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Wang S, Wang L, Wang Y, Zong S, Fan H, Jiang Y, Li X. Association between frailty index based on laboratory tests and all-cause mortality in critically ill patients with heart failure. ESC Heart Fail 2024. [PMID: 38979803 DOI: 10.1002/ehf2.14948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/05/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The frailty index based on laboratory tests (FI-lab) can identify individuals at increased risk for adverse health outcomes. The association between the FI-lab and all-cause mortality in patients with heart failure (HF) in the intensive care unit (ICU) remains unknown. This study aimed to determine the correlation between FI-lab and all-cause mortality to evaluate the impact of FI-lab on the prognosis of critically ill patients with HF. METHODS This retrospective observational study utilized data extracted from the Medical Information Mart for Intensive Care IV database. The FI-lab, which consists of 33 laboratory tests, was constructed. Patients were then grouped into quartiles (Q1-Q4) based on their FI-lab scores. Kaplan-Meier analysis was used to compare all-cause mortality among the four groups. A Cox proportional hazard analysis was conducted to examine the association between the FI-lab score and all-cause mortality. The incremental predictive value of adding FI-lab to classical disease severity scores was assessed using Harrell's C statistic, integrated discrimination improvement (IDI) and net reclassification improvement (NRI). RESULTS Among 3021 patients, 838 (27.74%) died within 28 days, and 1400 (46.34%) died within a 360 day follow-up period. Kaplan-Meier analysis indicated that patients with higher FI-lab scores had significantly higher risks of all-cause mortality (log-rank P < 0.001). Multivariable Cox regression suggested that FI-lab, evaluated as a continuous variable (for each 0.01 increase), was associated with increased 28 day mortality [hazard ratio (HR) 1.02, 95% confidence interval (CI) (1.01-1.03), P < 0.001] and 360 day mortality [HR 1.02, 95% CI (1.01-1.02), P < 0.001]. When assessed in quartiles, the 28 day mortality risk [HR 1.66, 95% CI (1.28-2.15), P < 0.001] and 360 day mortality risk [HR 1.48, 95% CI (1.23-1.8), P < 0.001] were significantly higher for FI-lab Q4 compared with FI-lab Q1. FI-lab significantly improved the predictive capability of classical disease severity scores for 28 and 360 day mortality. CONCLUSIONS In ICU patients diagnosed with HF, the FI-lab is a potent predictor of short-term and long-term mortality in critically ill patients with HF. The active use of FI-lab to identify high-risk groups among critically ill HF patients and initiate timely interventions may have significant value in improving the prognosis of critically ill patients with HF.
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Affiliation(s)
- Sutong Wang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Lin Wang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongcheng Wang
- Department of Cardiovascular Diseases, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Shuli Zong
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hesong Fan
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuehua Jiang
- Central Laboratory, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Xiao Li
- Department of Cardiovascular Diseases, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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Chung T, Bopp T, Ward C, Notarangelo FM, Schwarcz R, Westbrook R, Xue Q, Walston J, Hoke A. Deletion of quinolinate phosphoribosyltransferase gene accelerates frailty phenotypes and neuromuscular decline with aging in a sex-specific pattern. Aging Cell 2023; 22:e13849. [PMID: 37078472 PMCID: PMC10352574 DOI: 10.1111/acel.13849] [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: 11/04/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/21/2023] Open
Abstract
Decline in neuromuscular function with aging is known to be a major determinant of disability and all-cause mortality in late life. Despite the importance of the problem, the neurobiology of age-associated muscle weakness is poorly understood. In a previous report, we performed untargeted metabolomics on frail older adults and discovered prominent alteration in the kynurenine pathway, the major route of dietary tryptophan degradation that produces neurotoxic intermediate metabolites. We also showed that neurotoxic kynurenine pathway metabolites are correlated with increased frailty score. For the present study, we sought to further examine the neurobiology of these neurotoxic intermediates by utilizing a mouse model that has a deletion of the quinolinate phosphoribosyltransferase (QPRT) gene, a rate-limiting step of the kynurenine pathway. QPRT-/- mice have elevated neurotoxic quinolinic acid level in the nervous system throughout their lifespan. We found that QPRT-/- mice have accelerated declines in neuromuscular function in an age- and sex-specific manner compared to control strains. In addition, the QPRT-/- mice show premature signs of frailty and body composition changes that are typical for metabolic syndrome. Our findings suggest that the kynurenine pathway may play an important role in frailty and age-associated muscle weakness.
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Affiliation(s)
- Tae Chung
- Department of Physical Medicine and RehabilitationJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of NeurologyNeuromuscular DivisionJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Taylor Bopp
- Department of Physical Medicine and RehabilitationJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Chris Ward
- Department of OrthopedicsUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Francesca M. Notarangelo
- Maryland Psychiatric Research CenterDepartment of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Robert Schwarcz
- Maryland Psychiatric Research CenterDepartment of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Reyhan Westbrook
- Department of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Qian‐Li Xue
- Department of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jeremy Walston
- Department of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ahmet Hoke
- Department of NeurologyNeuromuscular DivisionJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Mounie M, Fabre D, Rapp T, Rolland Y, Blain H, Tchalla A, Carcaillon-Bentata L, Beltzer N, Assous L, Apparitio S, Caby D, Reina N, Andre L, Molinier L, Costa N. Costs and Survival of Patients having Experienced a Hospitalized Fall-Related Injury in France: A Population-Based Study. J Am Med Dir Assoc 2023; 24:951-957.e4. [PMID: 36934774 DOI: 10.1016/j.jamda.2023.02.005] [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: 10/21/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES To assess the annual costs 2 years before and 2 years after a hospitalized fall-related injury (HFRI) and the 2-year survival among the population 75+ years old. DESIGN We performed a population-based, retrospective cohort study using the French national health insurance claims database. SETTING AND PARTICIPANTS Patients 75+ years old who had experienced a fall followed by hospitalization, identified using an algorithm based on International Classification of Diseases codes. Data related to a non-HFRI population matched on the basis of age, sex, and geographical area were also extracted. METHODS Cost analyses were performed from a health insurance perspective and included direct costs. Survival analyses were conducted using Kaplan-Meier curves and Cox regression. Descriptive analyses of costs and regression modeling were carried out. Both regression models for costs and on survival were adjusted for age, sex, and comorbidities. RESULTS A total of 1495 patients with HFRI and 4484 non-HFRI patients were identified. Patients with HFRI were more comorbid than the non-HFRI patients over the entire periods, particularly in the year before and the year after the HFRI. Patients with HFRI have significantly worse survival probabilities, with an adjusted 2.14-times greater risk of death over 2-year follow-up and heterogeneous effects determined by sex. The annual incremental costs between patients with HFRI and non-HFRI individuals were €1294 and €2378, respectively, 2 and 1 year before the HFRI, and €11,796 and €1659, respectively, 1 and 2 years after the HFRI. The main cost components differ according to the periods and are mainly accounted for by paramedical acts, hospitalizations, and drug costs. When fully adjusted, the year before the HFRI and the year after the HFRI are associated with increase in costs. CONCLUSIONS AND IMPLICATIONS We have provided real-world estimates of the cost and the survival associated with patients with HFRI. Our results highlight the urgent need to manage patients with HFRI at an early stage to reduce the significant mortality as well as substantial additional cost management. Special attention must be paid to the fall-related increasing drugs and to optimizing management of comorbidities.
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Affiliation(s)
- Michael Mounie
- Health Economic Unit, University Hospital of Toulouse, Toulouse, France.
| | - Didier Fabre
- Department of Medical Information, University Hospital of Toulouse, Toulouse, France
| | - Thomas Rapp
- LIRAES (URP 4470), Chaire AgingUP!, LIEPP Sciences Po, Paris, France
| | - Yves Rolland
- Department of Geriatrics, Hospital and University of Toulouse, Toulouse, France
| | - Hubert Blain
- Department of Geriatrics, University Hospital of Montpellier, Montpellier, France
| | - Achille Tchalla
- Clinical Geriatric, University Hospital of Limoges, Limoges, France
| | | | - Nathalie Beltzer
- Directorate of Non-Communicable Diseases and Injuries, French National Public Health Agency, Saint-Maurice, France
| | | | | | | | - Nicolas Reina
- Locomotor Institute, University Hospital of Toulouse, Toulouse, France
| | - Laurine Andre
- Department of Geriatrics, Hospital and University of Toulouse, Toulouse, France
| | - Laurent Molinier
- Health Economic Unit, University Hospital of Toulouse, Toulouse, France
| | - Nadège Costa
- Health Economic Unit, University Hospital of Toulouse, Toulouse, France
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Shi X, Wang S, Hu J, Chen F, Zhang H, Yang Y, Li X, Ma Q. Relationship of Frailty with Kidney Function in Adults More Than 60-Years-Old: Effect of Using Different Formulas to Estimate Glomerular Filtration Rate. Clin Interv Aging 2023; 18:999-1007. [PMID: 37396789 PMCID: PMC10314749 DOI: 10.2147/cia.s409140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/08/2023] [Indexed: 07/04/2023] Open
Abstract
Objective Determine the relationship of renal function with frailty using different formulas for estimated glomerular filtration rate (eGFR). Methods Individuals who were 60-years-old or more (n=507) were recruited from August 2020 to June 2021, and the FRAIL scale was used to classify them as non-frail or frail. The three equations used to compute the eGFR were based on serum creatinine (eGFRcr), cystatin C (eGFRcys), or SCr+CysC (eGFRcr-cys). Renal function was classified using eGFR and defined as normal (≥90 mL/min/1.73m2), mild damage (59-89 mL/min/1.73m2), or moderate damage (≤60 mL/min/1.73m2). The relationship of frailty with renal function was analyzed. A subset of participants (n=358) was used to analyze changes in eGFR from 1 January 2012 to 31 December 2021 according to frailty and using the different eGFR equations. Results There were significant differences between the eGFRcr-cys and eGFRcr values in the frail group (P<0.05), but not the non-frail group; however, the differences between the eGFRcr-cys and eGFRcys values were significant in the frail and non-frail groups (P<0.001). Based on each eGFR equation, the prevalence of frailty increased as eGFR decreased (P<0.001), but there was no significant relationship after adjusting for age or the age-adjusted Charlson co-morbidity index. There were temporal declines in eGFR in all three frailty groups (robust, pre-frail, and frail), especially in the frail group (2.226 mL/min/1.73m2 per year; P<0.001). Conclusion For older individuals who are frail, the eGFRcr value may not provide accurate estimates of renal function. Frailty is associated with a rapid decline in kidney function.
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Affiliation(s)
- Xiaotian Shi
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shan Wang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jieqiong Hu
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fei Chen
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Heng Zhang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yifan Yang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xv Li
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qing Ma
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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Bruno RR, Wernly B, Bagshaw SM, van den Boogaard M, Darvall JN, De Geer L, de Gopegui Miguelena PR, Heyland DK, Hewitt D, Hope AA, Langlais E, Le Maguet P, Montgomery CL, Papageorgiou D, Seguin P, Geense WW, Silva-Obregón JA, Wolff G, Polzin A, Dannenberg L, Kelm M, Flaatten H, Beil M, Franz M, Sviri S, Leaver S, Guidet B, Boumendil A, Jung C. The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients: a meta-analysis of individual patient-level data. Ann Intensive Care 2023; 13:37. [PMID: 37133796 PMCID: PMC10155148 DOI: 10.1186/s13613-023-01132-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/20/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND This large-scale analysis pools individual data about the Clinical Frailty Scale (CFS) to predict outcome in the intensive care unit (ICU). METHODS A systematic search identified all clinical trials that used the CFS in the ICU (PubMed searched until 24th June 2020). All patients who were electively admitted were excluded. The primary outcome was ICU mortality. Regression models were estimated on the complete data set, and for missing data, multiple imputations were utilised. Cox models were adjusted for age, sex, and illness acuity score (SOFA, SAPS II or APACHE II). RESULTS 12 studies from 30 countries with anonymised individualised patient data were included (n = 23,989 patients). In the univariate analysis for all patients, being frail (CFS ≥ 5) was associated with an increased risk of ICU mortality, but not after adjustment. In older patients (≥ 65 years) there was an independent association with ICU mortality both in the complete case analysis (HR 1.34 (95% CI 1.25-1.44), p < 0.0001) and in the multiple imputation analysis (HR 1.35 (95% CI 1.26-1.45), p < 0.0001, adjusted for SOFA). In older patients, being vulnerable (CFS 4) alone did not significantly differ from being frail. After adjustment, a CFS of 4-5, 6, and ≥ 7 was associated with a significantly worse outcome compared to CFS of 1-3. CONCLUSIONS Being frail is associated with a significantly increased risk for ICU mortality in older patients, while being vulnerable alone did not significantly differ. New Frailty categories might reflect its "continuum" better and predict ICU outcome more accurately. TRIAL REGISTRATION Open Science Framework (OSF: https://osf.io/8buwk/ ).
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Affiliation(s)
- Raphael Romano Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstraße 37, 5110, Oberndorf, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124 Clinical Sciences Building, 8440 112Th ST, Edmonton, AB, T6G 2B7, Canada
| | - Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jai N Darvall
- Intensive Care Unit and Department of Anaesthesia & Pain Management, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3050, Australia
| | - Lina De Geer
- Department of Anaesthesiology and Intensive Care, Linköping University Hospital, Linköping, Sweden
| | | | - Daren K Heyland
- Clinical Evaluation Research Unit, and Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - David Hewitt
- Glasgow Royal Infirmary Intensive Care Unit, Glasgow, Scotland
| | - Aluko A Hope
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Emilie Langlais
- Réanimation Chirurgicale, CHU Rennes, Université Rennes 1, Rennes, France
| | - Pascale Le Maguet
- Département d'Anesthésie Réanimation, CHU Rennes, Rennes, France
- Service d'Anesthésie, CH Quimper, Quimper, France
| | - Carmel L Montgomery
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124 Clinical Sciences Building, 8440 112Th ST, Edmonton, AB, T6G 2B7, Canada
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 3-171, Edmonton, AB, T6G 1C9, Canada
| | - Dimitrios Papageorgiou
- Faculty of Health and Caring Sciences Department of Nursing, University of West Attica (UWA) Athens, Egaleo, Greece
| | - Philippe Seguin
- Réanimation Chirurgicale, CHU Rennes, Université Rennes 1, Rennes, France
| | - Wytske W Geense
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Alberto Silva-Obregón
- Department of Intensive Care Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Georg Wolff
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Amin Polzin
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Lisa Dannenberg
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), University Hospital of Düsseldorf, Germany, Düsseldorf, Germany
| | - Hans Flaatten
- Department of Clinical Medicine, Department of Anaesthesia and Intensive Care, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Michael Beil
- Dept. of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marcus Franz
- Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University, 07737, Jena, Germany
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Bertrand Guidet
- Equipe: Épidémiologie Hospitalière Qualité Et Organisation Des Soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, 75012, Paris, France
- Service de Réanimation Médicale, Hôpitaux de Paris, Hôpital Saint-Antoine, 75012, Paris, France
| | - Ariane Boumendil
- Equipe: Épidémiologie Hospitalière Qualité Et Organisation Des Soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, 75012, Paris, France
- Service de Réanimation Médicale, Hôpitaux de Paris, Hôpital Saint-Antoine, 75012, Paris, France
| | - Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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A novel easy-to-use index to predict institutionalization and death in older population - a 10-year population-based follow-up study. BMC Geriatr 2023; 23:80. [PMID: 36750784 PMCID: PMC9903495 DOI: 10.1186/s12877-023-03760-1] [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: 01/19/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Various indexes have been developed to estimate the risk for mortality, institutionalization, and other adverse outcomes for older people. Most indexes are based on a large number of clinical or laboratory parameters. An index based on only a few parameters would be more practical to use in every-day clinical practice. Our aim was to create an index to predict the risk for mortality and institutionalization with as few parameters as possible without compromising their predictive ability. METHODS A prospective study with a 10-year follow-up period. Thirty-six clinical and fourteen laboratory parameters were combined to form an index. Cox regression model was used to analyze the association of the index with institutionalization and mortality. A backward statistical method was used to reduce the number of parameters to form an easy-to-use index for predicting institutionalization and mortality. RESULTS The mean age of the participants (n = 1172) was 73.1 (SD 6.6, range 64‒97) years. Altogether, 149 (14%) subjects were institutionalized, and 413 (35%) subjects deceased during the follow-up. Institutionalization and mortality rates increased as index scores increased both for the large 50-parameter combined index and for the reduced indexes. After a backward variable selection in the Cox regression model, three clinical parameters remained in the index to predict institutionalization and six clinical and three laboratory parameters in the index to predict mortality. The reduced indexes showed a slightly better predictive value for both institutionalization and mortality compared to the full index. CONCLUSIONS A large index with fifty parameters included many unimportant parameters that did not increase its predictive value, and therefore could be replaced with a reduced index with only a few carefully chosen parameters, that were individually associated with institutionalization or death.
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Niebla-Cárdenas A, Bareke H, Juanes-Velasco P, Landeira-Viñuela A, Hernández ÁP, Montalvillo E, Góngora R, Arroyo-Anlló E, Silvia Puente-González A, Méndez-Sánchez R, Fuentes M. Translational research into frailty from bench to bedside: Salivary biomarkers for inflammaging. Exp Gerontol 2023; 171:112040. [PMID: 36455696 DOI: 10.1016/j.exger.2022.112040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Frailty is a complex physiological syndrome associated with adverse ageing and decreased physiological reserves. Frailty leads to cognitive and physical disability and is a significant cause of morbidity, mortality and economic costs. The underlying cause of frailty is multifaceted, including immunosenescence and inflammaging, changes in microbiota and metabolic dysfunction. Currently, salivary biomarkers are used as early predictors for some clinical diseases, contributing to the effective prevention and treatment of diseases, including frailty. Sample collection for salivary analysis is non-invasive and simple, which are paramount factors for testing in the vulnerable frail population. The aim of this review is to describe the current knowledge on the association between frailty and the inflammatory process and discuss methods to identify putative biomarkers in salivary fluids to predict this syndrome. This study describes the relationship between i.-inflammatory process and frailty; ii.-infectious, chronic, skeletal, metabolic and cognitive diseases with inflammation and frailty; iii.-inflammatory biomarkers and salivary fluids. There is a limited number of previous studies focusing on the analysis of inflammatory salivary biomarkers and frailty syndrome; hence, the study of salivary fluids as a source for biomarkers is an open area of research with the potential to address the increasing demands for frailty-associated biomarkers.
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Affiliation(s)
- Alfonssina Niebla-Cárdenas
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain
| | - Halin Bareke
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Institute of Health Sciences, Marmara University, Istanbul, Turkey; Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Pablo Juanes-Velasco
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Alicia Landeira-Viñuela
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Ángela-Patricia Hernández
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain; Department of Pharmaceutical Sciences: Organic Chemistry, Faculty of Pharmacy, University of Salamanca, CIETUS, IBSAL, 37007 Salamanca, Spain
| | - Enrique Montalvillo
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Rafael Góngora
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Eva Arroyo-Anlló
- Department of Psychobiology, Neuroscience Institute of Castilla-León, Faculty of Psychology, University of Salamanca, 37007 Salamanca, Spain
| | - Ana Silvia Puente-González
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; Institute of Biomedical Research of Salamanca. Primary Care, Public Health and Pharmacology Area, 37007 Salamanca, Spain.
| | - Roberto Méndez-Sánchez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; Institute of Biomedical Research of Salamanca. Primary Care, Public Health and Pharmacology Area, 37007 Salamanca, Spain
| | - Manuel Fuentes
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain; Proteomics Unit, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), Salamanca, Spain.
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Farrell S, Kane AE, Bisset E, Howlett SE, Rutenberg AD. Measurements of damage and repair of binary health attributes in aging mice and humans reveal that robustness and resilience decrease with age, operate over broad timescales, and are affected differently by interventions. eLife 2022; 11:e77632. [PMID: 36409200 PMCID: PMC9725749 DOI: 10.7554/elife.77632] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
As an organism ages, its health-state is determined by a balance between the processes of damage and repair. Measuring these processes requires longitudinal data. We extract damage and repair transition rates from repeated observations of binary health attributes in mice and humans to explore robustness and resilience, which respectively represent resisting or recovering from damage. We assess differences in robustness and resilience using changes in damage rates and repair rates of binary health attributes. We find a conserved decline with age in robustness and resilience in mice and humans, implying that both contribute to worsening aging health - as assessed by the frailty index (FI). A decline in robustness, however, has a greater effect than a decline in resilience on the accelerated increase of the FI with age, and a greater association with reduced survival. We also find that deficits are damaged and repaired over a wide range of timescales ranging from the shortest measurement scales toward organismal lifetime timescales. We explore the effect of systemic interventions that have been shown to improve health, including the angiotensin-converting enzyme inhibitor enalapril and voluntary exercise for mice. We have also explored the correlations with household wealth for humans. We find that these interventions and factors affect both damage and repair rates, and hence robustness and resilience, in age and sex-dependent manners.
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Affiliation(s)
| | - Alice E Kane
- Blavatnik Institute, Department of Genetics, Paul F. Glenn Center for Biology of Aging Research at Harvard Medical SchoolBostonUnited States
| | - Elise Bisset
- Department of Pharmacology, Dalhousie UniversityHalifaxCanada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie UniversityHalifaxCanada
- Department of Medicine (GeriatricMedicine), Dalhousie UniversityHalifaxCanada
| | - Andrew D Rutenberg
- Department of Physics and Atmospheric Science, Dalhousie UniversityHalifaxCanada
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9
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Wang C, Fang X, Tang Z, Hua Y, Zhang Z, Gu X, Liu B, Ji X. A frailty index based on routine laboratory data predicts increased risk of mortality in Chinese community-dwelling adults aged over 55 years: a five-year prospective study. BMC Geriatr 2022; 22:679. [PMID: 35978284 PMCID: PMC9382755 DOI: 10.1186/s12877-022-03374-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Frailty can be operationalized based on the accumulation of deficits using a frailty index (FI) and is associated with an increased risk of adverse health outcomes. Here, we aim to compare validity of a FI from laboratory data with that of the common clinical FI for prediction of mortality in adults aged 55 + years, also examine whether combined FI could improve identification of adults aged 55 + years at increased risk of death. Methods Data for this analysis were obtained from the Beijing Longitudinal Study of Aging that involved 1,257 community-dwelling Chinese people, aged 55 + years at baseline. The main outcome measure was 5-year mortality. An FI-self-report based on 30 self-reported health-related data was constructed. An FI-lab was developed using laboratory data, in addition to pulse, systolic and diastolic blood pressure, pulse pressure, body mass index (BMI) and waist. A combined FI comprised all items from each FI. Kaplan–Meier survival curve and Cox proportional hazards models were performed to evaluate the risk of each FI on death. The area under receiver operating characteristic(ROC) curves were used to compare the discriminative performance of each FI. Results Of 1257 participants, 155 died and 156 lost at the end of the 5-year follow-up. The mean FI-self-report score was 0.11 ± 0.10, the FI-lab score was 0.33 ± 0.14 and FI-combined score was 0.19 ± 0.09. Higher frailty level defined by each FI was associated with higher risk of death. After adjustment for age and sex, Cox proportional hazards models showed that the higher scores of frailty were associated with a higher risk of mortality for each FI, the hazard ratios for the FI-self-report and FI-lab and FI-combined were 1.04 (1.03 to 1.05) and 1.02 (1.01 to 1.03) and 1.05 (1.04 to 1.07), respectively. The areas under the ROC curve were 0.79 (0.77–0.82) for the FI-self-report, 0.77(0.75–0.80) for the FI-lab and 0.81(0.78–0.82) for FI-combined. Conclusions A FI from laboratory data can stratify older adults at increased risk of death alone and in combination with FI based on self-report data. Assessment in clinical settings of creating an FI using routine collected laboratory data needs to be further developed. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03374-z.
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Affiliation(s)
- Chunxiu Wang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng district, Beijing, China.
| | - Xianghua Fang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng district, Beijing, China
| | - Zhe Tang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng district, Beijing, China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongying Zhang
- Geriatric Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang Gu
- Geriatric Department, Affiliated Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Beibei Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurological Surgery, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng district, Beijing, China.
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10
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Ge L, Yap CW, Heng BH. Associations of social isolation, social participation, and loneliness with frailty in older adults in Singapore: a panel data analysis. BMC Geriatr 2022; 22:26. [PMID: 34991493 PMCID: PMC8734362 DOI: 10.1186/s12877-021-02745-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/23/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a shortage of research evidence about how social isolation, social participation, and loneliness were longitudinally associated with frailty. This study was to 1) examine the associations of social isolation, social participation, and loneliness with level of frailty among community-dwelling older adults using panel data, and 2) explore the moderating effect of gender on the association of social isolation, social participation and loneliness with frailty. METHODS The study included 606 participants aged 60 years and above from the longitudinal Population Health Index Survey conducted in Singapore. At each timepoint, level of frailty was determined using the Clinical Frailty Scale. Social isolation was assessed by the Lubben Social Network Scale-6, and loneliness was assessed using the three-item UCLA Loneliness Scale. Fixed-effects ordinal logistic regressions were conducted with level of frailty as the dependent variable and social isolation and loneliness as the independent variables, adjusting for time-varying socio-demographic, lifestyle, and health-related factors. RESULTS Increase in social participation was associated with lower level of frailty (odds ratio: 0.96, 95% confidence interval: 0.93-0.99) and feeling lonely was associated with higher level of frailty (odds ratio: 2.90, 95% confidence interval: 1.44-5.84). Social isolation was not associated with frailty. Gender did not have moderating effect on these associations. CONCLUSIONS This study observed that social isolation and loneliness had differential longitudinal association with level of frailty among community-dwelling older adults and suggested that loneliness and frailty should be measured and addressed concurrently among community-dwelling older adults.
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Affiliation(s)
- Lixia Ge
- Health Services & Outcomes Research, National Healthcare Group, Singapore, Singapore.
| | - Chun Wei Yap
- Health Services & Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Bee Hoon Heng
- Health Services & Outcomes Research, National Healthcare Group, Singapore, Singapore
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11
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Wang M, Sun X, Zhang W, Zhang Q, Qian J, Chen W, Yao S, Jin L, Kalantar-Zadeh K, Wang X, Chen J. Frailty and the risk of kidney function decline in the elderly population: the Rugao Longevity and Ageing Study. Nephrol Dial Transplant 2021; 36:2274-2281. [PMID: 33537782 DOI: 10.1093/ndt/gfaa323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The diverse risk factors for kidney impairments suggest that kidney function decline is more likely to occur in individuals with a broadly constituted health deficit. Here we conducted a longitudinal cohort study to evaluate the association of baseline frailty status with the risk of estimated glomerular filtration rate (eGFR) decline. METHODS Overall, 1269 participants aged 70-84 years from Rugao Longevity and Ageing cohort with 3-year follow-up were included. Frailty was measured using a modified Fried frailty assessment. GFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. Associations between baseline frailty status and rapid eGFR decline were examined by multinomial logistic analysis. A linear mixed-effect model was used to determine eGFR decline in mL/min/1.73 m2 over the study period comparing those with frail or prefrail at baseline versus those with robust status. RESULTS The mean (± standard deviation) age of participants was 75.1 ± 3.8 years. A total of 144 (11%) participants had rapid eGFR decline by at least 10% during the 3-year follow-up. Compared with robust status, baseline frail status was associated with a 2.48-fold [95% confidence interval (CI) 1.24-4.95] increased risk of rapid eGFR decline after multiple adjustments. In multivariate linear mixed model analysis, subjects with frail status but not prefrail status at baseline had a significant coefficient of -1.70 (95% CI -3.35 to -0.04) for the frail × visit term, which indicates an accelerated eGFR decline compared with robust subjects over the study period (P = 0.044). CONCLUSIONS Frailty may serve as an independent biomarker to predict the decline of kidney function.
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Affiliation(s)
- Mengjing Wang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xuehui Sun
- Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
| | - Weichen Zhang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qian Zhang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Qian
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weisheng Chen
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shun Yao
- Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
| | - Li Jin
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA, USA
- Fielding School of Public Health at UCLA, Los Angeles, CA, USA
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Xiaofeng Wang
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
| | - Jing Chen
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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12
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Ge L, Yap CW, Heng BH, Tan WS. Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore. BMC Geriatr 2020; 20:389. [PMID: 33023490 PMCID: PMC7542115 DOI: 10.1186/s12877-020-01800-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/28/2020] [Indexed: 12/22/2022] Open
Abstract
Background Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population. This study was conducted to investigate the association between frailty and healthcare utilisation in different care settings among community-dwelling older adults in Singapore. Methods Data from a population health survey among community-dwelling adults were linked with an administrative database to retrieve data of healthcare utilisation (including government primary care clinic visits, specialised outpatient clinic visits, emergency department visits, day surgery and hospitalisations) occurred during a six-month look-back period and six-month post-baseline respectively. Baseline frailty status was measured using the five-item FRAIL scale, which was categorised into three groups: robust (0), pre-frail (1–2), and frail (3–5). Negative binomial regression was applied to examine the association between frailty with respective healthcare utilisation (dependent variables), controlling for other confounding variables. Results In our sample of 701 older adults, 64.8% were of robust health, 27.7% were pre-frail, and 7.6% were frail. Compared to the robust group, frail individuals had a higher rate of specialised outpatient clinic visits (incidence rate ratio (IRR): 2.8, 95% confidence interval (CI): 1.2–6.5), emergency department visits (IRR: 3.1, 95%CI: 1.1–8.1), day surgery attendances (IRR: 6.4, 95%CI: 1.3–30.9), and hospitalisations (IRR: 6.7, 95%CI: 2.1–21.1) in the six-month period prior to the baseline and in subsequent 6 months (IRR: 3.3, 95%CI: 1.6–7.1; 6.4, 2.4–17.2; 5.8, 1.3–25.8; 13.1, 4.9–35.0; respectively), controlling for covariates. Conclusions Frailty was positively associated with the number of specialised outpatient clinic visits, emergency department visits, day surgeries and hospitalisations occurred during 6 months prior to and after the baseline. As frailty is a potentially reversible health state with early screening and intervention, providing preventive activities that delay the onset or progression of frailty should have potential effect on delaying secondary and tertiary care utilisation.
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Affiliation(s)
- Lixia Ge
- Health Services & Outcomes Research, National Healthcare Group Pte Ltd, 3 Fusionopolis Link, #03-08 Nexus@one-north (South Lobby), Singapore, 13854, Singapore.
| | - Chun Wei Yap
- Health Services & Outcomes Research, National Healthcare Group Pte Ltd, 3 Fusionopolis Link, #03-08 Nexus@one-north (South Lobby), Singapore, 13854, Singapore
| | - Bee Hoon Heng
- Health Services & Outcomes Research, National Healthcare Group Pte Ltd, 3 Fusionopolis Link, #03-08 Nexus@one-north (South Lobby), Singapore, 13854, Singapore
| | - Woan Shin Tan
- Health Services & Outcomes Research, National Healthcare Group Pte Ltd, 3 Fusionopolis Link, #03-08 Nexus@one-north (South Lobby), Singapore, 13854, Singapore.,Geriatric Education and Research Institute, Singapore, Singapore
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13
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Jung C, Romano Bruno R, Wernly B, Wolff G, Beil M, Kelm M. Frailty as a Prognostic Indicator in Intensive Care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:668-673. [PMID: 33357351 PMCID: PMC7838379 DOI: 10.3238/arztebl.2020.0668] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 03/31/2020] [Accepted: 06/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The percentage of patients in intensive care who are 80 years old or older is continually increasing. Such patients already made up more than 20% of all patients in intensive care in Germany in the years 2007-2011. Meanwhile, effective treatments that support the organs of the body and keep severely ill patients alive are also being continually developed and refined. Frailty is a key prognostic parameter. The scientifically based assessment of frailty can be highly useful in intensive care medicine with regard to consented decision-making, individualized prognostication, treatment planning, and aftercare. METHODS Pertinent publications were retrieved by a selective search in the PubMed database. On the basis of the literature assessment, a variety of screening instruments were used to assess frailty and its significance for very old, critically ill patients in German intensive care units. RESULTS Only a small number of screening instruments are suitable for routine use in German intensive care units. The scores vary in diagnostic precision. The Clinical Frailty Scale (CFS) enables highly accurate prognostication; it considers the patient in relation to his or her social environment, and to the reference population. Categorization is achieved by means of pictograms that are supplemented with brief written descriptions. The CFS can be used prospectively and is easy to learn. Its interrater reliability is high (weighted Cohen's κ: 0.85 [0.84; 0.87]), and it has been validated for routine use in intensive care units in Germany. CONCLUSION None of the available scores enable perfect prognostication. In Germany, frailty in intensive-care patients is currently best assessed on a simple visual scale (CFS).
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Affiliation(s)
- Christian Jung
- Department of Cardiology, Pulmonary Diseases and Vascular Medicine, Faculty of Medicine, Düsseldorf University Hospital
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonary Diseases and Vascular Medicine, Faculty of Medicine, Düsseldorf University Hospital
| | - Bernhard Wernly
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria; Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden:
| | - Georg Wolff
- Department of Cardiology, Pulmonary Diseases and Vascular Medicine, Faculty of Medicine, Düsseldorf University Hospital
| | - Michael Beil
- Department of Intensive Care Medicine, Hadassah-Hebrew University Hospital, Jerusalem, Israel
| | - Malte Kelm
- Department of Cardiology, Pulmonary Diseases and Vascular Medicine, Faculty of Medicine, Düsseldorf University Hospital
- Cardiovascular Research Institute Düsseldorf (CARID)
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14
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Thillainadesan J, Scott IA, Le Couteur DG. Frailty, a multisystem ageing syndrome. Age Ageing 2020; 49:758-763. [PMID: 32542377 DOI: 10.1093/ageing/afaa112] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Indexed: 12/11/2022] Open
Abstract
The management of frail older people is a key component of aged care. There has been a plethora of tools developed for the diagnosis and screening of frailty. Some of these tools are entering routine clinical practice at a time when the higher healthcare costs involved in caring for older people who are frail have become a potential target for cost-cutting. Yet there is still only limited evidence to support the widespread adoption of frailty tools, and foundational factors impact on their accuracy and validity. Despite the acceptance of frailty as a valid term in research and clinical practice, older people believe the term carries stigma. Such issues indicate that there may be a need to reconsider current approaches to frailty. Recent advances in the science of ageing biology can provide a new framework for reconfiguring how we screen, diagnose, treat and prevent frailty. Frailty can be considered to be a multisystem ageing syndrome of decreased physiological and functional reserve, where the biological changes of ageing are seen in most tissues and organs and are the pathogenic mechanism for frailty. Likewise age-related chronic disease and multimorbidity are syndromes where ageing changes occur in one or multiple systems, respectively. This model focusses diagnostic criteria for frailty onto the biomarkers of ageing and generates new targets for the prevention and treatment of frailty based on interventions that influence ageing biology.
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Affiliation(s)
- Janani Thillainadesan
- Centre for Education and Research on Ageing (CERA) and Department of Geriatric Medicine, The University of Sydney and Concord Hospital, Sydney, Australia
| | - Ian A Scott
- Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital and the Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing (CERA) and Department of Geriatric Medicine, The University of Sydney and Concord Hospital, Sydney, Australia
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15
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Russell JC, Burnaevskiy N, Ma B, Mailig MA, Faust F, Crane M, Kaeberlein M, Mendenhall A. Electrophysiological Measures of Aging Pharynx Function in C. elegans Reveal Enhanced Organ Functionality in Older, Long-lived Mutants. J Gerontol A Biol Sci Med Sci 2020; 74:1173-1179. [PMID: 29165668 DOI: 10.1093/gerona/glx230] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 11/16/2017] [Indexed: 02/03/2023] Open
Abstract
The function of the pharynx, an organ in the model system Caenorhabditis elegans, has been correlated with life span and motility (another measure of health) since 1980. In this study, in order to further understand the relationship between organ function and life span, we measured the age-related decline of the pharynx using an electrophysiological approach. We measured and analyzed electropharyngeograms (EPG) of wild type animals, short-lived hsf-1 mutants, and long-lived animals with genetically decreased insulin signaling or increased heat shock pathway signaling; we recorded a total of 2,478 EPGs from 1,374 individuals. As expected, the long-lived daf-2(e1370) and hsf-1OE(uthIs235) animals maintained pharynx function relatively closer to the youthful state during aging, whereas the hsf-1(sy441) and wild type animals' pharynx function deviated significantly further from the youthful state at advanced age. Measures of the amount of variation in organ function can act as biomarkers of youthful physiology as well. Intriguingly, the long-lived animals had greater variation in the duration of pharynx contraction at older ages.
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Affiliation(s)
| | | | - Bridget Ma
- Department of Pathology, University of Washington, Seattle
| | | | - Franklin Faust
- Department of Pathology, University of Washington, Seattle
| | - Matt Crane
- Department of Pathology, University of Washington, Seattle
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16
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Haren A, Lal R, Walker D, Nair R, Partridge J, Dhesi J. Frailty assessment in older urological patients prior to surgery: a systematic review and narrative synthesis. Ther Adv Urol 2020; 12:1756287220916614. [PMID: 32435276 PMCID: PMC7225795 DOI: 10.1177/1756287220916614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/07/2020] [Indexed: 01/30/2023] Open
Abstract
Background: Radical cystectomy (RC) and urinary diversion are the recommended treatment for patients with muscle invasive bladder cancer. This is complex surgery, associated with significant patient morbidity and mortality. Frailty has been shown to be an independent risk factor for adverse outcomes in several surgical populations. Preoperative assessment of frailty is advocated in current guidelines but is not yet standard clinical practice. Aims: This systematic review and narrative synthesis aims to examine whether patients undergoing RC are assessed for frailty, what tools are used, and whether an association is found between frailty and adverse outcomes in this population. Results: Nine studies, published within the last 4 years, describe the use of tools reporting to measure frailty in the RC population. All demonstrate increased risk of adverse postoperative outcomes with higher frailty levels. Only one study used a validated frailty tool. The majority of studies measure frailty using variations on a tool derived from a large database (ACS-NSQIP) effectively counting co-morbidities, rather than assessing the multidomain nature of the frailty syndrome. Conclusion: The recognition of frailty as an important consideration in the perioperative period is welcome. This systematic review and narrative synthesis demonstrates the need for collaboration in research and delivery of clinical care for older surgical patients. Such collaboration may provide clarity regarding terms such as frailty and multimorbidity, preventing the development of assessment tools inaccurately measuring these discreet syndromes interchangeably. More accurate assessment of patients in terms of frailty, multimorbidity and functional status may allow better modification and shared decision making leading to improved postoperative outcomes in older patients undergoing RC.
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Affiliation(s)
- Andrea Haren
- Perioperative Medicine Fellow, Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK
| | - Rajni Lal
- Perioperative Care of Older People undergoing Surgery (POPS) Fellow, Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David Walker
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK
| | - Rajesh Nair
- Consultant Urological Surgeon, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Judith Partridge
- Perioperative Care of Older People undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jugdeep Dhesi
- Perioperative Care of Older People undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
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17
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Jiao J, Wang Y, Zhu C, Li F, Zhu M, Wen X, Jin J, Wang H, Lv D, Zhao S, Wu X, Xu T. Prevalence and associated factors for frailty among elder patients in China: a multicentre cross-sectional study. BMC Geriatr 2020; 20:100. [PMID: 32164595 PMCID: PMC7068995 DOI: 10.1186/s12877-020-1496-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/27/2020] [Indexed: 12/27/2022] Open
Abstract
Background To date, most previous studies of frailty among hospitalized elderly Chinese patients have been conducted based on small samples, which cannot represent the elderly patient population. The aim of this study was to identify the prevalence of and risk factors for frailty among elderly patients in China. Study design and setting This cross-sectional study surveyed 9996 elderly patients from 6 tertiary-level hospitals in China. The prevalence of frailty among patients from selected wards was surveyed by trained investigators. A mixed-effects Poisson regression model was used to analyse the factors associated with frailty among elderly patients. Results The mean age of all subjects was 72.47 ± 5.77 years. The prevalence rate of frailty in this study was 18.02%. After adjustments were made for the confounding effect of the clustering of hospital wards, a mixed-effects Poisson regression model showed that the associated factors of frailty included the following: age (OR: 1.016, 95% CI: 1.012–1.020), BMI < 18.5 (OR: 1.248, 95% CI: 1.171–1.330), female gender (OR: 1.058, 95% CI: 1.004–1.115), ethnic minority (OR: 1.152, 95% CI: 1.073–1.236), admission to hospital by the emergency department (OR: 1.104, 95% CI: 1.030–1.184), transit from another hospital (OR: 1.159, 95% CI: 1.049–1.279), former alcohol use (OR: 1.094, 95% CI: 1.022–1.171), fall history in the past 12 months (OR: 1.257, 95% CI: 1.194–1.323), vision dysfunction (OR: 1.144, 95% CI: 1.080–1.211), cognition impairment (OR: 1.182, 95% CI: 1.130–1.237), sleeping dysfunction (OR: 1.215, 95% CI: 1.215–1.318), urinary dysfunction (OR: 1.175, 95% CI: 1.104–1.251), and defecation dysfunction (OR: 1.286, 95% CI: 1.217–1.358). The results also showed some of the following protective effects: BMI > 28 (OR: 0.897, 95% CI: 0.856–0.940); higher education level, including middle school (OR: 0.915, 95% CI: 0.857, 0.977) and diploma and above (OR: 0.891, 95% CI: 0.821, 0.966); and current alcohol use (OR: 0.869, 95% CI: 0.815, 0.927). Conclusion We identified a relatively high prevalence of frailty among elderly patients, and there are several associated factors among the population derived from this investigation of a large-scale, multicentre, nationally representative Chinese elderly inpatient population. Trial registration Chinese Clinical Trial Registry, ChiCTR1800017682, registered 09 August 2018.
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Affiliation(s)
- Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Wang
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fangfang Li
- Department of Endocrinae. Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minglei Zhu
- Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji medical college, Huazhong University of Science and Technology, Wuhan, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Haerbin Medical University, Haerbin, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
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18
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Guderyon MJ, Chen C, Bhattacharjee A, Ge G, Fernandez RA, Gelfond JAL, Gorena KM, Cheng CJ, Li Y, Nelson JF, Strong RJ, Hornsby PJ, Clark RA, Li S. Mobilization-based transplantation of young-donor hematopoietic stem cells extends lifespan in mice. Aging Cell 2020; 19:e13110. [PMID: 32012439 PMCID: PMC7059148 DOI: 10.1111/acel.13110] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/18/2019] [Accepted: 01/05/2020] [Indexed: 12/25/2022] Open
Abstract
Mammalian aging is associated with reduced tissue regeneration and loss of physiological integrity. With age, stem cells diminish in their ability to regenerate adult tissues, likely contributing to age-related morbidity. Thus, we replaced aged hematopoietic stem cells (HSCs) with young-donor HSCs using a novel mobilization-enabled hematopoietic stem cell transplantation (HSCT) technology as an alternative to the highly toxic conditioning regimens used in conventional HSCT. Using this approach, we are the first to report an increase in median lifespan (12%) and a decrease in overall mortality hazard (HR: 0.42, CI: 0.273-0.638) in aged mice following transplantation of young-donor HSCs. The increase in longevity was accompanied by reductions of frailty measures and increases in food intake and body weight of aged recipients. Young-donor HSCs not only preserved youthful function within the aged bone marrow stroma, but also at least partially ameliorated dysfunctional hematopoietic phenotypes of aged recipients. This compelling evidence that mammalian health and lifespan can be extended through stem cell therapy adds a new category to the very limited list of successful anti-aging/life-extending interventions. Our findings have implications for further development of stem cell therapies for increasing health and lifespan.
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Affiliation(s)
| | - Cang Chen
- Department of MedicineUT Health San AntonioSan AntonioTXUSA
| | | | - Guo Ge
- Department of MedicineUT Health San AntonioSan AntonioTXUSA
| | - Roman A. Fernandez
- Department of Epidemiology and BiostatisticsUT Health San AntonioSan AntonioTXUSA
| | | | - Karla M. Gorena
- Flow Cytometry Core FacilityUT Health San AntonioSan AntonioTXUSA
| | - Catherine J. Cheng
- Department of Cell Systems and AnatomyUT Health San AntonioSan AntonioTXUSA
- Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTXUSA
| | - Yang Li
- Department of Pathology and Laboratory MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - James F. Nelson
- Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTXUSA
- Department of Cellular and Integrative PhysiologyUT Health San AntonioSan AntonioTXUSA
| | - Randy J. Strong
- Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTXUSA
- Department of PharmacologyUT Health San AntonioSan AntonioTXUSA
- Research ServiceSouth Texas Veterans Health Care SystemSan AntonioTXUSA
| | - Peter J. Hornsby
- Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTXUSA
- Department of Cellular and Integrative PhysiologyUT Health San AntonioSan AntonioTXUSA
| | - Robert A. Clark
- Department of MedicineUT Health San AntonioSan AntonioTXUSA
- Research ServiceSouth Texas Veterans Health Care SystemSan AntonioTXUSA
| | - Senlin Li
- Department of MedicineUT Health San AntonioSan AntonioTXUSA
- Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTXUSA
- Department of PharmacologyUT Health San AntonioSan AntonioTXUSA
- Research ServiceSouth Texas Veterans Health Care SystemSan AntonioTXUSA
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19
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Herrera ML, Basmadjian OM, Falomir‐Lockhart E, Dolcetti FJ, Hereñú CB, Bellini MJ. Sex frailty differences in ageing mice: Neuropathologies and therapeutic projections. Eur J Neurosci 2020; 52:2827-2837. [DOI: 10.1111/ejn.14703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Macarena Lorena Herrera
- Departamento de Farmacología Facultad de Ciencias Químicas Instituto de Farmacología Experimental Córdoba (IFEC‐CONICET) Universidad Nacional de Córdoba Córdoba Argentina
- Facultad de Ciencias Médicas Instituto de Investigaciones Bioquímicas de La Plata (INIBIOLP‐CONICET) Universidad Nacional de La Plata Buenos Aires Argentina
| | - Osvaldo Martin Basmadjian
- Departamento de Farmacología Facultad de Ciencias Químicas Instituto de Farmacología Experimental Córdoba (IFEC‐CONICET) Universidad Nacional de Córdoba Córdoba Argentina
| | - Eugenia Falomir‐Lockhart
- Facultad de Ciencias Médicas Instituto de Investigaciones Bioquímicas de La Plata (INIBIOLP‐CONICET) Universidad Nacional de La Plata Buenos Aires Argentina
| | - Franco Juan‐Cruz Dolcetti
- Facultad de Ciencias Médicas Instituto de Investigaciones Bioquímicas de La Plata (INIBIOLP‐CONICET) Universidad Nacional de La Plata Buenos Aires Argentina
| | - Claudia Beatriz Hereñú
- Departamento de Farmacología Facultad de Ciencias Químicas Instituto de Farmacología Experimental Córdoba (IFEC‐CONICET) Universidad Nacional de Córdoba Córdoba Argentina
| | - María José Bellini
- Facultad de Ciencias Médicas Instituto de Investigaciones Bioquímicas de La Plata (INIBIOLP‐CONICET) Universidad Nacional de La Plata Buenos Aires Argentina
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20
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Tools for Assessing Frailty in Older People: General Concepts. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1216:9-19. [PMID: 31894542 DOI: 10.1007/978-3-030-33330-0_2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The general notion of frailty is widely understood to be a state of increased vulnerability to stressors, following age-related declines in function and reserves across multiple physiological systems. Frailty is clinically characterised by slower and/or incomplete recovery from stressors such as infection, injury, surgery or psychosocial distress. There is however no consensus on a single operational definition. Numerous assessment tools and scores are promoted to detect or measure frailty but two have widest research background and acceptance, the Frailty Phenotype and the deficit based Frailty Index. We describe these and other approaches in the context of a description of the psychometric properties, types of scaling, uses and misuses of assessment tools. We advocate the choice of an appropriate measurement tool be based on the population characteristics and the purpose for which it is to be used and illustrate how an understanding of the properties of different tools helps to inform this choice.
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21
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Kane AE, Keller KM, Heinze-Milne S, Grandy SA, Howlett SE. A Murine Frailty Index Based on Clinical and Laboratory Measurements: Links Between Frailty and Pro-inflammatory Cytokines Differ in a Sex-Specific Manner. J Gerontol A Biol Sci Med Sci 2019; 74:275-282. [PMID: 29788087 DOI: 10.1093/gerona/gly117] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Indexed: 12/12/2022] Open
Abstract
A frailty index (FI) based on clinical deficit accumulation (FI-Clinical) quantifies frailty in aging mice. We aimed to develop a laboratory test-based murine FI tool (FI-Lab) and to investigate the effects of age and sex on FI-Lab scores, FI-Clinical scores, and the combination (FI-Combined), as well as to explore links between frailty and inflammation. Studies used older (17 and 23 months) C57BL/6 mice of both sexes. We developed an FI-Lab (blood pressure, blood chemistry, echocardiography) based on deviation from reference values in younger adults (12 months), which showed similar characteristics to a human FI-Lab tool. Interestingly, while FI-Clinical scores were higher in females, the opposite was true for FI-Lab scores and there was no sex difference in FI-Combined scores. All three FI tools revealed a positive correlation between pro-inflammatory cytokine levels and frailty in aging mice that differed between the sexes. Elevated levels of the pro-inflammatory cytokines interleukin (IL)-6, IL-9, and interferon-γ were associated with higher FI scores in aging females, while levels of IL-12p40 rose as FI scores increased in older males. Thus, an FI tool based on common laboratory tests can quantify frailty in mice; the positive correlation between inflammation and frailty scores in naturally aging mice differs between the sexes.
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Affiliation(s)
- Alice E Kane
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Kaitlyn M Keller
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Stefan Heinze-Milne
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Scott A Grandy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.,School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.,Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada
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22
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Herrera ML, Basmadjian OM, Falomir Lockhart E, Dolcetti FJC, Hereñú CB, Bellini MJ. Novel adenoviral IGF-1 administration modulates the association between depressive symptoms and aging: Does gender matter? Behav Brain Res 2019; 372:112050. [DOI: 10.1016/j.bbr.2019.112050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/31/2019] [Accepted: 06/20/2019] [Indexed: 11/24/2022]
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23
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Stolz E, Mayerl H, Freidl W. Fluctuations in frailty among older adults. Age Ageing 2019; 48:547-552. [PMID: 31028381 DOI: 10.1093/ageing/afz040] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/22/2019] [Accepted: 04/05/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND frailty fluctuations, that is, within-person up and down deviations from individual long-term frailty index trajectories represent a hitherto both conceptually and empirically untapped facet of frailty among older adults. OBJECTIVE to assess the size of frailty fluctuations in old age and their association with frailty levels, frailty growth as well as sex and socio-economic position. METHODS a total of 18,704 biannual observations from 4,514 community-dwelling older adults (65+) in 10 European countries over 12 years from the Survey of Health, Ageing and Retirement in Europe (SHARE) were analysed. A frailty index was constructed based on 50 items. Long-term frailty trajectories and fluctuations were modelled simultaneously using Bayesian mixed-effects location-scale regression models. RESULTS frailty index fluctuations were non-negligible among older adults, amounting to 0.04/0.05 FI or 2.0/2.5 health deficits on average. 30% of fluctuations were between 0.04 and 0.1 FI (2 and 5 health deficits) and 8% were larger than 0.1 FI (5 health deficits). Fluctuations increased with age and frailty levels, and were higher among women, those with low socio-economic position (education) and individuals who died during follow-up. CONCLUSIONS frailty index fluctuations refer to instabilities in an older person's health status and represent a hitherto untapped but relevant aspect of vulnerability in old age. Future analysis of frailty fluctuations should be based on a larger number of repeated observations with shorter time intervals.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, Graz, Austria
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, Graz, Austria
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24
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Age-related deficit accumulation and the diseases of ageing. Mech Ageing Dev 2019; 180:107-116. [DOI: 10.1016/j.mad.2019.04.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
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25
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Chao CT, Huang JW, Chiang CK, Hung KY. Applicability of laboratory deficit-based frailty index in predominantly older patients with end-stage renal disease under chronic dialysis: A pilot test of its correlation with survival and self-reported instruments. Nephrology (Carlton) 2019; 25:73-81. [PMID: 30834584 DOI: 10.1111/nep.13583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 01/28/2023]
Abstract
AIM Laboratory deficit-based frailty index (LFI) exhibited outcome-prediction ability in the elderly, but not in those with end-stage renal disease (ESRD). We hypothesized that LFI results might have outcome correlation and correlate closely with other instruments in ESRD patients. METHODS We prospectively enroled ESRD patients between 2014 and 2015 and administered self-report frailty instruments (Strawbridge questionnaire, Edmonton frail scale (EFS), Groningen frailty indicator (GFI), Tilburg frailty indicator, G8 questionnaire and FRAIL scale), and Cardiovascular Health Study (CHS) scale, with two types of LFI calculated. They were followed up until June 30, 2017. Correlations between the results of six instruments, CHS scale, and those of LFI were identified, followed by Kaplan-Meier survival analyses and logistic regression analyses to compare those with high and low LFI. RESULTS The frailty prevalence was 33.3% (CHS), 78.8% Strawbridge questionnaire, 45.5% (EFS), 57.6% (GFI), 27.3% (Tilburg frailty indicator), 84.8% (G8) and 18.2% (FRAIL) among ESRD participants. LFI-1 results were significantly correlated with those of LFI-2 (P < 0.01), EFS (P = 0.04) and GFI (P < 0.01), while LFI-2 results were not. Those with CHS or GFI-identified frailty had significantly lower 1,25-(OH)2 -D levels than those without. After 32.3 ± 5.4 months, patients with high LFI-1 scores, but not LFI-2, had a significantly higher mortality than those with lower scores. GFI and EFS scores were also independently associated with LFI-1, while CHS scores exhibited borderline association only. CONCLUSION Among a group of predominantly older ESRD patients, LFI differentiates patients with good and poor outcomes, supporting its applicability in these patients.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu branch, Taipei, Taiwan
| | - Jenq-Wen Huang
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Kang Chiang
- Department of Integrative Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Yu Hung
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
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26
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Banga S, Heinze-Milne SD, Howlett SE. Rodent models of frailty and their application in preclinical research. Mech Ageing Dev 2019; 179:1-10. [PMID: 30703384 DOI: 10.1016/j.mad.2019.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/25/2019] [Indexed: 12/21/2022]
Abstract
In clinical medicine, the concept of frailty is viewed as a state of high vulnerability to adverse health outcomes in people of the same age. Frailty is an important challenge because the loss of physiological reserve means that even minor stressors can lead to disability and death in those who are frail. Even so, the biology of frailty is not well understood. Rodent models of frailty are stimulating research into the biology of frailty. These pre-clinical models are based on "reverse-translation". Investigators have adapted either the "frailty phenotype" approach or the "frailty index" approach, originally developed in humans, for use in animals. This review briefly describes rodent models of frailty, discusses how these models have been used to explore mechanisms of frailty and how they have been employed to assess the impact of frailty on various experimental outcomes. The review also highlights studies that have used rodent models to investigate interventions to attenuate frailty, including drug treatment, dietary modifications and exercise. The ability to model frailty in animals is an exciting development that promises to accelerate the translation of laboratory discoveries into new clinical interventions, and situates frailty research in the larger context of geroscience.
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Affiliation(s)
- Shubham Banga
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.
| | | | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada; Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada.
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27
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Peters R, Booth A, Rockwood K, Peters J, D’Este C, Anstey KJ. Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis. BMJ Open 2019; 9:e022846. [PMID: 30782689 PMCID: PMC6352772 DOI: 10.1136/bmjopen-2018-022846] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To systematically review the literature relating to the impact of multiple co-occurring modifiable risk factors for cognitive decline and dementia. DESIGN A systematic review and meta-analysis of the literature relating to the impact of co-occurring key risk factors for incident cognitive decline and dementia. All abstracts and full text were screened independently by two reviewers and each article assessed for bias using a standard checklist. A fixed effects meta-analysis was undertaken. DATA SOURCES Databases Medline, Embase and PsycINFO were searched from 1999 to 2017. ELIGIBILITY CRITERIA For inclusion articles were required to report longitudinal data from participants free of cognitive decline at baseline, with formal assessment of cognitive function or dementia during follow-up, and an aim to examine the impact of additive or clustered comorbid risk factor burden in with two or more core modifiable risk factors. RESULTS Seventy-nine full-text articles were examined. Twenty-two articles (18 studies) were included reporting data on >40 000 participants. Included studies consistently reported an increased risk associated with greater numbers of intraindividual risk factors or unhealthy behaviours and the opposite for healthy or protective behaviours. A meta-analysis of studies with dementia outcomes resulted in a pooled relative risk for dementia of 1.20 (95% CI 1.04 to 1.39) for one risk factor, 1.65 (95% CI 1.40 to 1.94) for two and 2.21 (95% CI 1.78 to 2.73) for three or more, relative to no risk factors. Limitations include dependence on published results and variations in study outcome, cognitive assessment, length of follow-up and definition of risk factor exposure. CONCLUSIONS The strength of the reported associations, the consistency across studies and the suggestion of a dose response supports a need to keep modifiable risk factor exposure to a minimum and to avoid exposure to additional modifiable risks. Further research is needed to establish whether particular combinations of risk factors confer greater risk than others. PROSPERO REGISTRATION NUMBER 42016052914.
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Affiliation(s)
- Ruth Peters
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Public Health, Imperial College London, London, UK
- University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Jean Peters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Catherine D’Este
- Australian National University (ANU), Canberra, Australian Capital Territory, Australia
- University of Newcastle, Callaghan, New South Wales, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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28
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Huang DD, Fan SD, Chen XY, Yan XL, Zhang XZ, Ma BW, Yu DY, Xiao WY, Zhuang CL, Yu Z. Nrf2 deficiency exacerbates frailty and sarcopenia by impairing skeletal muscle mitochondrial biogenesis and dynamics in an age-dependent manner. Exp Gerontol 2019; 119:61-73. [PMID: 30690066 DOI: 10.1016/j.exger.2019.01.022] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/12/2019] [Accepted: 01/22/2019] [Indexed: 01/18/2023]
Abstract
AIM Mitochondrial dysfunction during aging is a key factor that contributes to sarcopenia. Nuclear factor erythroid 2-related factor 2 (Nrf2) has been increasingly recognized to regulate mitochondrial function. The present study aimed to investigate the role of Nrf2 in the development of frailty and sarcopenia during aging, and to demonstrate whether Nrf2 contributes to the maintenance of muscle mass and function by regulation of mitochondrial biogenesis and dynamics during the aging process. METHODS Young (5-6 months), middle-aged (11-13 months), old (20-24 months) Nrf2-/- (knockout, KO) mice and age-matched wild-type (WT) C57/BL6 mice were used in this study. Physical function of the mice in the 6 groups was assessed by grip strength test, four paw inverted hanging test, rotarod analysis, open field analysis, and treadmill endurance test. Muscle mass was measured by cross-sectional area (CSA) of tibialis anterior muscles and gastrocnemius muscle weight. The frailty status of the 25 old WT mice and 23 old KO mice were assessed based on the mouse frailty phenotype assessment. Expression levels of genes involved in mitochondrial biogenesis (nuclear respiratory factor 1 (Nrf1), peroxisome proliferative activated receptor, gamma, coactivator 1 alpha (PGC-1α), mitochondrial transcription factor A (TFAM)) and mitochondrial dynamics (optic atrophy protein 1 (Opa1), mitofusin 1 (Mfn1), mitofusin 2 (Mfn2), and dynamin-related protein 1 (Drp1)) were measured in the skeletal muscle. SDH staining was performed and mitochondrial DNA (mtDNA) copy number was measured. Transmission electron microscopy was used to measure the mitochondria number and morphology. RESULTS Physical function and muscle mass decreased during aging. The mRNA expression levels of Nrf2 decreased with increasing frailty phenotype scores in the old WT mice. There were minimal differences in the physical function and muscle mass between the WT and KO mice in the young groups, whereas Nrf2 deficiency caused a declined physical function and muscle mass in the middle-aged and old mice, and exacerbated frailty in the old mice. The decreases of the physical function and muscle mass were accompanied by the reduced expression levels of genes involved in mitochondrial biogenesis and dynamics, as well as a reduction of mitochondrial number, mitochondrial content, mtDNA copy number, and an impaired mitochondria morphology in the skeletal muscle. CONCLUSION Nrf2 deficiency exacerbated frailty and sarcopenia during aging, at least partially by impairing skeletal muscle mitochondrial biogenesis and dynamics in an age-dependent manner.
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Affiliation(s)
- Dong-Dong Huang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Sheng-Dong Fan
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xi-Yi Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xia-Lin Yan
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xian-Zhong Zhang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bing-Wei Ma
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ding-Ye Yu
- Department of General Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Yu Xiao
- Shanghai Tenth People's Hospital Chongming Branch Affiliated to Tongji University, Shanghai, China
| | - Cheng-Le Zhuang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Zhen Yu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Shanghai Tenth People's Hospital Chongming Branch Affiliated to Tongji University, Shanghai, China.
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29
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Frailty indexes in perioperative and critical care: A systematic review. Arch Gerontol Geriatr 2018; 79:88-96. [DOI: 10.1016/j.archger.2018.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/19/2022]
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30
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Jayanama K, Theou O, Blodgett JM, Cahill L, Rockwood K. Frailty, nutrition-related parameters, and mortality across the adult age spectrum. BMC Med 2018; 16:188. [PMID: 30360759 PMCID: PMC6202862 DOI: 10.1186/s12916-018-1176-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/19/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nutritional status and individual nutrients have been associated with frailty in older adults. The extent to which these associations hold in younger people, by type of malnutrition or grades of frailty, is unclear. Our objectives were to (1) evaluate the relationship between individual nutrition-related parameters and frailty, (2) investigate the association between individual nutrition-related parameters and mortality across frailty levels, and (3) examine whether combining nutrition-related parameters in an index predicts mortality risk across frailty levels. METHODS This observational study assembled 9030 participants aged ≥ 20 years from the 2003-2006 cohorts of the National Health and Nutrition Examination Survey who had complete frailty data. A 36-item frailty index (FI) was constructed excluding items related to nutritional status. We examined 62 nutrition-related parameters with established cut points: 34 nutrient intake items, 5 anthropometric measurements, and 23 relevant blood tests. The 41 nutrition-related parameters which were associated with frailty were combined into a nutrition index (NI). All-cause mortality data until 2011 were identified from death certificates. RESULTS All 5 anthropometric measurements, 21/23 blood tests, and 19/34 nutrient intake items were significantly related to frailty. Although most nutrition-related parameters were directly related to frailty, high alcohol consumption and high levels of serum alpha-carotene, beta-carotene, beta-cryptoxanthin, total cholesterol, and LDL-c were associated with lower frailty scores. Only low vitamin D was associated with increased mortality risk across all frailty levels. Seventeen nutrition-related parameters were associated with mortality in the 0.1-0.2 FI group, 11 in the 0.2-0.3 group, and 16 in the > 0.3 group. Overall, 393 (5.8%) of the participants had an NI score less than 0.1 (abnormality in ≤ 4 of the 41 parameters examined). Higher levels of NI were associated with higher mortality risk after adjusting for frailty and other covariates (HR per 0.1: 1.19 [95%CI 1.133-1.257]). CONCLUSIONS Most nutrition-related parameters were correlated to frailty, but only low vitamin D was associated with higher risk for mortality across levels of frailty. As has been observed with other age-related phenomena, even though many nutrition-related parameters were not significantly associated with mortality individually, when combined in an index, they strongly predicted mortality risk.
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Affiliation(s)
- Kulapong Jayanama
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Health Care of the Elderly, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | - Leah Cahill
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kenneth Rockwood
- Centre for Health Care of the Elderly, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada. .,Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Camp Hill Veterans' Memorial Bldg., 5955 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E1, Canada.
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Simpson KN, Seamon BA, Hand BN, Roldan CO, Taber DJ, Moran WP, Simpson AN. Effect of frailty on resource use and cost for Medicare patients. J Comp Eff Res 2018; 7:817-825. [PMID: 29808714 PMCID: PMC7136980 DOI: 10.2217/cer-2018-0029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/08/2018] [Indexed: 01/23/2023] Open
Abstract
Aim: The effects of frailty and multiple chronic conditions (MCCs) on cost of care are rarely disentangled in archival data studies. We identify the marginal contribution of frailty to medical care cost estimates using Medicare data. Materials & methods: Use of the Faurot frailty score to identify differences in acute medical events and cost of care for patients, controlling for MCCs and medication use. Results: Estimated marginal cost of frailty was US$10,690 after controlling for demographics, comorbid conditions, polypharmacy and use of potentially inappropriate medications. Conclusion: Frailty contributes greatly to cost of care, but while often correlated, is not synonymous with MCCs. Thus, it is important to control separately for frailty in studies that compare medical care use and cost.
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Affiliation(s)
- Kit N Simpson
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, 151B Rutledge Ave, Charleston, SC 29425, USA
| | - Bryant A Seamon
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, 151B Rutledge Ave, Charleston, SC 29425, USA
| | - Brittany N Hand
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, 151B Rutledge Ave, Charleston, SC 29425, USA
| | - Courtney O Roldan
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, 151B Rutledge Ave, Charleston, SC 29425, USA
| | - David J Taber
- Department of Surgery, College of Medicine, 171 Ashley Ave, Charleston SC 29425, USA
| | - William P Moran
- Department of General Internal Medicine and Geriatrics, College of Medicine, 171 Ashley Ave, Charleston, SC 29425, USA
| | - Annie N Simpson
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, 151B Rutledge Ave, Charleston, SC 29425, USA
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Investigating pathogen burden in relation to a cumulative deficits index in a representative sample of US adults. Epidemiol Infect 2018; 146:1968-1976. [PMID: 29898795 DOI: 10.1017/s095026881800153x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pathogen burden is a construct developed to assess the cumulative effects of multiple, persistent pathogens on morbidity and mortality. Despite the likely biological wear and tear on multiple body systems caused by persistent infections, few studies have examined the impact of total pathogen burden on such outcomes and specifically on preclinical markers of dysfunction. Using data from two waves of the National Health and Nutrition Examination Survey, we compared three alternative methods for measuring pathogen burden, composed of mainly persistent viral infections, using a cumulative deficits index (CDI) as an outcome: single pathogen associations, a pathogen burden summary score and latent class analyses. We found significant heterogeneity in the distribution of the CDI by age, sex, race/ethnicity and education. There was an association between pathogen burden and the CDI by all three metrics. The latent class classification of pathogen burden showed particularly strong associations with the CDI; these associations remained after controlling for age, sex, body mass index, smoking, race/ethnicity and education. Our results suggest that pathogen burden may influence early clinical indicators of poor health as measured by the CDI. Our results are salient since we were able to detect these associations in a relatively young population. These findings suggest that reducing pathogen burden and the specific pathogens that drive the CDI may provide a target for preventing the early development of age-related physiological changes.
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Wallace L, Theou O, Rockwood K, Andrew MK. Relationship between frailty and Alzheimer's disease biomarkers: A scoping review. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:394-401. [PMID: 30094326 PMCID: PMC6072899 DOI: 10.1016/j.dadm.2018.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Frailty and dementia appear to be closely linked, although mechanisms remain unclear. The objective was to conduct a scoping review of the association between frailty and Alzheimer's disease (AD) biomarkers in humans. Methods Three databases, PubMed, PsycINFO, and Embase, were searched for articles using the following search terms: “frail elderly”, “Alzheimer's disease”, “dementia biomarkers” and their synonyms. Inclusion was limited to original research in humans published before 2017, which included a frailty measure and AD biomarker (fluid markers, neuroimaging, and neuropathology). Results Five hundred twenty-two articles were identified and screened; 10 were included. Most were cross-sectional (n = 6), measured the frailty phenotype (n = 6), and included people with dementia (n = 7). Biomarkers examined were postmortem AD pathology (n = 3), brain atrophy (n = 5), and in vivo fluid markers (n = 2). Eight studies reported that increased frailty was associated with at least one biomarker abnormality. Discussion Evidence is limited and suffers from design limitations but suggests that frailty and AD biomarkers are closely linked. Longitudinal research examining multiple biomarkers and frailty is warranted. Very few studies examined links between frailty and Alzheimer's disease biomarkers. Generally, increased frailty was linked to increased Alzheimer's disease biomarker levels. Studies investigating this topic were largely cross sectional and underpowered. Future work should include longitudinal studies of frailty and multiple biomarkers.
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Affiliation(s)
- Lindsay Wallace
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Corresponding author. Tel.: +1(902)473-8687; Fax: +1(902)473-1050.
| | - Melissa K. Andrew
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Ma T, Cai J, Zhu YS, Chu XF, Wang Y, Shi GP, Wang ZD, Yao S, Wang XF, Jiang XY. Association between a frailty index based on common laboratory tests and QTc prolongation in older adults: the Rugao Longevity and Ageing Study. Clin Interv Aging 2018; 13:797-804. [PMID: 29731619 PMCID: PMC5927057 DOI: 10.2147/cia.s149791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Risk factors for heart rate-corrected QT interval (QTc) proglongation should be explored to stratify high-risk individuals to aid the prevention of incident cardiovascular events and mortality. The diversity of risk factors for QTc prolongation suggests that use of the frailty index (FI), indicating general health deficits, may be an effective approach, especially in the elderly, to identify the risk of QTc prolongation. METHODS We used the data of 1,780 individuals aged 70-87 years from the Rugao Longevity and Ageing Study (RuLAS), a community-based longitudinal study. The FI was constructed using 20 routine laboratory tests, plus the body mass index and measures of systolic and diastolic blood pressures (FI-Lab). RESULTS The mean FI-Lab value was 0.24±0.09. The mean heart rate-corrected QT interval (QTc) was 407±38 ms. The prevalence of QTc prolongation was 5.2% in elderly community populations aged 70-87 years. A higher FI-Lab value was associated with a higher risk for QTc prolongation. Each 10% increase in the FI-Lab value increased the odds ratio (OR) by 33% (OR: 1.33; 95% CI: 1.07-1.64). Compared with the lowest quartile, the top quartile FI-Lab score was associated with a 2.50-fold QTc prolongation risk in elderly individuals (95% CI: 1.21-5.19). CONCLUSION An FI based on routine laboratory data can identify older adults at increased risk for QTc prolongation. The FI approach may therefore be useful for the risk stratification of QTc prolongation.
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Affiliation(s)
- Teng Ma
- Unit of Epidemiology, Ministry of Education Key Laboratory of Contemporary Anthropology, Fudan University, Shanghai, People’s Republic of China
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, People’s Republic of China
- National Clinical Research Center for Aging and Medicine (Huashan), Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jian Cai
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yin-Sheng Zhu
- Rugao People’s Hospital, Rugao, Jiangsu, People’s Republic of China
| | - Xue-Feng Chu
- Rugao People’s Hospital, Rugao, Jiangsu, People’s Republic of China
| | - Yong Wang
- Rugao People’s Hospital, Rugao, Jiangsu, People’s Republic of China
| | - Guo-Ping Shi
- Rugao People’s Hospital, Rugao, Jiangsu, People’s Republic of China
| | - Zheng-Dong Wang
- Rugao People’s Hospital, Rugao, Jiangsu, People’s Republic of China
| | - Shun Yao
- Unit of Epidemiology, Ministry of Education Key Laboratory of Contemporary Anthropology, Fudan University, Shanghai, People’s Republic of China
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, People’s Republic of China
- National Clinical Research Center for Aging and Medicine (Huashan), Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xiao-Feng Wang
- Unit of Epidemiology, Ministry of Education Key Laboratory of Contemporary Anthropology, Fudan University, Shanghai, People’s Republic of China
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, People’s Republic of China
- National Clinical Research Center for Aging and Medicine (Huashan), Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xiao-Yan Jiang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Institute of Medical Genetics, Tongji University, Shanghai, People’s Republic of China
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A frailty index from common clinical and laboratory tests predicts increased risk of death across the life course. GeroScience 2017; 39:447-455. [PMID: 28866737 PMCID: PMC5636769 DOI: 10.1007/s11357-017-9993-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/17/2017] [Indexed: 01/28/2023] Open
Abstract
A frailty index (FI) based entirely on common clinical and laboratory tests might offer scientific advantages in understanding ageing and pragmatic advantages in screening. Our main objective was to compare an FI based on common laboratory tests with an FI based on self-reported data; we additionally investigated if the combination of subclinical deficits with clinical ones increased the ability of the FI to predict mortality. In this secondary analysis of the 2003–2004 and 2005–2006 National Health and Nutrition Examination Survey data, 8888 individuals aged 20+ were evaluated. Three FIs were constructed: a 36-item FI using self-reported questionnaire data (FI-Self-report); a 32-item FI using data from laboratory test values plus pulse and blood pressure measures (FI-Lab); and a 68-item FI that combined all items from each index (FI-Combined). The mean FI-Lab score was 0.15 ± 0.09, the FI-Self-report was 0.11 ± 0.11 and FI-Combined was 0.13 ± 0.08. Each index showed some typical FI characteristics (skewed distribution with long right tail, non-linear increase with age). Even so, there were fewer people with low frailty levels and a slower increase with age for the FI-Lab compared to the FI-Self-report. Higher frailty level was associated with higher risk of death, although it was strongest at older ages. Both FI-Lab and FI-Self-report remained significant in a combined model predicting death. The FI-Lab was feasible and valid, demonstrating that even subclinical deficit accumulation increased mortality risk. This suggests that deficit accumulation, from the subcellular to the clinically visible is a useful construct that may advance our understanding of the ageing process.
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King KE, Fillenbaum GG, Cohen HJ. A Cumulative Deficit Laboratory Test-based Frailty Index: Personal and Neighborhood Associations. J Am Geriatr Soc 2017; 65:1981-1987. [PMID: 28665517 PMCID: PMC5603383 DOI: 10.1111/jgs.14983] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To explore the association between a newly developed cumulative laboratory-based frailty index (FI) and intrinsic (personal) and extrinsic (social, environmental) characteristics. DESIGN Cross-sectional longitudinal study. SETTING The third and fourth waves of the community-representative, five-county, 10-year Duke Established Populations for Epidemiologic Studies of the Elderly study, carried out in a health service-rich area. PARTICIPANTS Cognitively intact survivors of the third wave (N = 1,740), who provided blood samples for standard laboratory work. MEASUREMENTS Biomarkers (n = 28) were measured to develop a cumulative deficit laboratory test-based FI (Duke FI) derived from standard laboratory tests: SMAC-24 chemistry panel, high-density lipoprotein cholesterol panel, and complete blood count. Information was gathered on scales assessing intrinsic characteristics (personal locus of control, life satisfaction, self-esteem, depressive symptomatology) and extrinsic characteristics (support received from and provided to family and friends, stressful life events, neighborhood disadvantage). RESULTS The newly developed Duke FI had content, construct, concurrent, and predictive validity. In addition to sex, race, and income, the Duke FI was associated at the intrinsic level with locus of control, self-esteem, life satisfaction, and depressive symptomatology (each P < .01) and at the extrinsic level with provision (P < .01) and with receipt of instrumental help (P < .10), social stressors (P < .03), and neighborhood disadvantage (P < .01) in unadjusted analysis; race fully explained neighborhood disadvantage. CONCLUSION Intrinsic (personality) characteristics and personally close extrinsic characteristics (contacts with family and friends, personal stressors) are associated with laboratory test-based frailty, as is neighborhood disadvantage, although in this accessible, health service-rich environment, race fully explained association with neighborhood disadvantage, suggesting that interventions to reduce frailty in residents in such an environment should pay particular attention to characteristics that immediately affect the individual.
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Affiliation(s)
- Katherine E. King
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC
| | - Gerda G. Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
| | - Harvey J. Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
- Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, NC
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Miller AJ, Theou O, McMillan M, Howlett SE, Tennankore KK, Rockwood K. Dysnatremia in Relation to Frailty and Age in Community-dwelling Adults in the National Health and Nutrition Examination Survey. J Gerontol A Biol Sci Med Sci 2017; 72:376-381. [PMID: 27356976 DOI: 10.1093/gerona/glw114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/03/2016] [Indexed: 01/05/2023] Open
Abstract
Background Frailty represents an age-related state of increased risk of adverse health outcomes, reflecting some combination of increased damage and compromised repair processes. Our objectives were to establish whether frailty is associated with dysnatremia (a deviation of serum sodium from normal values), to determine whether frailty explains the previously established association between age and dysnatremia and to assay the impact of each on mortality. Methods The relationship between age, frailty, and dysnatremia was investigated across the adult life course in 8,911 respondents from the 2003-2004 and 2005-2006 cross-sectional National Health and Nutrition Examination Survey, on whom both laboratory and mortality data were available. A frailty index (FI) was calculated for each respondent and related to dysnatremia (serum sodium values outside a 136-144 mmol/L reference range). Results Dysnatremia was significantly related to both age and frailty; as the degree of frailty increased, so did the proportion with dysnatremia, for example, from 4.1% in those with FI less than 0.10, to 12.4% in those with FI 0.40 or more; p less than .001. Adjusted for frailty, the relationship between age and dysnatremia was no longer significant. In the age- and sex-adjusted Cox models, both frailty (hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 1.04-1.05 for every 0.01 increase in FI) and dysnatremia (HR: 1.85; 95% CI: 1.51-2.26) were significant predictors of mortality; when hyponatremia was separated from hypernatremia in the Cox models, hypernatremia wasn't significant, but only 41 participants were identified as hypernatremic. Conclusion Increasing frailty is associated with dysnatremia and confounds the association between age and dysnatremia.
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Affiliation(s)
| | | | | | - Susan E Howlett
- Division of Geriatric Medicine, and.,Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
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Bendayan R, Kuh D, Cooper R, Muthuri S, Muniz-Terrera G, Adams J, Ward K, Richards M. Associations of Childhood and Adulthood Cognition with Bone Mineral Density in Later Adulthood: A Population-Based Longitudinal Study. Front Aging Neurosci 2017; 9:241. [PMID: 28790912 PMCID: PMC5525002 DOI: 10.3389/fnagi.2017.00241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/10/2017] [Indexed: 01/14/2023] Open
Abstract
This study explores the association between cognitive ability in childhood and midlife and bone health outcomes in early old age; and the relationships of these bone measures with contemporaneous and subsequent cognitive ability in the MRC National Survey of Health and Development (NSHD). This British birth cohort assessed areal and volumetric bone mineral density (aBMD and vBMD) at age 60-64, derived from peripheral quantitative computed tomography and dual-energy X-ray absorptiometry, and cognitive performance from childhood to age 69, among 866 women and 792 men. Cognitive performance at age 15 was assessed using tests of verbal and non-verbal ability, and mathematics; and memory and search speed tasks were administered at ages 53, 60-64, and 69. Covariates included body size, pubertal timing, smoking, leisure time physical activity, socioeconomic circumstances and menopause timing. Multiple linear regression analyses showed that higher childhood cognitive ability was associated with higher hip aBMD, in women, and greater cortical and trabecular vBMD, in men. For women, there were positive associations between hip aBMD and total vBMD, and contemporaneous cognitive ability with associations also extending to subsequent cognitive ability for total vBMD. For men, some associations with trabecular and total vBMD emerged at ages 60-64 and 69 but only after adjusting for education, occupational class and health behaviors. Our findings highlight that higher cognitive ability in childhood is associated with BMD in early old age and these associations might be explained by social and behavioral pathways. The results suggest that individuals with greater cognitive ability in early life are more likely to engage in healthy behaviors (e.g., leisure time physical activity) in adulthood, which in turn are associated with greater BMD later in life. Associations between bone health and cognitive performance should be considered within a life course framework; and the potential role of smoking and physical activity should be addressed when advising adults at high future risk of osteoporosis and fracture.
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Affiliation(s)
- Rebecca Bendayan
- MRC Unit for Lifelong Health and Ageing, University College LondonLondon, United Kingdom
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing, University College LondonLondon, United Kingdom
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing, University College LondonLondon, United Kingdom
| | - Stella Muthuri
- MRC Unit for Lifelong Health and Ageing, University College LondonLondon, United Kingdom
| | | | - Judith Adams
- Radiology and Manchester Academic Health Science Centre, Manchester Royal Infirmary, Central Manchester University Hospitals, NHS Foundation TrustManchester, United Kingdom
- Centre for Imaging Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester, United Kingdom
| | - Kate Ward
- Nutrition and Bone Health, MRC Elsie Widdowson LaboratoryCambridge, United Kingdom
- MRC Lifecourse Epidemiology Unit, University of SouthamptonSouthampton, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing, University College LondonLondon, United Kingdom
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Pereira AA, Borim FSA, Neri AL. Absence of association between frailty index and survival in elderly Brazilians: the FIBRA Study. CAD SAUDE PUBLICA 2017; 33:e00194115. [PMID: 28614455 DOI: 10.1590/0102-311x00194115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 07/08/2016] [Indexed: 01/10/2023] Open
Abstract
In Brazil, the frailty index has not been evaluated previously for its capacity to predict mortality in community-dwelling elderly. The objective of the current study was to evaluate the association between frailty index and mortality in the elderly. This was a prospective study consisting of data from the FIBRA Network-2008-2009 in Campinas, São Paulo State, with information on community-dwelling older adults from the urban area and through the Mortality Information System. Comparisons and statistical associations were performed with the following tests: Mann-Whitney, Kruskal-Wallis, chi-square, and Cox regression with 95% confidence intervals. A total of 689 older adults participated 72.1 ± 5.3 years), of whom 68.8% were women. The prevalence rate for frailty was 38.8%, compared to 51.6% for pre-frailty and 9.6% for fit elders; overall mean frailty index was higher in women. There was no association between frailty index and chronological age. Cox regression showed that the variables age HR: 1.10; 95%CI: 1.05-1.15) and gender HR: 0.57; 95%CI: 0.33-0.99) were significantly associated with mortality. No association was found between frailty index and mortality HR: 3.02; 95%CI: 0.24-37.64). Frailty index was not capable of predicting mortality in community-dwelling elderly Brazilians.
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Feridooni HA, Kane AE, Ayaz O, Boroumandi A, Polidovitch N, Tsushima RG, Rose RA, Howlett SE. The impact of age and frailty on ventricular structure and function in C57BL/6J mice. J Physiol 2017; 595:3721-3742. [PMID: 28502095 DOI: 10.1113/jp274134] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/23/2017] [Indexed: 12/25/2022] Open
Abstract
KEY POINTS Heart size increases with age (called hypertrophy), and its ability to contract declines. However, these reflect average changes that may not be present, or present to the same extent, in all older individuals. That aging happens at different rates is well accepted clinically. People who are aging rapidly are frail and frailty is measured with a 'frailty index'. We quantified frailty with a validated mouse frailty index tool and evaluated the impacts of age and frailty on cardiac hypertrophy and contractile dysfunction. Hypertrophy increased with age, while contractions, calcium currents and calcium transients declined; these changes were graded by frailty scores. Overall health status, quantified as frailty, may promote maladaptive changes associated with cardiac aging and facilitate the development of diseases such as heart failure. To understand age-related changes in heart structure and function, it is essential to know both chronological age and the health status of the animal. ABSTRACT On average, cardiac hypertrophy and contractile dysfunction increase with age. Still, individuals age at different rates and their health status varies from fit to frail. We investigated the influence of frailty on age-dependent ventricular remodelling. Frailty was quantified as deficit accumulation in adult (≈7 months) and aged (≈27 months) C57BL/6J mice by adapting a validated frailty index (FI) tool. Hypertrophy and contractile function were evaluated in Langendorff-perfused hearts; cellular correlates/mechanisms were investigated in ventricular myocytes. FI scores increased with age. Mean cardiac hypertrophy increased with age, but values in the adult and aged groups overlapped. When plotted as a function of frailty, hypertrophy was graded by FI score (r = 0.67-0.55, P < 0.0003). Myocyte area also correlated positively with FI (r = 0.34, P = 0.03). Left ventricular developed pressure (LVDP) plus rates of pressure development (+dP/dt) and decay (-dP/dt) declined with age and this was graded by frailty (r = -0.51, P = 0.0007; r = -0.48, P = 0.002; r = -0.56, P = 0.0002 for LVDP, +dP/dt and -dP/dt). Smaller, slower contractions graded by FI score were also seen in ventricular myocytes. Contractile dysfunction in cardiomyocytes isolated from frail mice was attributable to parallel changes in underlying Ca2+ transients. These changes were not due to reduced sarcoplasmic reticulum stores, but were graded by smaller Ca2+ currents (r = -0.40, P = 0.008), lower gain (r = -0.37, P = 0.02) and reduced expression of Cav1.2 protein (r = -0.68, P = 0.003). These results show that cardiac hypertrophy and contractile dysfunction in naturally aging mice are graded by overall health and suggest that frailty, in addition to chronological age, can help explain heterogeneity in cardiac aging.
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Affiliation(s)
- H A Feridooni
- Department of Pharmacology, Dalhousie University, PO Box 15000, 5850 College St, B3H 4R2, Halifax, NS, Canada
| | - A E Kane
- Department of Pharmacology, Dalhousie University, PO Box 15000, 5850 College St, B3H 4R2, Halifax, NS, Canada
| | - O Ayaz
- Department of Pharmacology, Dalhousie University, PO Box 15000, 5850 College St, B3H 4R2, Halifax, NS, Canada
| | - A Boroumandi
- Department of Biology, Muscle Health Research Centre, York University, 4700 Keele St, Toronto, ON, Canada, M3J 1P3
| | - N Polidovitch
- Department of Biology, Muscle Health Research Centre, York University, 4700 Keele St, Toronto, ON, Canada, M3J 1P3
| | - R G Tsushima
- Department of Biology, Muscle Health Research Centre, York University, 4700 Keele St, Toronto, ON, Canada, M3J 1P3
| | - R A Rose
- Department of Physiology and Biophysics, Dalhousie University, PO Box 15000, 5850 College St, B3H 4R2, Halifax, NS, Canada
| | - S E Howlett
- Department of Pharmacology, Dalhousie University, PO Box 15000, 5850 College St, B3H 4R2, Halifax, NS, Canada.,Department of Medicine (Geriatric Medicine), Dalhousie University, PO Box 15000, 5850 College St, B3H 4R2, Halifax, NS, Canada
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Shinkai S, Yoshida H, Taniguchi Y, Murayama H, Nishi M, Amano H, Nofuji Y, Seino S, Fujiwara Y. Public health approach to preventing frailty in the community and its effect on healthy aging in Japan. Geriatr Gerontol Int 2017; 16 Suppl 1:87-97. [PMID: 27018287 DOI: 10.1111/ggi.12726] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/29/2022]
Abstract
Effective methods to prevent or delay the onset of frailty are urgently required in aging societies, such as Japan. As a public health approach, we carried out a 10-year community intervention for frailty prevention, and examined its impact on healthy aging among older adults. The target population was all residents aged 65 years or older in the town of Kusatsu, Gunma Prefecture, Japan. For community empowerment, we organized a community forum, and discussed how to address the frailty issue in the community. For primary prevention, we attempted to promote physical activity, nutrition and social participation by means of a health education program to motivate older residents. For secondary prevention, we added a comprehensive geriatric assessment to routine annual health check-ups, which helped older participants improve self-care ability of functional health. High-risk persons were screened and encouraged to participate in a frailty prevention class with a multicomponent program. The attendance rate at annual health check-ups has remained constant at 30-40% of the target population; however, over 80% of the population appeared at least once during the 10 year-period. For evaluation, we carried out biennial health monitoring surveys, and reviewed the records of the local Long-Term Care Insurance system. The functional health of older residents was significantly improved as a result of the interventions; the incidence rate of Long-Term Care Insurance system certification in the old-old population (age ≥75 years) was decreased by one second, and healthy life expectancy at age 70 years was extended by 1.2 years for women and 0.5 years for men. Such trends greatly contrasted with those in the reference area, and Japan as a whole. In summary, the present public health approach to frailty prevention appears to promote healthy aging among older adults.
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Affiliation(s)
- Shoji Shinkai
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hiroto Yoshida
- Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Miyagi, Japan
| | - Yu Taniguchi
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hiroshi Murayama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Mariko Nishi
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hidenori Amano
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yu Nofuji
- Health Promotion Center, Japan Association for Development of Community Medicine, Tokyo, Japan
| | - Satoshi Seino
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Sex Differences in the Biology and Pathology of the Aging Heart. Can J Cardiol 2016; 32:1065-73. [DOI: 10.1016/j.cjca.2016.03.017] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 01/30/2023] Open
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Blodgett JM, Theou O, Howlett SE, Wu FCW, Rockwood K. A frailty index based on laboratory deficits in community-dwelling men predicted their risk of adverse health outcomes. Age Ageing 2016; 45:463-8. [PMID: 27076524 DOI: 10.1093/ageing/afw054] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/25/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND abnormal laboratory test results accumulate with age and can be common in people with few clinically detectable health deficits. A frailty index (FI) based entirely on common physiological and laboratory tests (FI-Lab) might offer pragmatic and scientific advantages compared with a clinical FI (FI-Clin). OBJECTIVES to compare the FI-Lab with the FI-Clin and to assess their individual and combined relationships with mortality and other adverse health outcomes. DESIGN AND SUBJECTS secondary analysis of the eight-centre, longitudinal European Male Ageing Study (EMAS) of community-dwelling men aged 40-79 at baseline. Follow-up assessment occurred 4.4 ± 0.3 (mean ± SD) years later. METHODS we constructed a 23-item FI using common laboratory tests, blood pressure and pulse (FI-Lab), compared it with a previously validated 39-item FI using self-report and performance-based measures (FI-Clin) and finally combined both FIs to create a 62-item FI-Combined. Outcomes were all-cause mortality, institutionalisation, doctor visits, medication use, self-reported health, falls and fractures. RESULTS the mean FI-Lab score was 0.28 ± 0.11, the FI-Clin was 0.13 ± 0.11 and FI-Combined was 0.19 ± 0.09. Age-adjusted models demonstrated that each FI was associated with mortality [HR (CI) FI-Lab: 1.04 (1.03-1.06); FI-Clin: 1.05 (1.04-1.06); FI-Combined: 1.07 (1.06-1.09)], institutionalisation, doctor visits, medication use, self-reported health and falls. Combined in a model with FI-Clin, the FI-Lab remained independently associated with mortality, institutionalisation, doctor visits, medication use and self-reported health. CONCLUSIONS the FI-Lab detected an increased risk of adverse health outcomes alone and in combination with a clinical FI; further evaluation of the feasibility of the FI-Lab as a frailty screening tool within hospital care settings is needed.
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Affiliation(s)
- Joanna M Blodgett
- Andrology Research Unit, University of Manchester, Manchester, UK Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Frederick C W Wu
- Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Steves CJ, Bird S, Williams FMK, Spector TD. The Microbiome and Musculoskeletal Conditions of Aging: A Review of Evidence for Impact and Potential Therapeutics. J Bone Miner Res 2016; 31:261-9. [PMID: 26676797 DOI: 10.1002/jbmr.2765] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/01/2015] [Accepted: 12/11/2015] [Indexed: 12/16/2022]
Abstract
Recently, we have begun to realize that the billions of microorganisms living in symbiosis with us have an influence on disease. Evidence is mounting that the alimentary tract microbiome, in particular, influences both host metabolic potential and its innate and adaptive immune system. Inflammatory states characterize many bone and joint diseases of aging. This prompts the hypothesis that the gut microbiome could alter the inflammatory state of the individual and directly influence the development of these common and burdensome clinical problems. Because the microbiome is easily modifiable, this could have major therapeutic impact. This perspective discusses evidence to date on the role of the microbiome and the highly prevalent age-related disorders of osteoporosis, osteoarthritis, gout, rheumatoid arthritis, sarcopenia, and frailty. It also reviews data on the effects of probiotics and prebiotic interventions in animal and human models. Despite suggestive findings, research to date is not conclusive, and we identify priorities for research to substantiate and translate findings.
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Affiliation(s)
- Claire J Steves
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK.,Clinical Age Research Unit, Department of Clinical Gerontology, Kings College Hospitals NHS Foundation Trust, London, UK
| | - Sarah Bird
- Clinical Age Research Unit, Department of Clinical Gerontology, Kings College Hospitals NHS Foundation Trust, London, UK
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
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45
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Wallace LMK, Howlett SE. Commentary: Age-related neurodegenerative disease research needs aging models. Front Aging Neurosci 2016; 8:9. [PMID: 26858640 PMCID: PMC4731742 DOI: 10.3389/fnagi.2016.00009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/11/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie UniversityHalifax, NS, Canada; Institute of Cardiovascular Sciences, University of ManchesterManchester, UK
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Jackson MA, Jackson M, Jeffery IB, Beaumont M, Bell JT, Clark AG, Ley RE, O'Toole PW, Spector TD, Steves CJ. Signatures of early frailty in the gut microbiota. Genome Med 2016; 8:8. [PMID: 26822992 PMCID: PMC4731918 DOI: 10.1186/s13073-016-0262-7] [Citation(s) in RCA: 265] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/05/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Frailty is arguably the biggest problem associated with population ageing, and associates with gut microbiome composition in elderly and care-dependent individuals. Here we characterize frailty associations with the gut microbiota in a younger community dwelling population, to identify targets for intervention to encourage healthy ageing. METHOD We analysed 16S rRNA gene sequence data derived from faecal samples obtained from 728 female twins. Frailty was quantified using a frailty index (FI). Mixed effects models were used to identify associations with diversity, operational taxonomic units (OTUs) and taxa. OTU associations were replicated in the Eldermet cohort. Phenotypes were correlated with modules of OTUs collapsed by co-occurrence. RESULTS Frailty negatively associated with alpha diversity of the gut microbiota. Models considering a number of covariates identified 637 OTUs associated with FI. Twenty-two OTU associations were significant independent of alpha diversity. Species more abundant with frailty included Eubacterium dolichum and Eggerthella lenta. A Faecalibacterium prausnitzii OTU was less abundant in frailer individuals, and retained significance in discordant twin analysis. Sixty OTU associations were replicated in the Eldermet cohort. OTU co-occurrence modules had mutually exclusive associations between frailty and alpha diversity. CONCLUSIONS There was a striking negative association between frailty and gut microbiota diversity, underpinned by specific taxonomic associations. Whether these relationships are causal or consequential is unknown. Nevertheless, they represent targets for diagnostic surveillance, or for intervention studies to improve vitality in ageing.
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Affiliation(s)
| | - Matt Jackson
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital Campus, 3rd & 4th Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Ian B Jeffery
- School of Microbiology and Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland.
| | - Michelle Beaumont
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital Campus, 3rd & 4th Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Jordana T Bell
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital Campus, 3rd & 4th Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Andrew G Clark
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, USA.
| | - Ruth E Ley
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, USA.
| | - Paul W O'Toole
- School of Microbiology and Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland.
| | - Tim D Spector
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital Campus, 3rd & 4th Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Claire J Steves
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital Campus, 3rd & 4th Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK.
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Rockwood K, McMillan M, Mitnitski A, Howlett SE. A Frailty Index Based on Common Laboratory Tests in Comparison With a Clinical Frailty Index for Older Adults in Long-Term Care Facilities. J Am Med Dir Assoc 2015; 16:842-7. [DOI: 10.1016/j.jamda.2015.03.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
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Rae EA, Brown RE. The problem of genotype and sex differences in life expectancy in transgenic AD mice. Neurosci Biobehav Rev 2015; 57:238-51. [DOI: 10.1016/j.neubiorev.2015.09.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/27/2015] [Accepted: 09/02/2015] [Indexed: 01/23/2023]
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Abstract
Aging occurs as a series of small steps, first causing cellular damage and then affecting tissues and organs. This is also true in the brain. Frailty, a state of increased risk due to accelerated deficit accumulation, is robustly a risk factor for cognitive impairment. Community-based autopsy studies show that frail individuals have brains that show multiple deficits without necessarily demonstrating cognitive impairment. These facts cast a new light on the growing number of risk factors for cognitive impairment, suggesting that, on a population basis, most health deficits can be associated with late-life cognitive impairment. The systems mechanism by which things that are bad for the body are likely to be bad for the brain can be understood like this: the burden of health deficits anywhere indicates impaired ability to withstand or repair endogenous and environmental damage. This in turn makes additional damage more likely. If true, this suggests that a life course approach to preventing cognitive impairment is desirable. Furthermore, conducting studies in highly selected, younger, healthier individuals to provide ‘proof of concept’ information is now common. This strategy might exclude the very circumstances that are required for disease expression in the people in whom dementia chiefly occurs (that is, older adults who are often in poor health).
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Affiliation(s)
- Samuel D Searle
- Department of Medicine, Dalhousie University, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada ; Capital District Health Authority, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada ; Centre for Health Care of Elderly, Division of Geriatric Medicine QEII Health Sciences Centre, Capital District Health Authority, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada
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50
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A long-recommended but seldom-used method of analysis for fall injuries found a unique pattern of risk factors in the youngest-old. Aging Clin Exp Res 2015; 27:439-45. [PMID: 25583298 PMCID: PMC4513192 DOI: 10.1007/s40520-014-0308-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/24/2014] [Indexed: 11/20/2022]
Abstract
Background Few studies on fall risk factors use long-recommended methods for analysis of recurrent events. Previous falls are the biggest risk factor for future falls, but few fall studies focus on the youngest-old. Aims This study’s objective was to apply Cox regression for recurrent events to identify factors associated with injurious falls in the youngest-old. Methods Participants were community-dwelling residents of southern Sweden (n = 1,133), aged 59–67 at baseline (median 61.2), from the youngest cohorts of the larger Good Aging in Skåne (GÅS) study. Exposure variable data were collected from baseline study visits and medical records. Injurious falls, defined as emergency, inpatient, or specialist visits associated with ICD-10 fall codes during the follow-up period (2001–2011), were gathered from national and regional registries. Analysis was conducted using time to event Cox Regression for recurrent events. Results A majority (77.1 %) of injurious falls caused serious injuries such as fractures and open wounds. Exposure to nervous system medications [hazard ratio (HR) 1.40, 95 % confidence interval (CI) 1.03–1.89], central nervous system disease (HR 1.79, CI 1.18–2.70), and previous injurious fall(s) (HR 2.00, CI 1.50–2.68) were associated with increased hazard of injurious fall. Conclusions Regression for recurrent events is feasible with typical falls’ study data. The association of certain exposures with increased hazard of injurious falls begins earlier than previously studied. Different patterns of risk factors by age can provide insight into the progression of frailty. Tailored fall prevention screening and intervention may be of value in populations younger than those traditionally screened.
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