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Yuan G, Yang Y, Lin Y, Lin J, Wu Y. Current status and development trends in CKD with frailty research from 2000 to 2021: a bibliometric analysis. Ren Fail 2024; 46:2292142. [PMID: 38178378 PMCID: PMC10773684 DOI: 10.1080/0886022x.2023.2292142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The prevalence of chronic kidney disease (CKD) is gradually increasing in the elderly population. At the same time, frailty has become one of the research hotspots in the field of geriatrics. Bibliometric analyses help to understand the direction of a field. Therefore, this study aimed to analyze the status and emerging trends of frailty in CKD patients. DATA AND METHODS The Web of Science Core Collection (WoSCC) database was screened for relevant literature published between 1 January 2000 and 31 December 2021. Next, publications were analyzed for information including authors, journals, cited references, citing journals, institutions, countries and regions, high-frequency keywords and co-citations using VOSviewer, Microsoft Excel, and R software. RESULTS A total of 2223 articles were obtained, from which 613 relevant articles were selected based on title and abstract screening. There was an upward trend in the number of annual publications and Johansen KL was considered the most contributing author in the field. The Clinical Journal of the American Society of Nephrology was the most productive research journal. Johns Hopkins University is the most published organization. The United States is the global leader in the field and contributes the most to research. Research hotspots focus on epidemiological studies of frailty and frailty intervention. CONCLUSIONS This study presents a comprehensive bibliometric analysis of CKD and frailty research. Key findings highlight the current focus on early screening and assessment of frailty in CKD patients, as well as physical function interventions in frail patients.
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Affiliation(s)
- Guowei Yuan
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yaqin Yang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yujie Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiarong Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yuchi Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Fox ST, Hubbard R, Valks A, Matsuyama M, Kalaw E, Viecelli A, Aquino EM, Johnson D, Janda M. Protocol for the process evaluation of the GOAL trial: investigating how comprehensive geriatric assessment (CGA) improves patient-centred goal attainment in older adults with chronic kidney disease in the outpatient setting. BMJ Open 2024; 14:e076328. [PMID: 39097313 PMCID: PMC11298742 DOI: 10.1136/bmjopen-2023-076328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/19/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION The GOAL Cluster Randomised Controlled Trial (NCT04538157) is now underway, investigating the impact of comprehensive geriatric assessment (CGA) for frail older people with chronic kidney disease (CKD). The primary outcome is the attainment of patient-identified goals at 3 months, assessed using the goal attainment scaling process. The protocol requires a dedicated process evaluation that will occur alongside the main trial, to investigate issues of implementation, mechanisms of impact and contextual factors that may influence intervention success. This process evaluation will offer novel insights into how and why CGA might be beneficial for frail older adults with CKD and provide guidance when considering how to implement this complex intervention into clinical practice. METHODS AND ANALYSIS This process evaluation protocol follows guidance from the Medical Research Council and published guidance specific for the evaluation of cluster-randomised trials. A mixed methodological approach will be taken using data collected as part of the main trial and data collected specifically for the process evaluation. Recruitment and process data will include site feasibility surveys, screening logs and site issues registers from all sites, and minutes of meetings with intervention and control sites. Redacted CGA letters will be analysed both descriptively and qualitatively. Approximately 60 semistructured interviews will be analysed with a qualitative approach using a reflexive thematic analysis, with both inductive and deductive approaches underpinned by an interpretivist perspective. Qualitative analyses will be reported according to the Consolidated criteria for Reporting Qualitative research guidelines. The Standards for Quality Improvement Reporting Excellence guidelines will also be followed. ETHICS AND DISSEMINATION Ethics approval has been granted through Metro South Human Research Ethics Committee (HREC/2020/QMS/62883). Dissemination will occur through peer-reviewed journals and feedback to trial participants will be facilitated through the central coordinating centre. TRIAL REGISTRATION NUMBER NCT04538157.
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Affiliation(s)
- Sarah Therese Fox
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
- Internal Medicine Services, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Ruth Hubbard
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Andrea Valks
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Misa Matsuyama
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Emarene Kalaw
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Viecelli
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Eunise Martha Aquino
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - David Johnson
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
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Jackwert K, Holmér M, Hallongren M, Asmar T, Wretenberg P, Andersson ÅG. Agreement between Clinical Frailty Scale-scores based on information from patient interviews and Clinical Frailty Scale-scores based on information from medical records - a cross sectional study. BMC Geriatr 2024; 24:570. [PMID: 38956490 PMCID: PMC11218100 DOI: 10.1186/s12877-024-05160-5] [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: 09/28/2023] [Accepted: 06/18/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Frailty is an age-related condition with increased risk for adverse health outcomes. Assessing frailty according to the Clinical Frailty Scale (CFS) based on data from medical records is useful for previously unassessed patients, but the validity of such scores in exclusively geriatric populations and in patients with dementia is relatively unknown. METHODS Patients admitted for the first time to one of two geriatric wards at Örebro University hospital between January 1st - December 31st, 2021, were included in this study if they had been appointed a CFS-score by anamnestic interview (CFSI) at admission. CFS scores based on medical records (CFSR) were appointed by a single medical student, who was blinded to the CFSI score. Score-agreement was evaluated with quadratic weighted Cohen's kappa (κ). RESULTS In total, 145 patients between the age of 55-101 were included in the study. The CFSR and CFSI scores agreed perfectly in 102 cases (0.7, 95% CI 0.65-0.77). There was no significant difference regarding age, sex, comorbidity, or number of patients diagnosed with dementia between the patients with complete agreement and the patients whose scores did not agree. Agreement between the scores was substantial, κ = 0.66, 95% CI 0.53-0.80. CONCLUSIONS CFS scores based on information from medical records can be generated with substantial agreement to CFS scores based on in-person anamnestic interviews. A dementia diagnosis does not influence the agreement between the scores. Therefore, these scores are a useful tool for assessing frailty in geriatric patients who previously lack a frailty assessment, both in clinical practice and future research. The results support previous findings, but larger studies are warranted.
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Affiliation(s)
- Kim Jackwert
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden
| | - Michael Holmér
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden
- Department of Geriatrics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Matilda Hallongren
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden
| | - Todel Asmar
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden
| | - Per Wretenberg
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden
- Department of Orthopaedics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Åsa G Andersson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden.
- Department of Geriatrics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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Muscedere J, Bagshaw SM, Kho M, Mehta S, Cook DJ, Boyd JG, Sibley S, Wang HT, Archambault PM, Albert M, Rewa OG, Ball I, Norman PA, Day AG, Hunt M, Loubani O, Mele T, Sarti AJ, Shahin J. Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study. Intensive Care Med 2024; 50:1064-1074. [PMID: 38748266 PMCID: PMC11245420 DOI: 10.1007/s00134-024-07404-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/19/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE Frailty is common in critically ill patients but the timing and optimal method of frailty ascertainment, trajectory and relationship with care processes remain uncertain. We sought to elucidate the trajectory and care processes of frailty in critically ill patients as measured by the Clinical Frailty Scale (CFS) and Frailty Index (FI). METHODS This is a multi-centre prospective cohort study enrolling patients ≥ 50 years old receiving life support > 24 h. Frailty severity was assessed with a CFS, and a FI based on the elements of a comprehensive geriatric assessment (CGA) at intensive care unit (ICU) admission, hospital discharge and 6 months. For the primary outcome of frailty prevalence, it was a priori dichotomously defined as a CFS ≥ 5 or FI ≥ 0.2. Processes of care, adverse events were collected during ICU and ward stays while outcomes were determined for ICU, hospital, and 6 months. RESULTS In 687 patients, whose age (mean ± standard deviation) was 68.8 ± 9.2 years, frailty prevalence was higher when measured with the FI (CFS, FI %): ICU admission (29.8, 44.8), hospital discharge (54.6, 67.9), 6 months (34.1, 42.6). Compared to ICU admission, aggregate frailty severity increased to hospital discharge but improved by 6 months; individually, CFS and FI were higher in 45.3% and 50.6% patients, respectively at 6 months. Compared to hospital discharge, 18.7% (CFS) and 20% (FI) were higher at 6 months. Mortality was higher in frail patients. Processes of care and adverse events were similar except for worse ICU/ward mobility and more frequent delirium in frail patients. CONCLUSIONS Frailty severity was dynamic, can be measured during recovery from critical illness using the CFS and FI which were both associated with worse outcomes. Although the CFS is a global measure, a CGA FI based may have advantages of being able to measure frailty levels, identify deficits, and potential targets for intervention.
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Affiliation(s)
- John Muscedere
- Department of Critical Care Medicine, Kingston Health Sciences Center, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | - Michelle Kho
- School of Rehabilitation Science, Faculty of Health Science, Physiotherapy Department, McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Deborah J Cook
- Departments of Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - J Gordon Boyd
- Department of Medicine (Neurology) and Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Stephanie Sibley
- Department of Critical Care Medicine, Kingston Health Sciences Center, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Han T Wang
- Division of Critical Care Medicine, Department of Medicine, Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada
| | - Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Martin Albert
- Division of Critical Care Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal Research Center and Université de Montréal, Montreal, QC, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | - Ian Ball
- Department of Medicine and Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Patrick A Norman
- Kingston General Health Research Institute and Kingston Health Sciences Centre, Kingston, Canada
| | - Andrew G Day
- Kingston General Health Research Institute and Kingston Health Sciences Centre, Kingston, Canada
| | - Miranda Hunt
- Department of Critical Care Medicine, Kingston Health Sciences Center, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Osama Loubani
- Department of Critical Care, Dalhousie University, Halifax, ON, Canada
| | - Tina Mele
- Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Aimee J Sarti
- Department of Critical Care, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jason Shahin
- Department of Medicine, McGill University, Montreal, Qc, Canada
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Ferrante LE, Szczeklik W. Frailty is crucial in FORECASTing outcomes in critical care. Intensive Care Med 2024; 50:1119-1122. [PMID: 38953928 DOI: 10.1007/s00134-024-07518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/08/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
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Brighton LJ, Evans CJ, Farquhar M, Bristowe K, Kata A, Higman J, Ogden M, Nolan C, Yi D, Gao W, Koulopoulou M, Hasan S, Ingram K, Clarke S, Parmar KR, Baldwin E, Steves CJ, Man WDC, Maddocks M. Comprehensive geriatric assessment for people with both COPD and frailty starting pulmonary rehabilitation: a mixed-methods feasibility trial. ERJ Open Res 2024; 10:00774-2023. [PMID: 39076524 PMCID: PMC11284595 DOI: 10.1183/23120541.00774-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/26/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction Many people with COPD experience frailty. Frailty increases risk of poor health outcomes, including non-completion of pulmonary rehabilitation. Integrated approaches to support people with COPD and frailty throughout and following rehabilitation are indicated. The aim of the present study was to determine the feasibility of conducting a randomised controlled trial of integrating comprehensive geriatric assessment (CGA) for people with COPD and frailty starting pulmonary rehabilitation. Methods A multicentre mixed-methods randomised controlled feasibility trial ("Breathe Plus"; ISRCTN13051922) was carried out. People with COPD, aged ≥50 years, Clinical Frailty Scale ≥5 and referred for pulmonary rehabilitation were randomised 1:1 to usual pulmonary rehabilitation, or pulmonary rehabilitation plus CGA. Remote intervention delivery was used during COVID-19 restrictions. Outcomes (physical, psychosocial, service use) were measured at baseline, 90 and 180 days, alongside process data and qualitative interviews. Results Recruitment stopped at 31 participants (mean±sd age 72.4±10.1 years, 68% Medical Research Council Dyspnoea Scale 4-5), due to COVID-19-related disruptions. Recruitment (46% eligible recruited) and retention (87% at 90- and 180-day follow-up) were acceptable. CGAs occurred on average 60.5 days post-randomisation (range 8-129) and prompted 46 individual care recommendations (median 3 per participant, range 0-12), 65% of which were implemented during follow-up. The most common domains addressed during CGA were nutrition and cardiovascular health. Participants valued the holistic approach of CGA but questioned the optimal time to introduce it. Conclusion Integrating CGA alongside pulmonary rehabilitation is feasible and identifies unmet multidimensional need in people with COPD and frailty. Given challenges around timing and inclusivity, the integration of geriatric and respiratory care should not be limited to rehabilitation services.
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Affiliation(s)
- Lisa Jane Brighton
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
- King's College London, Department of Psychology, London, UK
| | - Catherine J. Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
- Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK
| | - Morag Farquhar
- University of East Anglia, School of Health Sciences, Norwich, UK
| | - Katherine Bristowe
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | | | - Jade Higman
- King's College London, Clinical Trials Unit, London, UK
| | - Margaret Ogden
- King's College London, Cicely Saunders Institute Public Involvement Group, London, UK
| | - Claire Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Brunel University London, College of Health, Medicine and Life Sciences, London, UK
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Maria Koulopoulou
- King's College Hospital NHS Foundation Trust, Pulmonary Rehabilitation, London, UK
| | - Sharmeen Hasan
- King's College Hospital NHS Foundation Trust, Department of Clinical Gerontology, London, UK
| | - Karen Ingram
- Harefield Pulmonary Rehabilitation, Heart Lung and Critical Care Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Stuart Clarke
- Harefield Pulmonary Rehabilitation, Heart Lung and Critical Care Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Kishan R. Parmar
- Department of Geriatric Medicine, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Eleni Baldwin
- Department of Geriatric Medicine, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Claire J. Steves
- King's College London, Department of Twin Research and Genetic Epidemiology, London, UK
- Guys and St. Thomas’ NHS Foundation Trust, Department of Ageing and Health, London, UK
| | - William D-C. Man
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Imperial College, National Heart and Lung Institute, London, UK
- King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
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Hussien H, Siriteanu L, Nistor I, Kanbay M, Covic A, Voroneanu L, Covic A. The Impact of Frailty and Severe Cognitive Impairment on Survival Time and Time to Initiate Dialysis in Older Adults With Advanced Chronic Kidney Disease: A Prospective Observational Cohort Study. Cureus 2024; 16:e64303. [PMID: 39130911 PMCID: PMC11316242 DOI: 10.7759/cureus.64303] [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] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
Background and objectives Frailty and cognitive impairment significantly impact survival time and time to initiate dialysis in older adults with advanced chronic kidney disease (CKD). This study aims to evaluate the effects of frailty and cognitive impairment on these outcomes and determine the most effective assessment tool for predicting early dialysis initiation and short survival time. Materials and methods This prospective observational cohort study involved 240 patients aged ≥65 years with stage 4 or 5 CKD, recruited from a nephrology outpatient department (ambulatory care) between March 2020 and March 2021. Frailty was assessed using the Physical Frailty Phenotype (PFP), PRISMA-7, Clinical Frailty Scale (CFS), and FRAIL scale. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA). The primary outcomes were time to initiate dialysis and survival time, with secondary outcomes including hospitalization rates, length of stay, and mortality after dialysis initiation. Results Frail patients only showed significantly shorter time to dialysis initiation when identified by the PFP and FRAIL scale (28.3 months for frail vs. 31.2 months for non-frail, p = 0.028; 26.9 months for frail vs. 30.9 months for non-frail, p = 0.038). The PFP, FRAIL, and CFS tools indicated significantly shorter survival times for frail patients compared to non-frail patients (26.8 months for frail vs. 30.6 months for non-frail, p = 0.003). Frailty is strongly correlated with severe cognitive impairment, as 45.5% of frail patients (according to the FRAIL scale) have dementia compared to 15.1% of non-frail patients (p<0.001). However, cognitive impairment did not significantly affect the time to dialysis initiation or survival time. Hospitalization rates and length of stay in the hospital were significantly higher only for frail patients identified by PRISMA-7, with a median hospital length of stay of 9.15 days for frail patients vs 6.37 days for non-frail patients (p = 0.044). Overall, 37.5% of the patients did not survive during the study follow-up, with frail patients having a higher mortality rate. Conclusion Frailty, mainly when assessed by PFP and FRAIL, is a significant predictor of early dialysis initiation and reduced survival time in older adults with advanced CKD. Cognitive impairment, while prevalent, did not independently predict these outcomes. Regular frailty screening should be incorporated into CKD management to tailor interventions and improve patient outcomes.
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Affiliation(s)
- Hani Hussien
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
| | - Lucian Siriteanu
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
| | - Ionut Nistor
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
| | - Mehmet Kanbay
- Department of Internal Medicine, Koc University School of Medicine, Istanbul, TUR
| | - Andreea Covic
- Department of Nephrology, "Dr. C.I. Parhon" University Hospital, Iasi, ROU
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
| | - Luminita Voroneanu
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
| | - Adrian Covic
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
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Waefler N, Abid I, Montaut V, Donzé J, Zender H, John G. Neurological diagnostic tests for patients with and without delirium: a prospective observational study. GeroScience 2024:10.1007/s11357-024-01246-5. [PMID: 38916662 DOI: 10.1007/s11357-024-01246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/06/2024] [Indexed: 06/26/2024] Open
Abstract
Since most of the precipitating factors of delirium are not due to neurological disorders, neurological diagnostic tests (NDTs) may be of limited value. We hypothesized that delirium has a high burden of NDTs with a low diagnostic yield. All patients admitted to the internal medicine wards of a single secondary teaching hospital between November 2019 and January 2020 were eligible. Within the first 48 h of their admission, they had a formal evaluation by a neuropsychologist to screen for presence of delirium. NDTs (brain MRI, brain CT, electroencephalography (EEG), and lumbar puncture) performed during the hospital stay were compared between patients with and without delirium using a logistic regression model stratified by a propensity score. The proportions of diagnostic yield (acute anomalies that changed the treatment management) provided by each type of examination were compared. Of 217 patients included, 19/32 patients (61%) with delirium had one or more NDTs, compared to 48/185 (26%) without delirium (adjusted OR 2.7; 95%CI 1.1-6.7; p = 0.027). The proportions of NDT results affecting management for patients with and without delirium were 13 and 20% for brain CT scans (p = 0.71), 29 and 38% for brain MRI (p = 0.99), and 20 and 10% for EEGs (p = 0.99), respectively. The higher proportion of NDTs performed on patients with delirium was associated with a low diagnostic yield, although not statistically different from those performed among inpatients without delirium. There is a need for restrictive, evidence-based guidelines to help with the work-up for patients with delirium.
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Affiliation(s)
- Noémie Waefler
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland
| | - Imen Abid
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland
| | - Victor Montaut
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland
| | - Jacques Donzé
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland
- Division of Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Medicine, University Hospital of Lausanne, Rue de Bugnon 21, CH-1011, Lausanne, Switzerland
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hervé Zender
- Department of Medicine, Neuchâtel Hospital Network, Rue du Chasseral 20, CH-2300, La Chaux-de-Fonds, Switzerland
- Department of Acute Medicine, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, CH-1205, Geneva, Switzerland
| | - Gregor John
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland.
- Department of Internal Medicine, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, CH-1205, Geneva, Switzerland.
- University of Geneva, Rue Michel Servet 1, CH-1211, Geneva, Switzerland.
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Tran TH, Ta TTH, Nguyen LTN, Vu HTT, Van Nguyen H. Adaptation of the comprehensive rheumatologic assessment of frailty (CRAF) as a multidimensional frailty screening tool in patients with rheumatoid arthritis in Vietnam. BMC Rheumatol 2024; 8:24. [PMID: 38849947 PMCID: PMC11161963 DOI: 10.1186/s41927-024-00394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND In recent times, there has been acknowledgment of the prevalence of frailty and pre-frailty among individuals with rheumatoid arthritis (RA). Comprehensive Rheumatologic Assessment of Frailty (CRAF) stands out as a dependable tool grounded in synthesis and clinical judgment. Despite this, a validated Vietnamese rendition of the CRAF is currently unavailable. This study seeks to assess the reliability and validity of the CRAF in a patient with RA in Vietnam. METHODS A cross-sectional investigation was carried out with 402 patients diagnosed with rheumatoid arthritis, encompassing both inpatients and outpatients at the Centre for Rheumatology at Bach Mai Hospital in Hanoi, Vietnam. CRAF was employed to gauge the extent of frailty. To establish convergent validity, the scores from the CRAF were correlated with those from the Fried phenotype. Discriminant validity was ascertained through the utilization of receiver operating characteristic (ROC) curve analysis. Additionally, a multivariate logistic regression model was applied to evaluate the individual determinants' relative impact on the CRAF. RESULTS In testing for convergent validity, a significant correlation was found between CRAF and Fried phenotype (p < 0.001). The discriminatory power of CRAF was higher than those of the Fried phenotype (difference between areas under the ROC curves = 0.947 (95% CI: 0.927-0.967). Variables associated with frailty at the multivariate analysis were comorbitidy, medication intake, BMI, DAS28-CRP, and age (all at p < 0.01). CONCLUSION CRAF exhibited strong validity and accurate discrimination. Incorporating frailty assessment into regular rheumatological practices could signify a significant advancement in the care of rheumatoid arthritis.
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Affiliation(s)
- Trang Huyen Tran
- Department of Internal Medicine, Hanoi Medical University, 01 Ton That Tung, Hanoi, Vietnam.
- Centre for Rheumatology, Bach Mai Hospital, Hanoi, Vietnam.
| | - Trang Thi Huong Ta
- Department of Internal Medicine, Hanoi Medical University, 01 Ton That Tung, Hanoi, Vietnam
- Centre for Rheumatology, Bach Mai Hospital, Hanoi, Vietnam
| | - Lan Thi Ngoc Nguyen
- Department of Internal Medicine, Hanoi Medical University, 01 Ton That Tung, Hanoi, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- National Geriatric Hospital, Hanoi, Vietnam
| | - Hung Van Nguyen
- Department of Internal Medicine, Hanoi Medical University, 01 Ton That Tung, Hanoi, Vietnam
- Centre for Rheumatology, Bach Mai Hospital, Hanoi, Vietnam
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10
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Azevedo PS, de Melo RC, de Souza JT, Frost R, Gavin JP, Robinson K, Boas PJFV, Minicucci MF, Aprahamian I, Wachholz PA, Hinslif-Smith K, Gordon AL. Frailty identification and management among Brazilian healthcare professionals: a survey. BMC Geriatr 2024; 24:486. [PMID: 38831274 PMCID: PMC11149253 DOI: 10.1186/s12877-024-05020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND National and international guidelines on frailty assessment and management recommend frailty screening in older people. This study aimed to determine how Brazilian healthcare professionals (HCPs) identify and manage frailty in practice. METHODS An anonymous online survey on the assessment and management of frailty was circulated virtually through HCPs across Brazil. RESULTS Most of the respondants used non-specific criteria such as gait speed (45%), handgrip strength (37.6%), and comprehensive geriatric assessment (33.2%). The use of frailty-specific criteria was lower than 50%. The most frequently used criteria were the Frailty Index (19.1%), Frailty Phenotype (13.2%), and FRAIL (12.5%). Only 43.5% felt confident, and 40% had a plan to manage frailty. In the multivariate-adjusted models, training was the most crucial factor associated with assessing frailty, confidence, and having a management plan (p < 0.001 for all). Those with fewer years of experience were more likely to evaluate frailty (p = 0.009). Being a doctor increased the chance of using a specific tool; the opposite was true for dietitians (p = 0.03). Those who assisted more older people had a higher likelihood of having a plan (p = 0.011). CONCLUSION Frailty assessment was heterogeneous among healthcare professions groups, predominantly using non-specific criteria. Training contributed to frailty assessment, use of specific criteria, confidence, and having a management plan. This data informs the need for standardized screening criteria and management plans for frailty, in association with increasing training at the national level for all the HCPs who assist older people.
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Affiliation(s)
- Paula Schmidt Azevedo
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | | | - Juli Thomaz de Souza
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | - Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - James P Gavin
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Katie Robinson
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), University of Nottingham, Nottingham, UK
| | - Paulo José Fortes Villas Boas
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | - Marcos Ferreira Minicucci
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | | | - Patrick Alexander Wachholz
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | - Kathryn Hinslif-Smith
- Leicester School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Adam Lee Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), University of Nottingham, Nottingham, UK.
- NIHR Applied Research Collaboration - East Midlands (ARC-EM), Nottingham, UK.
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11
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Alves J, Prendki V, Chedid M, Yahav D, Bosetti D, Rello J. Challenges of antimicrobial stewardship among older adults. Eur J Intern Med 2024; 124:5-13. [PMID: 38360513 DOI: 10.1016/j.ejim.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Older adults hospitalized in internal medicine wards or long-term care facilities (LTCF) are progressively increasing. Older adults with multimorbidity are more susceptible to infections, as well as to more vulnerable to adverse effects (and interactions) of antibiotics, resulting in a need for effective and safer strategies for antimicrobial stewardship (ASM), both in hospitalization wards and long-term care facilities. Studies on antimicrobial stewardship in older patients are scarce and guidelines are required. Given the peculiarities of the optimization of antimicrobial prescription in individual older adults for common infections, tactics to overcome barriers need an update. The use of rapid diagnosis tests, biomarkers, de-escalation and switching from intravenous to oral/subcutaneous therapy strategies are examples of successful AMS interventions. AMS interventions are associated with reduced side effects, lower mortality, shorter hospital stays, and reduced costs. The proposed AMS framework in LTCF should focus on five domains: strategic vision, team, interventions, patient-centred care and awareness. Internists can partner with geriatrists, pharmacists and infectious disease specialists to address barriers and to improve patient care.
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Affiliation(s)
- Joana Alves
- Infectious Diseases Specialist, Head of Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance, Hospital de Braga, Portugal.
| | - Virginie Prendki
- Department of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland; Department of Infectious Disease, Geneva University Hospital, Switzerland
| | - Marie Chedid
- Department of Infectious Disease, Geneva University Hospital, Switzerland
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - Davide Bosetti
- Department of Infectious Disease, Geneva University Hospital, Switzerland; Infection Control Programme and WHO Collaborating Centre for Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jordi Rello
- Medicine Department, Universitat Internacional de Catalunya, Spain; Clinical Research Pneumonia and Sepsis (CRIPS) Research Group-Vall d'Hebrón Institute Research (VHIR), Barcelona, Spain; Formation, Recherche, Evaluation (FOREVA), CHU Nîmes, Nîmes, France
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12
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Shafiee Hanjani L, Fox S, Hubbard RE, Gordon E, Reid N, Hilmer SN, Saunders R, Gnjidic D, Young A. Frailty knowledge, training and barriers to frailty management: A national cross-sectional survey of health professionals in Australia. Australas J Ageing 2024; 43:271-280. [PMID: 37563782 DOI: 10.1111/ajag.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE(S) To understand Australian health professionals' perceptions of their knowledge and previous training about frailty, as well as barriers to frailty assessment and management in their practice. METHODS A cross-sectional online survey was developed and distributed to health professionals (medical, nursing and allied health) engaged in clinical practice in Australia through convenience and snowball sampling techniques from March to May 2022. The survey consisted of five sections: frailty training and knowledge; confidence in recognising and managing adults with frailty; the importance and relevance of frailty; barriers to assessing and managing frailty in practice; and interest in further frailty training. Responses were analysed using descriptive statistics. RESULTS The survey was taken by 736 health professionals. Less than half of respondents (44%, 321/733) reported receiving any training on frailty, with 14% (105/733) receiving training specifically focussed on frailty. Most respondents (78%, 556/712) reported 'good' or 'fair' understanding of frailty. The majority (64%, 448/694) reported being 'fairly' or 'somewhat' confident with identifying frailty. Almost all respondents (>90%) recognised frailty as having an important impact on outcomes and believed that there are beneficial interventions for frailty. Commonly reported barriers to frailty assessment in practice included 'lack of defined protocol for managing frailty' and 'lack of consensus about which frailty assessment tool to use'. Most respondents (88%, 521/595) were interested in receiving further education on frailty, with a high preference for online training. CONCLUSIONS The findings suggest frailty is important to health professionals in Australia, and there is a need for and interest in further frailty education.
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Affiliation(s)
- Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Fox
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Emily Gordon
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Reid
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Young
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Greeley B, Chung SS, Graves L, Song X. Combating Barriers to the Development of a Patient-Oriented Frailty Website. JMIR Aging 2024; 7:e53098. [PMID: 38807317 DOI: 10.2196/53098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/02/2024] [Accepted: 03/07/2024] [Indexed: 05/30/2024] Open
Abstract
Unlabelled This viewpoint article, which represents the opinions of the authors, discusses the barriers to developing a patient-oriented frailty website and potential solutions. A patient-oriented frailty website is a health resource where community-dwelling older adults can navigate to and answer a series of health-related questions to receive a frailty score and health summary. This information could then be shared with health care professionals to help with the understanding of health status prior to acute illness, as well as to screen and identify older adult individuals for frailty. Our viewpoints were drawn from 2 discussion sessions that included caregivers and care providers, as well as community-dwelling older adults. We found that barriers to a patient-oriented frailty website include, but are not limited to, its inherent restrictiveness to frail persons, concerns over data privacy, time commitment worries, and the need for health and lifestyle resources in addition to an assessment summary. For each barrier, we discuss potential solutions and caveats to those solutions, including assistance from caregivers, hosting the website on a trusted source, reducing the number of health questions that need to be answered, and providing resources tailored to each users' responses, respectively. In addition to screening and identifying frail older adults, a patient-oriented frailty website will help promote healthy aging in nonfrail adults, encourage aging in place, support real-time monitoring, and enable personalized and preventative care.
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14
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Yau DKW, Griffith JF, Underwood MJ, Joynt GM, Lee A. Preoperative rectus femoris muscle ultrasound, its relationship with frailty scores, and the ability to predict recovery after cardiac surgery: a prospective cohort study. Perioper Med (Lond) 2024; 13:45. [PMID: 38783315 PMCID: PMC11112902 DOI: 10.1186/s13741-024-00401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Frailty is common in patients undergoing cardiac surgery and is associated with poorer postoperative outcomes. Ultrasound examination of skeletal muscle morphology may serve as an objective assessment tool as lean muscle mass reduction is a key feature of frailty. METHODS This study investigated the association of ultrasound-derived muscle thickness, cross-sectional area, and echogenicity of the rectus femoris muscle (RFM) with preoperative frailty and predicted subsequent poor recovery after surgery. Eighty-five patients received preoperative RFM ultrasound examination and frailty-related assessments: Clinical Frailty Scale (CFS) and 5-m gait speed test (GST5m). Association of each ultrasound measurement with frailty assessments was examined. Area under receiver-operating characteristic curve (AUROC) was used to assess the discriminative ability of each ultrasound measurement to predict days at home within 30 days of surgery (DAH30). RESULTS By CFS and GST5m criteria, 13% and 34% respectively of participants were frail. RFM cross-sectional area alone demonstrated moderate predictive association for frailty by CFS criterion (AUROC: 0.76, 95% CI: 0.66-0.85). Specificity improved to 98.7% (95% CI: 93.6%-100.0%) by utilising RFM cross-sectional area as an 'add-on' test to a positive gait speed test, and thus a combined muscle size and function test demonstrated higher predictive performance (positive likelihood ratio: 40.4, 95% CI: 5.3-304.3) for frailty by CFS criterion than either test alone (p < 0.001). The combined 'add-on' test predictive performance for DAH30 (AUROC: 0.90, 95% CI: 0.81-0.95) may also be superior to either CFS or gait speed test alone. CONCLUSIONS Preoperative RFM ultrasound examination, especially when integrated with the gait speed test, may be useful to identify patients at high risk of frailty and those with poor outcomes after cardiac surgery. TRIAL REGISTRATION The study was registered on the Chinese Clinical Trials Registry (ChiCTR2000031098) on 22 March 2020.
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Affiliation(s)
- Derek King Wai Yau
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR.
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, G/F Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - Malcolm John Underwood
- Cardiovascular Services, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
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15
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Vankova H, Schmalz M, Andel R, Rajnochova Bloudickova S. Frailty and depressive symptoms in older kidney transplant recipients: opportunities for collaboration between transplant nephrologists and geriatricians. BMC Geriatr 2024; 24:423. [PMID: 38741066 DOI: 10.1186/s12877-024-04972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Frailty is one of the key syndromes in geriatric medicine and an important factor for post-transplant outcomes. We aimed to describe the prevalence of frailty and examine the correlates of frailty and depressive symptoms in older kidney transplant recipients (KTRs). METHODS This cross-sectional study involved 112 kidney transplant recipients (KTRs) aged 70 and above. Frailty syndrome was assessed using the Fried frailty criteria, and patients were categorized as frail, pre-frail, or non-frail based on five frailty components: muscle weakness, slow walking speed, low physical activity, self-reported exhaustion, and unintentional weight loss. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS). The relationship between frailty and depressive symptoms was evaluated using multinomial logistic regression, with the three frailty categories as the dependent variable and the severity of depressive symptoms as the independent variable, while controlling for age, gender, renal graft function, and time since transplant surgery. RESULTS The participants had a mean age of 73.3 ± 3.3 years, and 49% were female. The prevalence of frailty syndrome was 25% (n = 28), pre-frailty was 46% (n = 52), and 29% (n = 32) of the KTRs were non-frail. The mean score for depressive symptoms was 3.1 ± 2.4 points, with 18% scoring above the clinical depression cutoff. Depressive symptoms were positively correlated with frailty (r = .46, p < .001). Among the frailty components, self-reported exhaustion (r = .43, p < .001), slow walking speed (r = .26, p < .01), and low physical activity (r = .44, p < .001) were significantly positively correlated with depressive symptoms, while muscle strength (p = .068) and unintentional weight loss (p = .050) were not. A multinomial logistic regression adjusted for covariates indicated that, compared to being non-frail, each additional point on the GDS increased the odds of being pre-frail by 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.01-1.96) and roughly doubled the odds of being frail (OR = 2.01, 95% CI 1.39-2.89). CONCLUSION There is a strong association between frailty and depression in KTRs aged 70 years and older. Targeted detection has opened up a new avenue for collaboration between geriatricians and transplant nephrologists.
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Affiliation(s)
- Hana Vankova
- Department of Internal Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruska 87, 10000 Praha 10, Prague, Czech Republic.
| | - Michal Schmalz
- Department of Internal Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruska 87, 10000 Praha 10, Prague, Czech Republic
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Sandrucci S. Frailty: How to assess, prognostic role. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106862. [PMID: 36922252 DOI: 10.1016/j.ejso.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
Despite the clear clinical significance of frailty in surgical populations, there is no consensus on how best to define or measure frailty, even within the geriatric literature. A diversity of measures exists to measure some or all these domains, but only research-focused tools have been validated in surgical populations. These tools are too resource-intensive for rapid, cost-effective, preoperative screening of entire populations considering elective surgery. This narrative review deals with the definition of frailty and the different assessment methods of the phenotypic definition and the accumulation of deficits definition. Moreover, as in the area of surgery frailty seems to be an independent risk factor for mortality, morbidity, length of stay, and postoperative complication, different studies reporting the association of preoperative frailty with postoperative outcomes after cancer surgery and the association with postoperative mortality within 30 days are considered. Preoperative care should include a focus on the goals of treatment and care options. Patient-oriented functional and cognitive outcomes as well as the development and implementation of interventions that could potentially improve adverse postoperative effects must be further investigated.
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Affiliation(s)
- Sergio Sandrucci
- General Surgery Department, CDSS University of Turin, Torino, Italy.
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17
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Voorend CG, Berkhout-Byrne NC, van Bodegom-Vos L, Diepenbroek A, Franssen CF, Joosten H, Mooijaart SP, Bos WJW, van Buren M. Geriatric Assessment in CKD Care: An Implementation Study. Kidney Med 2024; 6:100809. [PMID: 38660344 PMCID: PMC11039322 DOI: 10.1016/j.xkme.2024.100809] [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] [Indexed: 04/26/2024] Open
Abstract
Rationale & Objective Older people with progressive chronic kidney disease (CKD) have complex health care needs. Geriatric evaluation preceding decision making for kidney replacement is recommended in guidelines, but implementation is lacking in routine care. We aimed to evaluate implementation of geriatric assessment in CKD care. Study Design Mixed methods implementation study. Setting & Participants Dutch nephrology centers were approached for implementation of geriatric assessment in patients aged ≥70 years and with an estimated glomerular filtration rate of ≤20 mL/min/1.73 m2. Quality Improvement Activities/Exposure We implemented a consensus-based nephrology-tailored geriatric assessment: a patient questionnaire and professionally administered test set comprising 16 instruments covering functional, cognitive, psychosocial, and somatic domains and patient-reported outcome measures. Outcomes We aimed for implementation in 10 centers and 200 patients. Implementation was evaluated by (i) perceived enablers and barriers of implementation, including integration in work routines (Normalization Measure Development Tool) and (ii) relevance of the instruments to routine care for the target population. Analytical Approach Variations in implementation practices were described based on field notes. The postimplementation survey among health care professionals was analyzed descriptively, using an explanatory qualitative approach for open-ended questions. Results Geriatric assessment was implemented in 10 centers among 191 patients. Survey respondents (n = 71, 88% response rate) identified determinants that facilitated implementation, ie, multidisciplinary collaboration (with geriatricians) -meetings and reports and execution of assessments by nurses. Barriers to implementation were patient illiteracy or language barrier, time constraints, and patient burden. Professionals considered geriatric assessment sufficiently integrated into work routines (mean, 6.7/10 ± 2.0 [SD]) but also subject to improvement. Likewise, the relevance of geriatric assessment for routine care was scored as 7.8/10 ± 1.2. The Clinical Frailty Score and Montreal Cognitive Assessment were perceived as the most relevant instruments. Limitations Selection bias of interventions' early adopters may limit generalizability. Conclusions Geriatric assessment could successfully be integrated in CKD care and was perceived relevant to health care professionals.
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Affiliation(s)
- Carlijn G.N. Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Noeleen C. Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Adry Diepenbroek
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper F.M. Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hanneke Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W. Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marjolijn van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
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Hernández-Aguiar Y, Becerra-Bolaños Á, Rodríguez-Pérez A. Preoperative diagnosis of frailty. J Int Med Res 2024; 52:3000605241251705. [PMID: 38818532 PMCID: PMC11143825 DOI: 10.1177/03000605241251705] [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: 01/16/2024] [Accepted: 04/14/2024] [Indexed: 06/01/2024] Open
Abstract
The aging world population obliges physicians to establish measures to optimize and estimate the outcomes of increasingly frail patients. Thus, in the last few years there has been an increase in the application of frailty indices. Multiple scales have emerged that can be applied in the perioperative setting. Each one has demonstrated some utility, either by way of establishing postoperative prognosis or as a method for the clinical optimization of patient care. Anaesthesiologists are offered a wide choice of scales, the characteristics and appropriate management of which they are often unaware. This narrative review aims to clarify the concept of frailty, describe its importance in the perioperative setting and evaluate the different scales that are most applicable to the perioperative setting. It will also establish paths for the future optimization of patient care.
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Affiliation(s)
- Yanira Hernández-Aguiar
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ángel Becerra-Bolaños
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Aurelio Rodríguez-Pérez
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Coca-Martinez M, Carli F. Prehabilitation: Who can benefit? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106979. [PMID: 37451924 DOI: 10.1016/j.ejso.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 05/29/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Prehabilitation is an intervention that occurs between cancer diagnosis and the start of an acute treatment. It involves physical, nutritional, and psychological assessments to establish a baseline functional level and provide targeted interventions to improve a person's health and prevent future impairments. Prehabilitation has been applied to surgical oncology and has shown positive results at improving functional capacity, reducing hospital stay, decreasing complications, and enhancing health-related quality of life. The importance of collaboration between various healthcare professionals and the implementation of multimodal interventions, including exercise training, nutrition optimization, and emotional support is discussed in this manuscript. The need for screening and assessment of conditions such as sarcopenia, frailty, or low functional status in order to identify patients who would benefit the most from prehabilitation is vital and should be a part of all prehabilitation programs. Exercise and nutrition play complementary roles in prehabilitation, enhancing anabolism and performance. However, in the presence of malnutrition and sarcopenia, exercise-related energy expenditure without sufficient protein intake can lead to muscle wasting and further deterioration of functional capacity, thus special emphasis on nutrition and protein intake should be made in these cases. Finally, the challenges and the need for a paradigm shift in perioperative care are discussed to effectively implement personalized prehabilitation programs.
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Affiliation(s)
- Miquel Coca-Martinez
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada; Department of Anesthesia and Intensive Care, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Franco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
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Xie R, Jing X, Yang C. The prevalence and characteristics of frailty in cirrhosis patients: a meta-analysis and systematic review. Front Med (Lausanne) 2024; 11:1353406. [PMID: 38745743 PMCID: PMC11092890 DOI: 10.3389/fmed.2024.1353406] [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: 12/10/2023] [Accepted: 03/08/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives This study aimed to assess the prevalence of frailty in cirrhosis patients and the distribution of age, sex, and body mass index (BMI) in cirrhotic patients with frailty. Methods We performed a thorough literature search using PubMed, Embase, Web of Science, and the Cochrane Library from inception to 29 February 2024. The estimated prevalence with a 95% confidence interval (CI) was calculated with a random effect model. Subgroup analysis and sensitivity analysis were performed to assess the heterogeneity and characterize the distribution of age, sex, and body mass index (BMI) in cirrhotic patients. Publication bias was assessed by the funnel plot, Begg's test, and Egger's test. Results The 16 included studies, which were all observational, reported a prevalence of frailty in 8,406 cirrhosis patients ranging from 9 to 65%, and the overall estimated prevalence was 27% (95% CI: 21-33%; I2 = 97.7%, P < 0.001). This meta-analysis indicated that the estimated prevalence of frailty in cirrhosis patients was high, and compared to the non-frail cohort, the frail cohort tended to have a higher mean age, with a mean age of 63.3 (95% CI: 59.9, 66.7; Z = 36.48; P < 0.001), and a larger proportion of male patients with worse liver function, with a mean of 73.5% (95% CI: 71.4, 75.5%; Z = 7.65; P < 0.001), ND in the frail cohort, 54.8% (95% CI: 43.1, 66.5%; P < 0.001) and 23.4% (95% CI: 13.2, 33.7%; P < 0.001) were classified into Child-Pugh B and C, respectively. Meanwhile, the patients in the non-frail cohort are more likely to have a higher BMI, with a mean of 28.4 (95% CI: 24.1, 32.7; Z = 13.07; P < 0.001). Conclusion The current study suggests that cirrhosis patients have a high prevalence of frailty. Compared with the non-frail cohort, the frail patients tend to be male, older, and have a lower BMI with worse liver function.
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Affiliation(s)
- Ruiyu Xie
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, Shijiazhuang, Hebei, China
| | - Xiaotong Jing
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chuanjie Yang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, Shijiazhuang, Hebei, China
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21
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Kwok VKY, Reid N, Hubbard RE, Thavarajah H, Gordon EH. Multicomponent perioperative interventions to improve outcomes for frail patients: a systematic review. BMC Geriatr 2024; 24:376. [PMID: 38671345 PMCID: PMC11055226 DOI: 10.1186/s12877-024-04985-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Preoperative frailty is associated with increased risk of adverse outcomes. In 2017, McIsaac and colleagues' systematic review found that few interventions improved outcomes in this population and evidence was low-quality. We aimed to systematically review the evidence for multicomponent perioperative interventions in frail patients that has emerged since McIsaac et al.'s review. METHODS PUBMED, EMBASE, Cochrane, and CINAHL databases were searched for English-language studies published since January 1, 2016, that evaluated multicomponent perioperative interventions in patients identified as frail. Quality was assessed using the National Institute of Health Quality Assessment Tool. A narrative synthesis of the extracted data was conducted. RESULTS Of 2835 articles screened, five studies were included, all of which were conducted in elective oncologic gastrointestinal surgical populations. Four hundred and thirteen patients were included across the five studies and the mean/median age ranged from 70.1 to 87.0 years. Multicomponent interventions were all applied in the preoperative period. Two studies also applied interventions postoperatively. All interventions addressed exercise and nutritional domains with variability in timing, delivery, and adherence. Multicomponent interventions were associated with reduced postoperative complications, functional deterioration, length of stay, and mortality. Four studies reported on patient-centred outcomes. The quality of evidence was fair. CONCLUSIONS This systematic review provides evidence that frail surgical patients undergoing elective oncologic gastrointestinal surgery may benefit from targeted multicomponent perioperative interventions. Yet methodological issues and substantial heterogeneity of the interventions precludes drawing clear conclusions regarding the optimal model of care. Larger, low risk of bias studies are needed to evaluate optimal intervention delivery, effectiveness in other populations, implementation in health care settings and ascertain outcomes of importance for frail patients and their carers.
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Affiliation(s)
- Vivian Ka-Yan Kwok
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia.
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Ruth E Hubbard
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Emily H Gordon
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Dong S, Zeng Q, He W, Cheng W, Zhang L, Zhong R, He W, Fang X, Wei H. Effect of Lactobacillus plantarum BFS1243 on a female frailty model induced by fecal microbiota transplantation in germ-free mice. Food Funct 2024; 15:3993-4009. [PMID: 38516869 DOI: 10.1039/d3fo05282f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Frailty, a complex geriatric syndrome, significantly impedes the goal of achieving 'healthy aging'. Increasing evidence suggests a connection between gut microbiota, systemic inflammation, and disease. However, it remains to be determined whether interventions targeting the intestinal flora can effectively ameliorate frailty. Our research involved fecal microbiota transplantation (FMT) experiments on germ-free (GF) mice, dividing these mice into three groups: a group receiving transplants from healthy elderly individuals (HF group), a group of frailty patients (FF group), and the FF group supplemented with Lactobacillus plantarum BFS1243 (FFL group). Our findings indicated a significant shift in the gut microbiota of the FF group, in contrast to the HF group, characterized by decreased Akkermansia and increased Enterocloster, Parabacteroides, and Eisenbergiella. Concurrently, there was a reduction in amino acids and SCFAs, with BFS1243 partially mitigating these changes. The FF group exhibited an upregulation of inflammatory markers, including PGE2, CRP, and TNF-α, and a downregulation of irisin, all of which were moderated by BFS1243 treatment. Furthermore, BFS1243 improved intestinal barrier integrity and physical endurance in the FF mice. Correlation analysis revealed a negative association between SCFA-producing species and metabolites like lysine and butyric acid with pro-inflammatory factors. In conclusion, our study conclusively demonstrated that alterations in the gut microbiota of elderly individuals can lead to physical frailty, likely due to detrimental effects on the intestinal barrier and a pro-inflammatory state. These findings underscore the potential of gut microbiome modulation as a clinical strategy for treating frailty.
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Affiliation(s)
- Sashuang Dong
- Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
- College of Food Science, South China Agricultural University, Guangzhou, Guangdong, 510630, P. R. China.
- Guangdong Provincial Key Laboratory of Utilization and Conservation of Food and Medicinal Resources in Northern Region, Shaoguan University, Shaoguan, 512000, P. R. China
| | - Qi Zeng
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
| | - Weimin He
- Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
- College of Food Science, South China Agricultural University, Guangzhou, Guangdong, 510630, P. R. China.
| | - Wei Cheng
- Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
| | - Ling Zhang
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
| | - Ruimin Zhong
- Guangdong Provincial Key Laboratory of Utilization and Conservation of Food and Medicinal Resources in Northern Region, Shaoguan University, Shaoguan, 512000, P. R. China
| | - Wen He
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
| | - Xiang Fang
- College of Food Science, South China Agricultural University, Guangzhou, Guangdong, 510630, P. R. China.
| | - Hong Wei
- Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
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23
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Qian L, Chan A, Cai J, Lewicke J, Gregson G, Lipsett M, Rios Rincón A. Evaluation of the accuracy of a UWB tracker for in-home positioning for older adults. Med Eng Phys 2024; 126:104155. [PMID: 38621851 DOI: 10.1016/j.medengphy.2024.104155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 03/04/2024] [Accepted: 03/16/2024] [Indexed: 04/17/2024]
Abstract
The population of older adults is rapidly growing. In-home monitoring systems have been used to support aging-in-place. Ambient sensors or wearable localizers can be used but may be too low resolution, while camera systems are invasive to privacy. Ultra-wideband (UWB) localization offers precise positioning by placing anchors throughout the house and wearing a tag that is tracked by the anchors. In this study, the accuracy of UWB for indoor tracking was evaluated in a motion capture gait lab and in a mock condo in the Glenrose Rehabilitation Hospital. First, the configuration of UWB was tested, changing factors related to sampling time, anchor placement and line-of-sight. Comparing these factors to the configurations recommended by the manufacturer guidelines, accuracies remained within 14 cm. We then performed static and dynamic accuracy tests, with dynamic testing comprised of rolling and walking motions. In the motion capture lab, we found localization accuracies of 7.0 ± 11.1 cm while in the mock condo, we found accuracies of 27.3 ± 12.9 cm. Dynamic testing with rolling motions had an average of 19.1 ± 1.6 cm while walking was 20.5 ± 4.2 cm. The mean accuracy of UWB is within the 30 cm target for indoor localization.
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Affiliation(s)
- Linna Qian
- Department of Mechanical Engineering, University of Alberta, 10th Floor, Donadeo Innovation Centre for Engineering, 9211 116St NW, Edmonton, AB T6G 1H9, Canada
| | - Andrew Chan
- Research, Innovation and Technology, Glenrose Rehabilitation Hospital, 10105 112 Ave NW, Edmonton, AB T5G 0H1, Canada.
| | - Joanne Cai
- Department of Mechanical Engineering, University of Alberta, 10th Floor, Donadeo Innovation Centre for Engineering, 9211 116St NW, Edmonton, AB T6G 1H9, Canada
| | - Justin Lewicke
- Research, Innovation and Technology, Glenrose Rehabilitation Hospital, 10105 112 Ave NW, Edmonton, AB T5G 0H1, Canada
| | - Geoff Gregson
- Research, Innovation and Technology, Glenrose Rehabilitation Hospital, 10105 112 Ave NW, Edmonton, AB T5G 0H1, Canada; Department of Occupational Therapy, University of Alberta, 8205 - 114St, 2-64 Corbett Hall, Edmonton, AB T6G 2G4, Canada
| | - Michael Lipsett
- Department of Mechanical Engineering, University of Alberta, 10th Floor, Donadeo Innovation Centre for Engineering, 9211 116St NW, Edmonton, AB T6G 1H9, Canada
| | - Adriana Rios Rincón
- Department of Occupational Therapy, University of Alberta, 8205 - 114St, 2-64 Corbett Hall, Edmonton, AB T6G 2G4, Canada
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Vassallo W, Jarman H. Frailty assessment of older patients in the emergency department. Emerg Nurse 2024; 32:27-31. [PMID: 37461322 DOI: 10.7748/en.2023.e2177] [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] [Accepted: 03/15/2023] [Indexed: 03/06/2024]
Abstract
An ageing population is leading to an increase in patients attending emergency departments (EDs) with comorbidities and age-related syndromes such as frailty. Frailty is a clinical syndrome defined as an increased vulnerability to age-related or disease-related insults in older adults due to diminishing physiological reserves. It also places increased demands on staff and hospital services. Screening for frailty early in the care pathway ensures goal-directed and timely care. This article provides an overview of frailty and its assessment in older people presenting to the ED. It discusses the most commonly used frailty assessment tool in the ED, the Clinical Frailty Scale, and identifies that the results of frailty assessment should be used to initiate appropriate individualised care in older patients.
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Affiliation(s)
- Wendy Vassallo
- Emergency Department Clinical Research Group, St George's University Hospitals NHS Foundation Trust, London, England
| | - Heather Jarman
- midwifery and allied health professions, Emergency Department Clinical Research Group, St George's University Hospitals NHS Foundation Trust, London, England
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25
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Bulcock A, Weatherburn A, Gbadebo A, De Sousa M. Improving access to Comprehensive Geriatric Assessment by improving flow through a Frailty Assessment Area-A QI project. Future Healthc J 2024; 11:100018. [PMID: 38646043 PMCID: PMC11025059 DOI: 10.1016/j.fhj.2024.100018] [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] [Indexed: 04/23/2024]
Abstract
Early Comprehensive Geriatric Assessment is a key component of the assessment of older adults presenting to hospital with frailty syndromes, often this is facilitated through Acute Frailty Units. In this paper we describe how using QI methodology we improved access to our Frailty Unit using a digital solution. The impact of this improvement was demonstrated via the reduction in length of stay that these patients experienced compared to patients admitted to General Care of the Older Person wards.
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Voie KS, Wiles J, Mæhre KS, Kristiansen M, Helgesen AK, Blix BH. The timescapes of older adults living alone and receiving home care: An interview study. J Aging Stud 2024; 68:101212. [PMID: 38458730 DOI: 10.1016/j.jaging.2024.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/10/2024]
Abstract
In this study, we drew on Barbara Adam's (1998) timescape perspective and applied a timescape lens to our analysis of how nine older adults who live alone, receive home care and are considered by home care professionals to be frail, experience living (in) time. Over a period of eight months, we conducted three interviews with each of the nine participants. We analysed the data using reflexive thematic analysis and drew on timescapes to further interpret our preliminary analysis. Our results show that situated everyday time, place across time, and large-scale time interact in the framing and shaping of older adults' everyday lives. Older adults' embodied experiences of being of advanced age, living alone and receiving home care influenced their timescapes. We propose that paying attention to older adults' timescapes can enable home care professionals and other supporters to consider older adults' health, well-being, vulnerabilities and strengths from a broader perspective than the 'here and now' and thereby enhance the provision of person-centred care.
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Affiliation(s)
- Kristin S Voie
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Janine Wiles
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Kjersti Sunde Mæhre
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Margrethe Kristiansen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Ann Karin Helgesen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway; Faculty of Health, Welfare and Organisation, Østfold University College, Halden 1757, Norway.
| | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway; Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Bergen 5063, Norway.
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Yeung MT, Gan Y, Teo SQ, Lim KQ, Leow HX, Jbabdi M, Raiche M, Yang M. The Chinese translation and cross-cultural adaptation of PRISMA-7 questionnaire: an observational study to establish the accuracy, reliability and validity. BMC Geriatr 2024; 24:204. [PMID: 38418958 PMCID: PMC10900580 DOI: 10.1186/s12877-024-04825-5] [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: 10/30/2022] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Frailty is a health condition linked to adverse health outcomes and lower life quality. The PRISMA-7, a 7-item questionnaire from the Program on Research for Integrating Services for the Maintenance of Autonomy (PRISMA), is a validated case-finding tool for frailty with good sensitivity and specificity. This study aimed to translate, culturally adapt, and validate the PRISMA-7 questionnaire for Chinese use. METHODS A prospective observational study with convenience sampling recruited bilingual adults aged 65 and over living in the community. The Functional Autonomy Measurement System (SMAF) was the gold standard benchmark. The English PRISMA-7 questionnaire was culturally adapted to Chinese using forward and backward translation. Intra- and inter-rater reliability were determined using the intraclass correlation coefficient (ICC). Face, content and criterion validity were determined. The Receiver Operator characteristic (ROC) curve determined the optimal cut-off score. RESULTS One-hundred-twenty participants (55 females and 65 males) were recruited. The Chinese PRISMA-7 questionnaire had excellent intra-rater and inter-rater reliability (ICC = 1.000). The rigorous forward and backward translation established the face and content validity. The moderately high correlations between the English PRISMA-7 with SMAF (r = - 0.655, p < 0.001) and Chinese PRISMA-7 with SMAF (r = - 0.653, p < 0.001) pairs established the criterion validity. An optimal cut-off score of three "Yes" responses was reported with 100% sensitivity and 85.3% specificity. CONCLUSION This translation, cross-cultural adaptation, and validation study established the Chinese PRISMA-7 questionnaire. The preliminary results suggest adequate diagnostic test accuracy for frailty screening among the Chinese-literate community.
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Affiliation(s)
- Meredith T Yeung
- Health and Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 169683, Singapore.
| | - Yen Gan
- Health and Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 169683, Singapore
| | - Shu Qi Teo
- Health and Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 169683, Singapore
| | - Kai Quan Lim
- Health and Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 169683, Singapore
| | - Hui Xuan Leow
- Health and Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 169683, Singapore
| | - Myriam Jbabdi
- Centre d'expertise en santé de Sherbrooke / Sherbrooke Health Expertise Centre, 500, rue Murray, Sherbrooke, Québec, J1G 2K6, Canada
| | - Michel Raiche
- Centre d'expertise en santé de Sherbrooke / Sherbrooke Health Expertise Centre, 500, rue Murray, Sherbrooke, Québec, J1G 2K6, Canada
- Faculté des sciences de l'activité physique, Université de Sherbrooke, 2500 Boul. Université, Sherbrooke, Québec, J1K 2R1, Canada
| | - Mingxing Yang
- Singhealth Polyclinic, SHP-Head Office, 167 Jalan Bukit Merah Connection One (Tower 5), #15-10, Singapore, 150167, Singapore
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Iozzo P, Spina N, Cannizzaro G, Gambino V, Patinella A, Bambi S, Vellone E, Alvaro R, Latina R. Association between Boarding of Frail Individuals in the Emergency Department and Mortality: A Systematic Review. J Clin Med 2024; 13:1269. [PMID: 38592117 PMCID: PMC10932317 DOI: 10.3390/jcm13051269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Older patients who attend emergency departments are frailer than younger patients and are at a high risk of adverse outcomes; (2) Methods: To conduct this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. We systematically searched literature from PubMed, Embase, OVID Medline®, Scopus, CINAHL via EBSCOHost, and the Cochrane Library up to May 2023, while for grey literature we used Google Scholar. No time restrictions were applied, and only articles published in English were included. Two independent reviewers assessed the eligibility of the studies and extracted relevant data from the articles that met our predefined inclusion criteria. The Critical Appraisal Skills Program (CASP) was used to assess the quality of the studies; (3) Results: Evidence indicates that prolonged boarding of frail individuals in crowded emergency departments (Eds) is associated with adverse outcomes, exacerbation of pre-existing conditions, and increased mortality risk; (4) Conclusions: Our results suggest that frail individuals are at risk of longer ED stays and higher mortality rates. However, the association between the mortality of frail patients and the amount of time a patient spends in exposure to the ED environment has not been fully explored. Further studies are needed to confirm this hypothesis.
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Affiliation(s)
- Pasquale Iozzo
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy; (E.V.); (R.A.)
| | - Noemi Spina
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, Via del Vespro, 129, 90127 Palermo, Italy; (N.S.); (G.C.); (V.G.); (A.P.)
| | - Giovanna Cannizzaro
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, Via del Vespro, 129, 90127 Palermo, Italy; (N.S.); (G.C.); (V.G.); (A.P.)
| | - Valentina Gambino
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, Via del Vespro, 129, 90127 Palermo, Italy; (N.S.); (G.C.); (V.G.); (A.P.)
| | - Agostina Patinella
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, Via del Vespro, 129, 90127 Palermo, Italy; (N.S.); (G.C.); (V.G.); (A.P.)
| | - Stefano Bambi
- Department of Health Sciences, University of Florence, Viale GB Morgagni, 48, 50134 Florence, Italy;
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy; (E.V.); (R.A.)
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wrocław, Poland
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy; (E.V.); (R.A.)
| | - Roberto Latina
- Department of Health Promotion Science, Maternal and Infant Care, Internal Medicine, and Medical Specialities (PROMISE), University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy;
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Silva S, Ramadasa U, Lekamwasam S. Cultural adaptation and validation of the Sinhala version of the Frail Non-disabled tool (FiND). BMC Geriatr 2024; 24:154. [PMID: 38355436 PMCID: PMC10865609 DOI: 10.1186/s12877-024-04749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Frailty, a common geriatric syndrome of vulnerability, is associated with a decline in health and function. The most problematic expression of population ageing is associated with weakness, slowing, decreased energy, lower activity and when severe, unintended weight loss. Frailty is not consciously identified in clinical practice and is not widely studied in Sri Lanka. A validated tool for screening frailty in a busy clinical setting is therefore much needed. This study was done as a part of validating the Sinhala version of the Frail Non-Disabled (S-FiND) tool. METHODS The FiND tool was translated from English to Sinhala by two translators, blinded to each other. They were combined and translated back to the original language by two separate translators. After verifying the content validity, unambiguity and clarity of items in a focused group discussion, the pre-final version was piloted among 30 volunteers. After assessing the psychometric properties of the pre-final version, the final version was tested among 100 adults older than 65 years from the Colombo South Teaching Hospital. The tool was compared with Fried's frailty phenotype taken as the gold standard. RESULTS Data were analysed for the agreement with the reference standard, the Fried Phenotype. The mean (SD) age of subjects was 73.9 (7.8) years. The overall time taken to fill out the questionnaire was 2 min. The agreement (Kappa) between the S-FiND questionnaire and the Fried phenotype was 0.7 (P < 001). The sensitivity and specificity of FiND in detecting frailty were 92% and 74%, respectively. The agreements (Kappa) between the individual items of S-Find: involuntary loss of weight/ more than 4.5 kg over one year, the feeling of effort/ not getting going and level of physical activity, with the Fried phenotype, were 0.28 (p = 0.001), 0.06 (p = 0.045) and 0.339 (p < 0.001). respectively. When subjects were categorized frail and robust based on FiND, frail subjects reported a higher incidence of falls (50%) during the previous 12 months, compared to those robust (13%) (p < 0.001 for Chi stat). CONCLUSION The S-FiND is a reliable, valid and well-received tool that can be used in detecting the frailty of non-disabled Sinhala-speaking older adults.
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Affiliation(s)
- Shehan Silva
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - Udayangani Ramadasa
- Department of Medicine, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka
| | - Sarath Lekamwasam
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Bunch PM, Rigdon J, Niazi MKK, Barnard RT, Boutin RD, Houston DK, Lenchik L. Association of CT-Derived Skeletal Muscle and Adipose Tissue Metrics with Frailty in Older Adults. Acad Radiol 2024; 31:596-604. [PMID: 37479618 PMCID: PMC10796847 DOI: 10.1016/j.acra.2023.06.003] [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: 03/25/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 07/23/2023]
Abstract
RATIONALE AND OBJECTIVES Tools are needed for frailty screening of older adults. Opportunistic analysis of body composition could play a role. We aim to determine whether computed tomography (CT)-derived measurements of muscle and adipose tissue are associated with frailty. MATERIALS AND METHODS Outpatients aged ≥ 55 years consecutively imaged with contrast-enhanced abdominopelvic CT over a 3-month interval were included. Frailty was determined from the electronic health record using a previously validated electronic frailty index (eFI). CT images at the level of the L3 vertebra were automatically segmented to derive muscle metrics (skeletal muscle area [SMA], skeletal muscle density [SMD], intermuscular adipose tissue [IMAT]) and adipose tissue metrics (visceral adipose tissue [VAT], subcutaneous adipose tissue [SAT]). Distributions of demographic and CT-derived variables were compared between sexes. Sex-specific associations of muscle and adipose tissue metrics with eFI were characterized by linear regressions adjusted for age, race, ethnicity, duration between imaging and eFI measurements, and imaging parameters. RESULTS The cohort comprised 886 patients (449 women, 437 men, mean age 67.9 years), of whom 382 (43%) met the criteria for pre-frailty (ie, 0.10 < eFI ≤ 0.21) and 138 (16%) for frailty (eFI > 0.21). In men, 1 standard deviation changes in SMD (β = -0.01, 95% confidence interval [CI], -0.02 to -0.001, P = .02) and VAT area (β = 0.008, 95% CI, 0.0005-0.02, P = .04), but not SMA, IMAT, or SAT, were associated with higher frailty. In women, none of the CT-derived muscle or adipose tissue metrics were associated with frailty. CONCLUSION We observed a positive association between frailty and CT-derived biomarkers of myosteatosis and visceral adiposity in a sex-dependent manner.
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Affiliation(s)
- Paul M Bunch
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, NC 27157 (P.M.B., L.L.).
| | - Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (J.R., R.T.B.)
| | - Muhammad Khalid Khan Niazi
- Center for Biomedical Informatics, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (M.K.K.N.)
| | - Ryan T Barnard
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (J.R., R.T.B.)
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, California (R.D.B.)
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (D.K.H.)
| | - Leon Lenchik
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, NC 27157 (P.M.B., L.L.)
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Özcan B, Güner M, Ceylan S, Öztürk Y, Girgin S, Okyar Baş A, Koca M, Balcı C, Doğu BB, Cankurtaran M, Yıldırım T, Halil MG. Calf circumference predicts sarcopenia in maintenance hemodialysis. Nutr Clin Pract 2024; 39:193-201. [PMID: 37933421 DOI: 10.1002/ncp.11089] [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: 06/21/2023] [Revised: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Early recognition of sarcopenia in hemodialysis (HD) patients will be of great importance in preventing adverse outcomes and improving the quality of life in these patients. The main goal of this study was to evaluate the diagnostic accuracy of calf circumference (CC) measurement in detecting sarcopenia among CKD patients undergoing maintenance HD. METHODS This cross-sectional study included 52 patients (53 ± 17 years) who were currently in a maintenance HD. Muscle strength was evaluated using handgrip strength, and smooth muscle mass index (SMI) was assessed through bioelectrical impedance analysis, and CC was measured at the widest part of the calf with the foot pressed against a hard surface. RESULTS Out of the total patient population, sarcopenia was identified in 32.7% (n = 17). The two groups were comparable in terms of age, weight, and height, but the median body mass index of sarcopenic group was statistically lower than nonsarcopenic group (21.6 kg/m2 [18.9-24.6] vs 24.7 kg/m2 [21.4-27.3]. The sarcopenic group had a substantially smaller CC than the nonsarcopenic group (30.0 cm [26.5-32.0] vs 31.5 cm [30.3-34.8], P = 0.013; respectively). In the regression analysis, CC was found to be independently associated with post-HD SMI (P < 0.001; odds ratio, 1.938; and 95% CI, 1.020-2.856). CC was positively but weakly correlated with handgrip strength, however strong and significant correlation was found between CC and SMI (r = 0.277, P = 0.047 and r = 0.733, P < 0.001; respectively). A CC of 31 cm or less predicted confirmed sarcopenia in HD patients (area under the curve = 0.709, P = 0.006, specificity = 0.556, sensitivity = 0.765). CONCLUSIONS Low muscle mass and potentially low muscle strength in HD patients can be accurately identified through the use of CC measurements. Specifically, a CC measurement below 31 cm has found to be a useful indicator to identify individuals on maintenance HD.
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Affiliation(s)
- Berşan Özcan
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Merve Güner
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serdar Ceylan
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Öztürk
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sinem Girgin
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Okyar Baş
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Koca
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cafer Balcı
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Doğu
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tolga Yıldırım
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Gülhan Halil
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Elendu C, Amaechi DC, Elendu TC, Fiemotonghan BE, Okoye OK, Agu-Ben CM, Onyekweli SO, Amapu DA, Ikpegbu R, Asekhauno M, Pius E, Bayo-Shodipo AT, Okezie-Okoye CA, Bello N, Oguine C, Edochie P, Dike N, Amos I, Asekhauno J, Wusu-Ejalonibu TM, Ozigi EE, Otobo GO, Olokodana AR, Ayabazu CP, Nwafor RT, Gonji NJ, Akpovona O, Awotoye TI, Ozigis MO, Afolabi O, Alabi OS, Adebayo M. A comprehensive review of heart failure: Unraveling the etiology, decoding pathophysiological mechanisms, navigating diagnostic modalities, exploring pharmacological interventions, advocating lifestyle modifications, and charting the horizon of emerging therapies in the complex landscape of chronic cardiac dysfunction. Medicine (Baltimore) 2024; 103:e36895. [PMID: 38241566 PMCID: PMC10798706 DOI: 10.1097/md.0000000000036895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
Heart failure (HF) poses a significant global health burden, necessitating a profound understanding of its multifaceted dimensions. This comprehensive review aims to unravel the etiology, decode pathophysiological mechanisms, navigate diagnostic modalities, explore pharmacological interventions, advocate lifestyle modifications, and chart the horizon of emerging therapies in the complex landscape of chronic cardiac dysfunction. The exploration of HF begins with an insightful journey into its diverse etiological factors, encompassing genetic predispositions, hypertension, and coronary artery disease. Delving into pathophysiological mechanisms, this review elucidates the intricate processes of cardiac remodeling, neurohormonal activation, and cellular dysfunction that underlie the progression of HF. Diagnostic modalities play a pivotal role in unraveling the mysteries of HF by examining advanced imaging techniques, biomarkers, and comprehensive clinical assessments. The pharmacological interventions section provides an in-depth analysis of traditional medications, such as diuretics and angiotensin-converting enzyme inhibitors, while highlighting the emergence of novel drug classes transforming HF management. Advocating lifestyle modifications emphasizes the crucial role of diet, exercise, smoking cessation, and alcohol moderation in enhancing patient outcomes. Lastly, the review delves into the promising horizon of emerging therapies, offering a glimpse into current research, innovative treatment approaches, and potential breakthroughs. As HF management faces challenges in patient compliance, healthcare access, and education, this comprehensive review aims to equip healthcare professionals and researchers with a holistic understanding of chronic cardiac dysfunction's intricacies. In conclusion, synthesizing key findings emphasizes the need for an integrated and multidimensional approach to effectively address the complex landscape of heart failure.
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Affiliation(s)
| | | | | | | | - Osinachi K. Okoye
- Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | | | | | | | | | | | - Erica Pius
- Babcock University, Ilishan-Remo, Nigeria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Otite Akpovona
- King’s College Hospital NHS Foundation Trust, London, England
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Zhang J, Zhang Y, Wu Z, Fu X. Enhancing understanding of healthy aging based on time-varying dependencies among multidimensional health, life satisfaction, and health behaviors of older adults aged 60 years and over. BMC Public Health 2024; 24:192. [PMID: 38229050 PMCID: PMC10790531 DOI: 10.1186/s12889-024-17752-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Healthy aging is a process of not only achieving good health but also increasing the life satisfaction of older adults aged 60 years and over, in which health behaviors play an important role. There is a lack of research on the time-varying dependencies between health, life satisfaction, and health behaviors, impeding a deeper understanding of healthy aging. PURPOSE To develop an integrated framework for modeling the interrelationships among the components of healthy aging between multiple time slices. METHODS Based on the Chinese Longitudinal Healthy Living Survey (CLHLS) data in the three waves of 2011/2012, 2014, and 2017/2018, Bayesian network and dynamic Bayesian network are jointly employed to study the relationships among the components of healthy aging within one time slice, as well as to explore the time-varying dependencies among the components between time slices. RESULTS The results of structure learning reveal the direction of effects between different dimensions of health, with mental health and social health affecting physical health and self-rated health affecting both physical and mental health. In addition, health behaviors are found to affect mental health and social health, while self-rated health can influence life satisfaction. The parameters learned from the data show the magnitude and direction of concurrent effects, one-period lagged effects and two-period lagged effects between the factors, which find that the time-varying dependencies vary but are generally positive, long-term, and accumulative over time. In addition, the results of autoregressive effects show the positive predictive effects of health and life satisfaction. CONCLUSIONS It confirms the influence pathway from health behaviors to multidimensional health to life satisfaction, and the time-varying dependencies among the components of healthy aging, which facilitates a deeper understanding of healthy aging. Combining the results of autoregressive effects and descriptive statistics, it further indicates that healthy aging is a comprehensive result arising from interactions of multiple factors. Policymakers should guide older adults aged 60 years and over to adopt healthier behaviors and ensure the long-term sustainability and continuity of policies.
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Affiliation(s)
- Jianghua Zhang
- School of Management, Shandong University, Jinan, 250100, China
| | - Yunbao Zhang
- School of Management, Shandong University, Jinan, 250100, China
| | - Zhiyi Wu
- School of Management, Shandong University, Jinan, 250100, China
| | - Xuemei Fu
- School of Management, Shandong University, Jinan, 250100, China.
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Sabatini S, Martyr A, Hunt A, Gamble LD, Matthews FE, Thom JM, Jones RW, Allan L, Knapp M, Victor C, Pentecost C, Rusted JM, Morris RG, Clare L. Comorbid health conditions and their impact on social isolation, loneliness, quality of life, and well-being in people with dementia: longitudinal findings from the IDEAL programme. BMC Geriatr 2024; 24:23. [PMID: 38182985 PMCID: PMC10768096 DOI: 10.1186/s12877-023-04601-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Most people with dementia have multiple health conditions. This study explores (1) number and type of health condition(s) in people with dementia overall and in relation to age, sex, dementia type, and cognition; (2) change in number of health conditions over two years; and (3) whether over time the number of health conditions at baseline is related to social isolation, loneliness, quality of life, and/or well-being. METHODS Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised people with dementia (n = 1490) living in the community (at baseline) in Great Britain. Health conditions using the Charlson Comorbidity Index, cognition, social isolation, loneliness, quality of life, and well-being were assessed over two years. Mixed effects modelling was used. RESULTS On average participants had 1.8 health conditions at baseline, excluding dementia; increasing to 2.5 conditions over two years. Those with vascular dementia or mixed (Alzheimer's and vascular) dementia had more health conditions than those with Alzheimer's disease. People aged ≥ 80 had more health conditions than those aged < 65 years. At baseline having more health conditions was associated with increased loneliness, poorer quality of life, and poorer well-being, but was either minimally or not associated with cognition, sex, and social isolation. Number of health conditions had either minimal or no influence on these variables over time. CONCLUSIONS People with dementia in IDEAL generally had multiple health conditions and those with more health conditions were lonelier, had poorer quality of life, and poorer well-being.
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Affiliation(s)
- Serena Sabatini
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - Anna Hunt
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Jeanette M Thom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Claire Pentecost
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Robin G Morris
- King's College Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Cole E, Crouch R, Baxter M, Wang C, Sivapathasuntharam D, Peck G, Jennings C, Jarman H. Investigating the effects of frailty on six-month outcomes in older trauma patients admitted to UK major trauma centres: a multi-centre follow up study. Scand J Trauma Resusc Emerg Med 2024; 32:1. [PMID: 38178162 PMCID: PMC10768225 DOI: 10.1186/s13049-023-01169-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Pre-injury frailty is associated with adverse in-hospital outcomes in older trauma patients, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older frail patients at six months after Major Trauma Centre (MTC) admission. METHODS This was a multi-centre study of patients aged ≥ 65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5 L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5 L VAS at follow up. RESULTS Fifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p = 0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p = 0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤ 50) for frail patients (Frail: 65% vs. Not-frail: 30% p < 0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p = 0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p = 0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p = 0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p = 0.01). CONCLUSIONS Frailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. Pre-injury frailty is a predictor of poor longer-term HRQoL after trauma and recognition should enable early specialist pathways and discharge planning.
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Affiliation(s)
- Elaine Cole
- Centre for Trauma Sciences, Queen Mary University, London, England.
| | - Robert Crouch
- University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Mark Baxter
- University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Chao Wang
- Kingston University, Kingston, England
| | | | - George Peck
- Imperial College Healthcare NHS Trust, London, England
| | - Cara Jennings
- King's College Hospital NHS Foundation, Kingston, England
| | - Heather Jarman
- St George's University Hospital NHS Foundation Trust, London, England
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Teng L, Wang D, Zhou Z, Sun J, Zhu M, Wang R. Associations among frailty status, hypertension, and fall risk in community-dwelling older adults. Int J Nurs Sci 2024; 11:11-17. [PMID: 38352292 PMCID: PMC10859585 DOI: 10.1016/j.ijnss.2023.12.010] [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: 04/25/2023] [Revised: 12/02/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives Frailty and hypertension often coexist in older adults, which may lead to fall risks. This study aimed to examine the relationship between frailty status, hypertension, and fall risk. Methods In this cross-sectional study, a total of 401 older adults were conveniently recruited from communities in Wuxi, China, between September 2022 and November 2022. The fall risk self-assessment checklist from the Stopping Elderly Accidents, Deaths & Injuries (STEADI) Toolkit was used to evaluate their fall risks. The FRAIL scale questionnaire was used to assess frailty status. Participants' demographic information and comorbidities were collected. Multivariate logistic regression, generalized additive model, and smooth curve fitting were used to analyze the association between frailty, hypertension, and fall risk. Results Frailty had a strong association with increased prevalence of fall risk among the participants (OR 8.52, 95% CI 3.21-22.57; P < 0.001). Hypertension significantly increased the fall risk among older adults (OR 1.87, 95% CI 1.11-3.13; P = 0.019). The group with hypertension and frailty had the highest prevalence of fall risk (OR 12.24, 95% CI 3.51-42.65). Smooth curve fitting showed a nonlinear association between frailty and fall risk in hypertension status. In the progress of pre-frailty to frailty status, a higher tendency to fall was found among older adults with hypertension. Conclusions Frailty status and hypertension independently and jointly influenced the increased prevalence of fall risk. Enhanced frailty and hypertension management may help decrease fall risk among this population.
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Affiliation(s)
- Liping Teng
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Danhui Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
- Traditional Chinese Medicine Hospital of Qinghai Province, Xining, Qinghai, China
| | - Zhou Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Jun Sun
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Min Zhu
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Renrong Wang
- Department of Cardiology, Jiangnan University Medical Center, Wuxi, Jiangsu, China
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Chen X, Chu NM, Thompson V, Quint EE, Alasfar S, Xue QL, Brennan DC, Norman SP, Lonze BE, Walston JD, Segev DL, McAdams-DeMarco MA. Development and Validation of an Abridged Physical Frailty Phenotype for Clinical Use: A Cohort Study Among Kidney Transplant Candidates. J Gerontol A Biol Sci Med Sci 2024; 79:glad173. [PMID: 37466327 PMCID: PMC10733181 DOI: 10.1093/gerona/glad173] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Frailty is associated with poor outcomes in surgical patients including kidney transplant (KT) recipients. Transplant centers that measure frailty have better pre- and postoperative outcomes. However, clinical utility of existing tools is low due to time constraints. To address this major barrier to implementation in the preoperative evaluation of patients, we developed an abridged frailty phenotype. METHODS The abridged frailty phenotype was developed by simplifying the 5 physical frailty phenotype (PFP) components in a two-center prospective cohort of 3 220 KT candidates and tested for efficiency (time to completion) in 20 candidates evaluation (January 2009 to March 2020). We examined area under curve (AUC) and Cohen's kappa agreement to compare the abridged assessment with the PFP. We compared waitlist mortality risk (competing risks models) by frailty using the PFP and abridged assessment, respectively. Model discrimination was assessed using Harrell's C-statistic. RESULTS Of 3 220 candidates, the PFP and abridged assessment identified 23.8% and 27.4% candidates as frail, respectively. The abridged frailty phenotype had substantial agreement (kappa = 0.69, 95% CI: 0.66-0.71) and excellent discrimination (AUC = 0.861). Among 20 patients at evaluation, abridged assessment took 5-7 minutes to complete. The PFP and abridged assessment had similar associations with waitlist mortality (subdistribution hazard ratio [SHR] = 1.62, 95% CI: 1.26-2.08 vs SHR = 1.70, 95% CI: 1.33-2.16) and comparable mortality discrimination (p = .51). CONCLUSIONS The abridged assessment is an efficient and valid way to identify frailty. It predicts waitlist mortality without sacrificing discrimination. Surgical departments should consider utilizing the abridged assessment to evaluate frailty in patients when time is limited.
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Affiliation(s)
- Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Valerie Thompson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evelien E Quint
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Sami Alasfar
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Qian-Li Xue
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Daniel C Brennan
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Silas P Norman
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Bonnie E Lonze
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York, USA
| | - Jeremy D Walston
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York, USA
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Karunananthan S, Rahgozar A, Hakimjavadi R, Yan H, Dalsania KA, Bergman H, Ghose B, LaPlante J, McCutcheon T, McIsaac DI, Abbasgholizadeh Rahimi S, Sourial N, Thandi M, Wong ST, Liddy C. Use of Artificial Intelligence in the Identification and Management of Frailty: A Scoping Review Protocol. BMJ Open 2023; 13:e076918. [PMID: 38154888 PMCID: PMC10759108 DOI: 10.1136/bmjopen-2023-076918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Rapid population ageing and associated health issues such as frailty are a growing public health concern. While early identification and management of frailty may limit adverse health outcomes, the complex presentations of frailty pose challenges for clinicians. Artificial intelligence (AI) has emerged as a potential solution to support the early identification and management of frailty. In order to provide a comprehensive overview of current evidence regarding the development and use of AI technologies including machine learning and deep learning for the identification and management of frailty, this protocol outlines a scoping review aiming to identify and present available information in this area. Specifically, this protocol describes a review that will focus on the clinical tools and frameworks used to assess frailty, the outcomes that have been evaluated and the involvement of knowledge users in the development, implementation and evaluation of AI methods and tools for frailty care in clinical settings. METHODS AND ANALYSIS This scoping review protocol details a systematic search of eight major academic databases, including Medline, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ageline, Web of Science, Scopus and Institute of Electrical and Electronics Engineers (IEEE) Xplore using the framework developed by Arksey and O'Malley and enhanced by Levac et al and the Joanna Briggs Institute. The search strategy has been designed in consultation with a librarian. Two independent reviewers will screen titles and abstracts, followed by full texts, for eligibility and then chart the data using a piloted data charting form. Results will be collated and presented through a narrative summary, tables and figures. ETHICS AND DISSEMINATION Since this study is based on publicly available information, ethics approval is not required. Findings will be communicated with healthcare providers, caregivers, patients and research and health programme funders through peer-reviewed publications, presentations and an infographic. REGISTRATION DETAILS OSF Registries (https://doi.org/10.17605/OSF.IO/T54G8).
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Affiliation(s)
- Sathya Karunananthan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Arya Rahgozar
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramtin Hakimjavadi
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hui Yan
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kunal A Dalsania
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Howard Bergman
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Bishwajit Ghose
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Nadia Sourial
- Department of Health Management, Evaluation & Policy, Université de Montréal, Montreal, Québec, Canada
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Manpreet Thandi
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
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Blázquez-Andión M, Montiel-Dacosta JA, Rizzi-Bordigoni M, Acosta-Mejuto B, Moliné-Pareja A, Ris-Romeu J, Puig-Campmany M. Frailty and mortality: Utility of Frail-VIG index in ED short-stay units for older adults. Arch Gerontol Geriatr 2023; 115:105208. [PMID: 37774490 DOI: 10.1016/j.archger.2023.105208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Frailty assessment allows the identification of patients at risk of death. The aim here was to study the ability of Frail-VIG Index (FI-VIG) in order to discriminate frailty groups of older adults and garner its correlation with mortality in an Emergency-Department Short-Stay Unit (ED-SSU). METHODS Our observational, single-center, prospective study consecutively included patients over 65-years-old admitted between March 1, 2021, and April 30, 2021. RESULTS 302 patients were included (56 % women), mean age 83 ± 8 years, and 39.1 % of them had a functional disability whilst 16.5 % of them had dementia. A total of 174 patients (58 %) met the frailty criteria (FI-VIG ≥ 0.2): 111 (63.8 %) had mild frailty (FI-VIG 0.2-0.36), 52 (29.9 %) had moderate frailty (FI-VIG 0.36-0.55), and 11 (6.3 %) had advanced frailty (FI-VIG > 0.55). Mortality at 30 days, 6 months, and 1 year was analyzed: no frailty was 6.3 %, 10.8 %, and 12.5 %, respectively; mild frailty was 10.8 %, 22.5 %, and 22.5 %, respectively; moderate frailty was 25 %, 34.6 %, and 42.3 %, respectively; advanced frailty was 36.4 %, 54.5 %, and 3.6 %, respectively. This shows the significant differences between the groups (1-year mortality p < 0.001). Mild frailty vs. non-frail HR was 2.47 (95 %CI 1.12-5.46), moderate frailty vs. non-frail HR was 6.93 (95 %CI 3.16-15.23), and advanced frailty vs. non-frail HR was 11.29 (95 %CI 3.54-36.03). The mean test time was 7 min. CONCLUSIONS There was a strong correlation between frailty degree and mortality at 1, 6, and 12 months. FI-VIG is fast and easy-to-use in this setting. It is routine implementation in ED-SSUs could enable early risk stratification.
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Affiliation(s)
- Marta Blázquez-Andión
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain
| | - Josep Anton Montiel-Dacosta
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain
| | - Miguel Rizzi-Bordigoni
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain
| | - Belen Acosta-Mejuto
- Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain
| | - Antoni Moliné-Pareja
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain
| | - Josep Ris-Romeu
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain; Urgent Care Process Hospital de la Santa Creu i Sant Pau. Sant Quintí 87, Barcelona 08025, Spain
| | - Mireia Puig-Campmany
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain.
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DuMontier C, Hennis R, Yildirim C, Seligman BJ, Fonseca-Valencia C, Lubinski BL, Sison SM, Dharne M, Kim DH, Schwartz AW, Driver JA, Fillmore NR, Orkaby AR. Construct validity of the electronic Veterans Affairs Frailty Index against clinician frailty assessment. J Am Geriatr Soc 2023; 71:3857-3864. [PMID: 37624049 PMCID: PMC10841281 DOI: 10.1111/jgs.18540] [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: 04/26/2023] [Revised: 06/23/2023] [Accepted: 07/13/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Electronic frailty indices (eFIs) can expand measurement of frailty in research and practice and have demonstrated predictive validity in associations with clinical outcomes. However, their construct validity is less well studied. We aimed to assess the construct validity of the VA-FI, an eFI developed for use in the U.S. Veterans Affairs Healthcare System. METHODS Veterans who underwent comprehensive geriatric assessments between January 31, 2019 and June 6, 2022 at VA Boston and had sufficient data documented for a comprehensive geriatric assessment-frailty index (CGA-FI) were included. The VA-FI, based on diagnostic and procedural codes, and the CGA-FI, based on geriatrician-measured deficits, were calculated for each patient. Geriatricians also assessed the Clinical Frailty Scale (CFS), functional status (ADLs and IADLs), and 4-meter gait speed (4MGS). RESULTS A total of 132 veterans were included, with median age 81.4 years (IQR 75.8-88.7). Across increasing levels of VA-FI (<0.2; 0.2-0.4; >0.4), mean CGA-FI increased (0.24; 0.30; 0.40). The VA-FI was moderately correlated with the CGA-FI (r 0.45, p < 0.001). Every 0.1-unit increase in the VA-FI was associated with an increase in the CGA-FI (linear regression beta 0.05; 95% confidence interval [CI] 0.03-0.06), higher CFS category (ordinal regression OR 1.69; 95% CI 1.24-2.30), higher odds of ADL dependency (logistic regression OR 1.59; 95% CI 1.20-2.11), IADL dependency (logistic regression OR 1.68; 95% CI 1.23-2.30), and a decrease in 4MGS (linear regression beta -0.07, 95% CI -0.12 to -0.02). All models were adjusted for age and race, and associations held after further adjustment for the Charlson Comorbidity Index. CONCLUSION Our results demonstrate the construct validity of the VA-FI through its associations with clinical measures of frailty, including summary frailty measures, functional status, and objective physical performance. Our findings complement others' in showing that eFIs can capture functional and mobility domains of frailty beyond just comorbidity and may be useful to measure frailty among populations and individuals.
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Affiliation(s)
- Clark DuMontier
- Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute
| | - Robert Hennis
- Texas Tech University Health Sciences Center, El Paso, TX
| | - Cenk Yildirim
- VA Providence Healthcare, Providence, Rhode Island, USA
| | - Benjamin J. Seligman
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles, Los Angeles, CA, USA
| | | | - Brooke L. Lubinski
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Mayuri Dharne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA
- VA Boston CSP Center, Boston, MA, USA
| | - Dae Hyun Kim
- Harvard Medical School, Boston, MA, USA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jane A. Driver
- Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
| | - Nathanael R. Fillmore
- Harvard Medical School, Boston, MA, USA
- Dana-Farber Cancer Institute
- UMass Memorial Med Center, Worcester, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA
| | - Ariela R. Orkaby
- Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
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Chew J, Chia JQ, Kyaw KK, Fu KJ, Lim C, Chua S, Tan HN. Frailty Screening and Detection of Geriatric Syndromes in Acute Inpatient Care: Impact on Hospital Length of Stay and 30-Day Readmissions. Ann Geriatr Med Res 2023; 27:315-323. [PMID: 37743682 PMCID: PMC10772326 DOI: 10.4235/agmr.23.0124] [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: 08/08/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Frailty is prevalent in acute care and is associated with negative outcomes. While a comprehensive geriatric assessment to identify geriatric syndromes is recommended after identifying frailty, more evidence is needed to support this approach in the inpatient setting. This study examined the association between frailty and geriatric syndromes and their impact on outcomes in acutely admitted older adults. METHODS A total of 733 individuals aged ≥65 years admitted to the General Surgery Service of a tertiary hospital were assessed for frailty using the Clinical Frailty Scale (CFS) and for geriatric syndromes using routine nursing admission assessments, including cognitive impairment, falls, incontinence, malnutrition, and poor oral health. Multinomial logistic regression and Cox regression were used to evaluate the associations between frailty and geriatric syndromes and their concomitant impact on hospital length of stay (LOS) and 30-day readmissions. RESULTS Greater frailty severity was associated with an increased likelihood of geriatric syndromes. Individuals categorized as CFS 4-6 and CFS 7-8 with concomitant geriatric syndromes had 29% and 35% increased risks of a longer LOS, respectively. CFS 4-6 was significantly associated with functional decline (relative risk ratio =1.46; 95% confidence interval [CI], 1.03-2.07) and 30-day readmission (hazare ratio=1.78; 95% CI, 1.04-3.04), whereas these associations were not significant for CFS 7-8. CONCLUSION Geriatric syndromes in frail individuals can be identified from routine nursing assessments and represent a potential approach for targeted interventions following frailty identification. Tailored interventions may be necessary to achieve optimal outcomes at different stages of frailty. Further research is required to evaluate interventions for older adults with frailty in a wider hospital context.
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Affiliation(s)
- Justin Chew
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
| | - Jia Qian Chia
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
| | - Kay Khine Kyaw
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Katrielle Joy Fu
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Celestine Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Shiyun Chua
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Huei Nuo Tan
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
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Liau SJ, Hamada S, Jadczak AD, Sakata N, Lalic S, Tsuchiya-Ito R, Taguchi R, Visvanathan R, Bell JS. Symptomatic and preventive medication use according to age and frailty in Australian and Japanese nursing homes. Aging Clin Exp Res 2023; 35:3047-3057. [PMID: 37934399 PMCID: PMC10721681 DOI: 10.1007/s40520-023-02600-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To investigate symptomatic and preventive medication use according to age and frailty in Australian and Japanese nursing homes (NHs). METHODS Secondary cross-sectional analyses of two prospective cohort studies involving 12 Australian NHs and four Japanese NHs. Frailty was measured using the FRAIL-NH scale (non-frail 0-2; frail 3-6; most-frail 7-14). Regular medications were classified as symptomatic or preventive based on published lists and expert consensus. Descriptive statistics were used to compare the prevalence and ratio of symptomatic to preventive medications. RESULTS Overall, 550 Australian residents (87.7 ± 7.3 years; 73.3% females) and 333 Japanese residents (86.5 ± 7.0 years; 73.3% females) were included. Australian residents used a higher mean number of medications than Japanese residents (9.8 ± 4.0 vs 7.7 ± 3.7, p < 0.0001). Australian residents used more preventive than symptomatic medications (5.5 ± 2.5 vs 4.3 ± 2.6, p < 0.0001), while Japanese residents used more symptomatic than preventive medications (4.7 ± 2.6 vs 3.0 ± 2.2, p < 0.0001). In Australia, symptomatic medications were more prevalent with increasing frailty (non-frail 3.4 ± 2.6; frail 4.0 ± 2.6; most-frail 4.8 ± 2.6, p < 0.0001) but less prevalent with age (< 80 years 5.0 ± 2.9; 80-89 years 4.4 ± 2.6; ≥ 90 years 3.9 ± 2.5, p = 0.0042); while preventive medications remained similar across age and frailty groups. In Japan, there was no significant difference in the mean number of symptomatic and preventive medications irrespective of age and frailty. CONCLUSIONS The ratio of symptomatic to preventive medications was higher with increasing frailty but lower with age in Australia; whereas in Japan, the ratio remained consistent across age and frailty groups. Preventive medications remained prevalent in most-frail residents in both cohorts, albeit at lower levels in Japan.
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Affiliation(s)
- Shin J Liau
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Agathe D Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Nobuo Sakata
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Heisei Medical Welfare Group Research Institute, Tokyo, Japan
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Pharmacy Department, Monash Health, Melbourne, Australia
| | - Rumiko Tsuchiya-Ito
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Reina Taguchi
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
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Sun PC, Kao CY, Kao CL, Wei SH. Interactive Game-Based Platform System for Assessing and Improving Posture Control in the Elderly. Bioengineering (Basel) 2023; 10:1291. [PMID: 38002415 PMCID: PMC10669706 DOI: 10.3390/bioengineering10111291] [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: 06/30/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/26/2023] Open
Abstract
Inadequate response to balance perturbations lead to posture instability in the elderly. The fall risks are increased by a reduced capacity to control the center of pressure (COP) displacement within the safety limit of the supporting base. This study developed an interactive evaluation and training platform. The system incorporated a computerized program with instantaneous force plate evaluation. Ten young subjects underwent a baseline evaluation and twenty-nine community-dwelling elderly received pre- and post-intervention testing. The ability to reach the stability limit was assessed by measuring the maximum voluntary excursion of the COP in anterior-posterior and medial-lateral directions. Functional mobility tests including Berg Balance Scale, Timed-Up-and-Go and functional reach were used as functional outcomes. The experimental group (n = 15) received a 40 min intervention three times a week for six weeks. The interactive game-based training focused on multi-directional weight shifting by tracing a COPcontrolled target to challenge an individual's stability limit. The control group (n = 14) maintained daily activities as usual. The young group revealed a superior COP displacement through active ankle control than the elderly, especially in the anterior-posterior direction. The experimental group improved their COP displacement control more in the medial-lateral direction due to the predominant side-to-side gameplay movement. The functional outcome measures were also significantly improved after training. Using the COPcontrolled game-based program, the stability limit was challenged to facilitate dynamic posture control by an incremental increase in self-initiated perturbations. The platform system could assist in transferring the immediate training effects into daily functional mobility in the elderly.
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Affiliation(s)
- Pi-Chang Sun
- Department of Rehabilitation Medicine, Taipei City Hospital, Taipei City 11556, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City 11221, Taiwan
| | - Chen-Yang Kao
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei City 11221, Taiwan
| | - Chung-Lan Kao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City 11221, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei City 11217, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei City 11221, Taiwan
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Kamwa V, Jackson T, Hassan-Smith Z, Sapey E. Exploring fraity and sarcopenia in older adults admitted to acute medical unit, looking at prevalence, trajectory, and outcomes: A protocol testing the feasibility and acceptability of the TYSON study. PLoS One 2023; 18:e0293650. [PMID: 37922241 PMCID: PMC10624263 DOI: 10.1371/journal.pone.0293650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Frailty and sarcopenia are common in older people and are associated with adverse outcomes including increased mortality and morbidity. It is unclear whether screening for frailty and sarcopenia would identify specific populations most at risk of poor outcomes during unplanned hospital admissions, which screening tools should be used and what the trajectory of both conditions are over the course of an admission. The TYSON study is an observational cohort study aiming to determine the prevalence, trajectory and outcomes associated with frailty and sarcopenia in different patient cohorts. This protocol tests the feasibility and acceptability of TYSON processes. OBJECTIVES To determine in acutely admitted medical patients who are older adults: Primary: The feasibility and acceptability of frailty and sarcopenia assessments; Secondary: (1) Differences in community and hospital frailty assessments, as assessed by the medical team, the patient and elderly care physicians, (2) The dynamic changes in frailty and sarcopenia during a hospital admission, and patient outcomes; Exploratory: Inflammatory and metabolic mediators associated with frailty and sarcopenia. METHODS A single centre, prospective observational study including patients aged ≥ 65 years admitted to an acute medical unit. Frailty assessments include the Rockwood clinical frailty and e-frailty index. Sarcopenia assessments include the Bilateral Anterior Thigh Thickness (BATT) measurement. Each participant will be asked to complete 5 visits, at day 0, day 3, day 7, month 3 and month 6. Blood samples will be collected to explore inflammatory and metabolic markers associated with frailty and sarcopenia. The study and protocol have been ethically approved by the Health Research Authority (REC 20/WA/0263). DISCUSSION The study will determine the feasibility and acceptability of frailty and sarcopenia assessments in an acute hospital setting, and inform on the prevalence, trajectory and associated outcomes of frailty and sarcopenia in this group of patients. An inflammatory and metabolic profile will be explored in frailty and sarcopenia.
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Affiliation(s)
- Vicky Kamwa
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, The University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Thomas Jackson
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Department of Geriatrics, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
| | - Zaki Hassan-Smith
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Institute of Metabolism and Systems Research, The University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Elizabeth Sapey
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, The University of Birmingham, Birmingham, West Midlands, United Kingdom
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Nyende A, Ellis-Hill C, Mantzoukas S. A Sense of Control and Wellbeing in Older People Living with Frailty: A Scoping Review. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:1043-1072. [PMID: 37139581 DOI: 10.1080/01634372.2023.2206438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
A sense of control is important for supporting older people living with frailty to develop adaptive functioning to optimize wellbeing. This scoping review examined the literature on the sense of control and wellbeing in older people living with frailty within their everyday life and care service use. Nine databases were searched using the timeframe 2000 to 2021 to identify key ideas regarding control and wellbeing in older people with frailty. The review highlighted three major themes: a) Control as conveyed in bodily expressions and daily activities, b) Sense of control and influence of place of residence, and c) Control within health and social care relationships. Maintaining a sense of control is not only an internal feeling but is impacted by physical and social environments. Greater focus is needed on the nature of relationships between older people living with frailty and those who work alongside them, which support control and wellbeing.
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Affiliation(s)
- Adam Nyende
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Scarlata S, Zotti S, Finamore P, Osadnik CR, Scichilone N, Antonelli Incalzi R, Claudio P, Cesari M. Frailty in the chronic respiratory patient: association with mortality and clinical features in obstructive, restrictive, and mixed spirometric patterns. Aging Clin Exp Res 2023; 35:2573-2581. [PMID: 37644258 DOI: 10.1007/s40520-023-02535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Frailty associates with increased vulnerability to adverse health outcomes and reduced tolerance to medical interventions. Its impact on patients with chronic respiratory diseases, particularly beyond chronic obstructive pulmonary disease (COPD), remains poorly understood. AIMS To evaluate the association between frailty index and 5-year mortality across different "spirometric" patterns and the variation in their occurring frailty determinants. METHODS This study analyzed data from the SARA study, which enrolled 1968 older adults, to evaluate the association between frailty and 5-year mortality across different spirometric patterns. Frailty was assessed using the frailty index (FI), and spirometry was performed to determine lung function patterns. Hazard ratios (HRs) were calculated using Cox regression models, adjusting for age and sex. RESULTS Among the study participants, 16% were classified as frail. Frailty was associated with a significantly increased risk of mortality across all spirometric patterns. The 5-year mortality rates were 34.3% in subjects with normal spirometry, 45.1% in those with obstructive defects, 55% in those with restrictive defects, and 42.6% in those with mixed airflow defects. The unadjusted HRs for mortality were 2.64 (95% CI 2.10-3.32) for the overall cohort, 2.24 (95% CI 1.48-3.40) for obstructive defects, 2.45 (95% CI 1.12-5.36) for restrictive defects, and 2.79 (95% CI 1.41-3.17) for mixed airflow defects. After adjusting for age and sex, the HRs remained statistically significant: 2.25 (95% CI 1.37-2.84) for the overall cohort, 2.08 (95% CI 1.37-3.18) for obstructive defects, 2.27 (95% CI 1.04-1.17) for restrictive defects, and 2.21 (95% CI 1.20-3.08) for mixed airflow defects. CONCLUSION Frailty is a common syndrome and is associated with a significantly increased risk of mortality. The FI provides valuable information for risk profiling and personalized interventions beyond age and lung function parameters. Including frailty assessment in clinical evaluations can aid in resource allocation and improve patient care in respiratory diseases.
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Affiliation(s)
- Simone Scarlata
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Sonia Zotti
- Department of Medicine and Surgery, Internship Program in Geriatrics, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Panaiotis Finamore
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Moorooduc Hwy, Frankston, Melbourne, VIC, 3199, Australia
- Monash Lung and Sleep Department, Monash Health, 246 Clayton Road, CLAYTON, Melbourne, VIC, 3168, Australia
| | - Nicola Scichilone
- PROMISE Department, University of Palermo, Via del Vespro 133, 90127, Palermo, Italy
| | - Raffaele Antonelli Incalzi
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Pedone Claudio
- Operative Research Unit of Geriatrics, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milano, Italy
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Guo R, Zhang S, Yu S, Li X, Liu X, Shen Y, Wei J, Wu Y. Inclusion of frailty improved performance of delirium prediction for elderly patients in the cardiac intensive care unit (D-FRAIL): A prospective derivation and external validation study. Int J Nurs Stud 2023; 147:104582. [PMID: 37672971 DOI: 10.1016/j.ijnurstu.2023.104582] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The elderly patients admitted to cardiac intensive care unit (CICU) are at relatively high risk for developing delirium. A simple and reliable predictive model can benefit them from early recognition of delirium followed by timely and appropriate preventive strategies. OBJECTIVE To explore the role of frailty in delirium prediction and develop and validate a delirium predictive model including frailty for elderly patients in CICU. DESIGN A prospective, observational cohort study. SETTINGS CICU at China-Japan Friendship Hospital from March 1, 2022 to August 25, 2022 (derivation cohort); CICU at Beijing Anzhen Hospital affiliated to Capital Medical University from March 14, 2023 to May 8, 2023 (external validation cohort). PARTICIPANTS A total of 236 and 90 participants were enrolled in the derivation and external validation cohorts, respectively. Participants in the derivation cohort were assigned into either the delirium (n = 70) or non-delirium group (n = 166) based on the occurrence of delirium. METHODS The simplified Chinese version of the Confusion Assessment Method for the Diagnosis of Delirium in the Intensive Care Unit was used to assess delirium twice a day at 8:00-10:00 and 18:00-20:00 until the onset of delirium or discharge from the CICU. Frailty was assessed using the FRAIL scale during the first 24 h in the CICU. Other possible risk factors were collected prospectively through patient interviews and medical records review. After processing missing data via multiple imputations, univariate analysis and bootstrapped forward stepwise logistic regression were performed to select optimal predictors and develop the models. The models were internally validated using bootstrapping and evaluated comprehensively via discrimination, calibration, and clinical utility in both the derivation and external validation cohorts. RESULTS The study developed D-FRAIL predictive model using FRAIL score, hearing impairment, Acute Physiology and Chronic Health Evaluation-II score, and fibrinogen. The area under the receiver operating characteristic curve (AUC) was 0.937 (95% confidence interval [CI]: 0.907-0.967) and 0.889 (95%CI: 0.840-0.938) even after bootstrapping in the derivation cohort. Inclusion of frailty was demonstrated to improve the model performance greatly with the AUC increased from 0.851 to 0.937 (p < 0.001). In the external validation cohort, the AUC of D-FRAIL model was 0.866 (95%CI: 0.782-0.907). Calibration plots and decision curve analysis suggested good calibration and clinical utility of the D-FRAIL model in both the derivation and external validation cohorts. CONCLUSIONS For elderly patients in the CICU, FRAIL score is an independent delirium predictor and the D-FRAIL model demonstrates superior performance in predicting delirium.
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Affiliation(s)
- Rongrong Guo
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Shan Zhang
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Saiying Yu
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Xiangyu Li
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Xinju Liu
- Cardiac Intensive Care Unit, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yanling Shen
- Surgical Intensive Care Unit, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jinling Wei
- Cardiac Intensive Care Unit, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing 100069, China.
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Knight SP, Ward M, Duggan E, Xue F, Kenny RA, Romero-Ortuno R. Evaluation of a 3-Item Health Index in Predicting Mortality Risk: A 12-Year Follow-Up Study. Diagnostics (Basel) 2023; 13:2801. [PMID: 37685339 PMCID: PMC10487174 DOI: 10.3390/diagnostics13172801] [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: 07/19/2023] [Revised: 08/20/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
This study was carried out using a large cohort (N = 4265; 416 deceased) of older, community-dwelling adults from The Irish Longitudinal Study on Ageing (TILDA). The study compared the performance of a new 3-item health index (HI) with two existing measures, the 32-item frailty index (FI) and the frailty phenotype (FP), in predicting mortality risk. The HI was based on the objective measurement of resting-state systolic blood pressure sample entropy, sustained attention reaction time performance, and usual gait speed. Mortality data from a 12-year follow up period were analyzed using Cox proportional regression. All data processing was performed using MATLAB and statistical analysis using STATA 15.1. The HI showed good discriminatory power (AUC = 0.68) for all-cause mortality, similar to FI (AUC = 0.68) and superior to FP (AUC = 0.60). The HI classified participants into Low-Risk (84%), Medium-Risk (15%), and High-Risk (1%) groups, with the High-Risk group showing a significant hazard ratio (HR) of 5.91 in the unadjusted model and 2.06 in the fully adjusted model. The HI also exhibited superior predictive performance for cardiovascular and respiratory deaths (AUC = 0.74), compared with FI (AUC = 0.70) and FP (AUC = 0.64). The HI High-Risk group had the highest HR (15.10 in the unadjusted and 5.61 in the fully adjusted models) for cardiovascular and respiratory mortality. The HI remained a significant predictor of mortality even after comprehensively adjusting for confounding variables. These findings demonstrate the effectiveness of the 3-item HI in predicting 12-year mortality risk across different causes of death. The HI performed similarly to FI and FP for all-cause mortality but outperformed them in predicting cardiovascular and respiratory deaths. Its ability to classify individuals into risk groups offers a practical approach for clinicians and researchers. Additionally, the development of a user-friendly MATLAB App facilitates its implementation in clinical settings. Subject to external validation in clinical research settings, the HI can be more useful than existing frailty measures in the prediction of cardio-respiratory risk.
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Affiliation(s)
- Silvin P. Knight
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Mark Ward
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Eoin Duggan
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Mercer’s Institute for Successful Ageing (MISA), St. James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Feng Xue
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Mercer’s Institute for Successful Ageing (MISA), St. James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Mercer’s Institute for Successful Ageing (MISA), St. James’s Hospital, D08 NHY1 Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
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Moretti A, Iolascon G. Sclerostin: clinical insights in muscle-bone crosstalk. J Int Med Res 2023; 51:3000605231193293. [PMID: 37632438 PMCID: PMC10467411 DOI: 10.1177/03000605231193293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/21/2023] [Indexed: 08/28/2023] Open
Abstract
Sclerostin, a protein encoded by the sclerostin (SOST) gene, is mostly expressed in osteocytes. First described in the pathogenesis of three disorders, sclerosteosis, van Buchem's disease, and craniodiaphyseal dysplasia, sclerostin has been identified as an important regulator of bone homeostasis, controlling bone formation by osteoblasts through inhibition of the canonical Wnt signaling pathway. Recent studies have highlighted a hypothetical role of sclerostin in myogenesis, thus modulating the interaction between bone and muscle. This narrative review provides an overview of the clinical implications of sclerostin modulation on skeletal muscle mass and function, and bone metabolism. Improving knowledge about muscle-bone crosstalk may represent a turning point in the development of therapeutic strategies for musculoskeletal disorders, particularly osteosarcopenia.
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Affiliation(s)
- Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
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50
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Osadnik CR, Brighton LJ, Burtin C, Cesari M, Lahousse L, Man WDC, Marengoni A, Sajnic A, Singer JP, Ter Beek L, Tsiligianni I, Varga JT, Pavanello S, Maddocks M. European Respiratory Society statement on frailty in adults with chronic lung disease. Eur Respir J 2023; 62:2300442. [PMID: 37414420 DOI: 10.1183/13993003.00442-2023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Abstract
Frailty is a complex, multidimensional syndrome characterised by a loss of physiological reserves that increases a person's susceptibility to adverse health outcomes. Most knowledge regarding frailty originates from geriatric medicine; however, awareness of its importance as a treatable trait for people with chronic respiratory disease (including asthma, COPD and interstitial lung disease) is emerging. A clearer understanding of frailty and its impact in chronic respiratory disease is a prerequisite to optimise clinical management in the future. This unmet need underpins the rationale for undertaking the present work. This European Respiratory Society statement synthesises current evidence and clinical insights from international experts and people affected by chronic respiratory conditions regarding frailty in adults with chronic respiratory disease. The scope includes coverage of frailty within international respiratory guidelines, prevalence and risk factors, review of clinical management options (including comprehensive geriatric care, rehabilitation, nutrition, pharmacological and psychological therapies) and identification of evidence gaps to inform future priority areas of research. Frailty is underrepresented in international respiratory guidelines, despite being common and related to increased hospitalisation and mortality. Validated screening instruments can detect frailty to prompt comprehensive assessment and personalised clinical management. Clinical trials targeting people with chronic respiratory disease and frailty are needed.
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Affiliation(s)
- Christian R Osadnik
- Monash University, Department of Physiotherapy, Frankston, Australia
- Monash Health, Monash Lung, Sleep, Allergy and Immunology, Frankston, Australia
| | - Lisa J Brighton
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Chris Burtin
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Hasselt University, Hasselt, Belgium
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lies Lahousse
- Department of Bioanalysis, Ghent University, Ghent, Belgium
| | - Will D C Man
- Heart Lung and Critical Care Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alessandra Marengoni
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Andreja Sajnic
- Department for Respiratory Diseases Jordanovac, University Hospital Center, Zagreb, Croatia
| | - Jonathan P Singer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lies Ter Beek
- Vrije Universiteit Amsterdam, University Medical Center Groningen, Amsterdam, The Netherlands
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Janos T Varga
- Semmelweis University, Department of Pulmonology, Budapest, Hungary
- National Koranyi Institute of Pulmonology, Department of Pulmonary Rehabilitation, Budapest, Hungary
| | | | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
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