant difference between the occurrence of erectile dysfunction in patients with sinus node dysfunction (87.5%) compared to patients with atrioventricular blocks (90%); p = .7236.

CONCLUSION

We demonstrated that sexuality and sexual behaviors among men with cardiac arrhythmias was found to be statistically worse in the population with atrioventricular blocks compared to those with sinus node dysfunction. It was especially marked in the area of orgasmic function as well as for intercourse satisfaction.

Association between cognitive reserve dimensions and frailty among older adults: A structured narrative review

Frailty is a broadly investigated geriatric condition, which is characterized by an increased vulnerability to stressors. It represents an extremely relevant public health issue, increasingly conceptualized in a multidimensional perspective. The concept of cognitive reserve (CR), as originally conceptualized by Stern, has been developed in the past decades as a potential factor able to determine individual differences in cognitive vulnerability and trajectories occurring with aging. Our purpose was to provide a comprehensive review of the literature exploring the relationship between CR dimensions, selected according to the Stern model, and frailty status. A review of the literature on the association between potential CR dimensions and frailty was carried out through PubMed, Web of Knowledge and Scopus. CR expressed in terms of education, occupation, premorbid intelligence quotient and leisure time activities was associated with frailty in both cross-sectional and longitudinal observations. The majority of reviewed evidence suggests a potential protective role of CR factors against the onset and the worsening of frailty among older adults. To the best of our knowledge, this is the first attempt to provide a comprehensive overview regarding the association between CR dimensions and frailty. Education, occupation, premorbid intelligence quotient and leisure time activities are able to interact with the general concept of frailty, rather than simply affecting the cognitive trajectory towards dementia. The lack of a unique and operationalized approach to the assessment of CR, as well as the wide heterogeneity of frailty evaluation tools and criteria, denote some methodological critical issues that need to be overcome. Geriatr Gerontol Int 2020; 20: 1005-1023..

Modified Frailty as a Novel Factor in Predicting the Maintenance of the Sinus Rhythm After Electrical Cardioversion of Atrial Fibrillation in the Elderly Population

Introduction

Frailty is a common geriatric syndrome that causes an elevated risk of catastrophic declines in the health and function among older adults – we hypothesized that frailty may be related to the maintenance of sinus rhythm after cardioversion.

Methods

The study sample was a group of 199 consecutive patients over 60 (average age 71.41 ± 6.99; 40.2% women) with AF who were hospitalized in order to perform electrical cardioversion. The Tilburg Frailty Indicator (TFI) was used to assess frailty before cardioversion. The six-month visit after the electrical cardioversion was a follow-up. The follow-up period for the maintenance of sinus rhythm after electrical cardioversion was 180 ± 14 days.

Results

Patients in whom cardioversion was effective had a statistically significantly lower severity of frailty syndrome (3.44 ± 1.83 vs 5.87 ± 1.12; p=0.000) and its components: physical components (2.14 ± 1.33 vs 3.62 ± 1.05 p=0.000); emotional components (0.92 ± 0.79 vs 1.29 ± 0.86 p=0.037) and social components (0.37 ± 0.56 vs 0.96 ± 0.46; p=0.000) compared to those patients in which cardioversion was ineffective. In the logistic regression, frailty (OR: 0.65, 95% CI:0.5010–0.8330; p=0.000) was observed to be an independent predictor for maintaining sinus rhythm.

Conclusion

Frailty is a novel, independent factor that can be used to predict the effectiveness of electrical cardioversion and the maintenance of sinus rhythm in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator to a 4 improved the prediction of the effectiveness of electrical cardioversion as well as the maintenance of sinus rhythm.

Associations Between Obesity and Multidimensional Frailty in Older Chinese People with Hypertension

Purpose

To investigate the prevalence of multidimensional frailty in older people with hypertension and to examine a possible relationship of general obesity and abdominal obesity to frailty in older people with hypertension.

Patients and Methods

A sample of 995 community-dwelling older people with hypertension, aged 65 years and older and living in Zhengzhou (China), completed the Tilburg Frailty Indicator (TFI), a validated self-report questionnaire for assessing multidimensional frailty. In addition, socio-demographic and lifestyle characteristics were assessed by self-report, and obesity was determined by measuring waist circumference and calculating the body mass index.

Results

The prevalence of multidimensional frailty in this older population with hypertension was 46.5%. Using multiple linear regression analysis, body mass index was significantly associated with physical frailty (p = 0.001), and waist circumference was significantly positively associated with multidimensional frailty and all three frailty domains. Older age was positively associated with multidimensional frailty, physical frailty, and psychological frailty, while gender (woman) was positively associated with multidimensional, psychological, and social frailty. Furthermore, comorbid diseases and being without a partner were positively associated with multidimensional, physical, psychological, and social frailty. Of the lifestyle characteristics, drinking alcohol was positively associated with frailty domains.

Conclusion

Multidimensional frailty was highly prevalent among Chinese community-dwelling older people with hypertension. Abdominal obesity could be a concern in physical frailty, psychological frailty, and social frailty, while general obesity was concerning in relation to physical frailty.