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Liu Q, Huang Y, Wang B, Li Y, Zhou W, Yu J, Chen H, Wang C. Joint trajectories of pain, depression and frailty and associations with adverse outcomes among community-dwelling older adults: A longitudinal study. Geriatr Nurs 2024; 59:26-32. [PMID: 38981205 DOI: 10.1016/j.gerinurse.2024.06.039] [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: 04/06/2024] [Revised: 06/12/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
This study aimed to examine joint trajectories of pain, depression and frailty and their associations with adverse outcomes. Four waves of national data from the China Health and Retirement Longitudinal Study (CHARLS 2011-2018) were used, involving 4217 participants aged ≥60 years. Joint trajectories were fit using parallel-process latent class growth analysis, and their associations with adverse outcomes were evaluated using modified Poisson regression. Four joint trajectories were identified. Compared with most favorable group, other three joint trajectory groups had higher risk of functional disability and hospitalization. Slowly progressive pain, depression and frailty and persistent combination of pain, depression and frailty were also associated with cognitive decline, while slowly reduced pain and depression but persistent frailty was associated with all-cause mortality. The findings highlight unique characteristics and health impacts of concurrent changes in pain, depression and frailty over time, implicating the integrated physical and psychological care for older adults.
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Affiliation(s)
- Qinqin Liu
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yuli Huang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Binlin Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yanyan Li
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Wendie Zhou
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jiaqi Yu
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Hejing Chen
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Cuili Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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Thompson HM, Thanik E, Sabra A, Ko F, Hung WW, Colicino E, Lucchini RG, Bello G, Crane M, Teitelbaum SL, Ornstein KA. A pilot study to identify factors associated with frailty within the World Trade Center general responder cohort. Am J Ind Med 2024; 67:582-591. [PMID: 38735862 DOI: 10.1002/ajim.23590] [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: 08/17/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Given the significant exposures experienced by the World Trade Center (WTC) general responders, there is increasing interest in understanding the effect of these exposures on aging in this population. We aim to identify factors that may be associated with frailty, a clinical syndrome characterized by a decrease in one's reserve that has been linked to poor health outcomes. METHODS WTC general responders enrolled in the WTC Health Program aged 50 and older provided informed consent. Validated frailty assessments, the Frailty Phenotype (with the Johns Hopkins Frailty Assessment Calculator) along with the FRAIL scale, categorized nonfrail from prefrail/frail. Fall risk, functional status, and cognition were also assessed. WTC variables, including an identified WTC-certified condition, were utilized. The risk of frailty was estimated using log binomial regression analysis. A 95% confidence interval (CI) was used to estimate the prevalence ratio (PR). RESULTS One hundred and six participants were included; 38 (35.8%) were classified as pre-frail or frail. More of the pre-frail/frail group were obese (57.9% vs. 25%; p = 0.004) and had a WTC-certified condition (78.9% vs. 58.8%; p = 0.036). Obesity (PR = 2.43, 95% CI = 1.31, 4.53), a WTC-certified condition (PR = 1.77, 95% CI = 1.09, 2.89), and risk of falling (PR = 1.97, 95% CI = 1.01, 3.84) were independently associated with frailty. CONCLUSIONS Obesity and having a WTC-certified condition were found to be risk factors for frailty in our pilot study. Future work may focus on further identifying risk factors for frailty in the larger WTC general responder population.
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Affiliation(s)
- Hannah M Thompson
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Thanik
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmad Sabra
- General Responder Data Center, Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fred Ko
- Brookdale Department of Geriatrics and Palliative Medicine, Geriatric, Research, Education and Clinical Center, Icahn School of Medicine at Mount Sinai, James J Peters VA Medical Center, New York, New York, USA
| | - William W Hung
- Brookdale Department of Geriatrics and Palliative Medicine, Geriatric, Research, Education and Clinical Center, Icahn School of Medicine at Mount Sinai, James J Peters VA Medical Center, New York, New York, USA
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto G Lucchini
- Department of Environmental Health Sciences, School of Public Health, Florida International University, Miami, Florida, USA
| | - Ghalib Bello
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Crane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susan L Teitelbaum
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Yoshiyuki N, Ishihara T, Kono A, Fukushima N, Miura T, Kaneko K. Trajectories of medical care expenditure in the last year of life associated with long-term care utilization in frail older adults: A retrospective cohort study. PLoS One 2024; 19:e0297198. [PMID: 38805415 PMCID: PMC11132452 DOI: 10.1371/journal.pone.0297198] [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: 09/05/2023] [Accepted: 12/31/2023] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Medical care and long-term care utilization in the last year of life of frail older adults could be a key indicator of their quality of life. This study aimed to identify the medical care expenditure (MCE) trajectories in the last year of life of frail older adults by investigating the association between MCE and long-term care utilization in each trajectory. METHODS The retrospective cohort study of three municipalities in Japan included 405 decedents (median age at death, 85 years; 189 women [46.7%]) from a cohort of 1,658 frail older adults aged ≥65 years who were newly certified as support level in the long-term care insurance program from April 2012 to March 2013. This study used long-term care and medical insurance claim data from April 2012 to March 2017. The primary outcome was MCE over the 12 months preceding death. Group-based trajectory modeling was conducted to identify the MCE trajectories. A mixed-effect model was employed to examine the association between long-term care utilization and MCE in each trajectory. RESULTS Participants were stratified into four groups based on MCE trajectories over the 12 months preceding death as follows: rising (n = 159, 39.3%), persistently high (n = 143, 35.3%), minimal (n = 56, 13.8%), and descending (n = 47, 11.6%) groups. Home-based long-term care utilization was associated with increased MCE in the descending trajectory (coefficient, 1.48; 95% confidence interval [CI], 1.35-1.62). Facility-based long-term care utilization was associated with reduced MCE in the rising trajectory (coefficient, 0.59; 95% CI, 0.50-0.69). Both home-based (coefficient, 0.92; 95% CI, 0.85-0.99) and facility-based (coefficient; 0.53; 95% CI, 0.41-0.63) long-term care utilization were associated with reduced MCE in the persistently high trajectory. CONCLUSIONS These findings may facilitate the integration of medical and long-term care models at the end of life in frail older adults.
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Affiliation(s)
- Noriko Yoshiyuki
- Department of Community-based Integrated Care science, School of Nursing, Osaka Metropolitan University, Osaka, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu University, Gifu, Japan
| | - Ayumi Kono
- Long-term Care Insurance Division, Department of Health and Welfare, Izumi City Municipal, Osaka, Japan
| | - Naomi Fukushima
- Department of Community-based Integrated Care science, School of Nursing, Osaka Metropolitan University, Osaka, Japan
- Long-term Care Insurance Division, Department of Health and Welfare, Izumi City Municipal, Osaka, Japan
| | - Takeshi Miura
- Department of Community-based Integrated Care science, School of Nursing, Osaka Metropolitan University, Osaka, Japan
| | - Katsunori Kaneko
- School of Economics, Osaka Metropolitan University, Osaka, Japan
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Hong J, Chu NM, Cockey SG, Long J, Cronin N, Ghildayal N, Hall RK, Huisingh-Scheetz M, Scherer J, Segev DL, McAdams-DeMarco MA. Frailty, but not cognitive impairment, improves mortality risk prediction among those with chronic kidney disease-a nationally representative study. BMC Nephrol 2024; 25:177. [PMID: 38778286 PMCID: PMC11112880 DOI: 10.1186/s12882-024-03613-y] [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: 09/29/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Though older adults with chronic kidney disease (CKD) have a greater mortality risk than those without CKD, traditional risk factors poorly predict mortality in this population. Therefore, we tested our hypothesis that two common geriatric risk factors, frailty and cognitive impairment, and their co-occurrence, might improve mortality risk prediction in CKD. METHODS Among participants aged ≥ 60 years from National Health and Nutrition Examination Survey (2011-2014), we quantified associations between frailty (physical frailty phenotype) and global/domain-specific cognitive function (immediate-recall [CERAD-WL], delayed-recall [CERAD-DL], verbal fluency [AF], executive function/processing speed [DSST], and global [standardized-average of 4 domain-specific tests]) using linear regression, and tested whether associations differed by CKD using a Wald test. We then tested whether frailty, global cognitive impairment (1.5SD below the mean), or their combination improved prediction of mortality (Cox models, c-statistics) compared to base models (likelihood-ratios) among those with and without CKD. RESULTS Among 3,211 participants, 1.4% were cognitively impaired, and 10.0% were frail; frailty and cognitive impairment co-occurrence was greater among those with CKD versus those without (1.2%vs.0.1%). Frailty was associated with worse global cognitive function (Cohen's d = -0.26SD,95%CI -0.36,-0.17), and worse cognitive function across all domains; these associations did not differ by CKD (pinteractions > 0.05). Mortality risk prediction improved only among those with CKD when accounting for frailty (p[likelihood ratio test] < 0.001) but not cognitive impairment. CONCLUSIONS Frailty is associated with worse cognitive function regardless of CKD status. While CKD and frailty improved mortality prediction, cognitive impairment did not. Risk prediction tools should incorporate frailty to improve mortality prediction among those with CKD.
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Affiliation(s)
- Jingyao Hong
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Samuel G Cockey
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Jane Long
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Nicolai Cronin
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Nidhi Ghildayal
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Rasheeda K Hall
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, University of Chicago, Section of Geriatrics and Palliative Medicine, Chicago, IL, USA
| | - Jennifer Scherer
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
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Blumberg MJ, Petersson AM, Jones PW, Jones AA, Panenka WJ, Leonova O, Vila-Rodriguez F, Lang DJ, Barr AM, MacEwan GW, Buchanan T, Honer WG, Gicas KM. Differential sensitivity of intraindividual variability dispersion and global cognition in the prediction of functional outcomes and mortality in precariously housed and homeless adults. Clin Neuropsychol 2024:1-24. [PMID: 38444068 DOI: 10.1080/13854046.2024.2325167] [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: 10/01/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To examine cognitive intraindividual variability (IIV) dispersion as a predictor of everyday functioning and mortality in persons who are homeless or precariously housed. METHOD Participants were 407 community-dwelling adults, followed for up to 13 years. Neurocognition was assessed at baseline and IIV dispersion was derived using a battery of standardized tests. Functional outcomes (social, physical) were obtained at baseline and last follow-up. Mortality was confirmed with Coroner's reports and hospital records (N = 103 deaths). Linear regressions were used to predict current social and physical functioning from IIV dispersion. Repeated measures Analysis of Covariance were used to predict long-term change in functioning. Cox regression models examined the relation between IIV dispersion and mortality. Covariates included global cognition (i.e. mean-level performance), age, education, and physical comorbidities. RESULTS Higher IIV dispersion predicted poorer current physical functioning (B = -0.46 p = .010), while higher global cognition predicted better current (B = 0.21, p = .015) and change in social functioning over a period of up to 13 years (F = 4.23, p = .040). Global cognition, but not IIV dispersion, predicted mortality in individuals under 55 years old (HR = 0.50, p = .013). CONCLUSIONS Our findings suggest that indices of neurocognitive functioning (i.e. IIV dispersion and global cognition) may be differentially related to discrete dimensions of functional outcomes in an at-risk population. IIV dispersion may be a complimentary marker of emergent physical health dysfunction in precariously housed adults and may be best used in conjunction with traditional neuropsychological indices.
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Affiliation(s)
| | - Anna M Petersson
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Paul W Jones
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Canada
- Department of Psychology, University of the Fraser Valley, Abbotsford, Canada
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Yokote T, Yatsugi H, Chu T, Liu X, Wang L, Kishimoto H. Association of the Combination of Moderate-to-Vigorous Physical Activity and Sleep Quality with Physical Frailty. Geriatrics (Basel) 2024; 9:31. [PMID: 38525748 PMCID: PMC10961777 DOI: 10.3390/geriatrics9020031] [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: 02/06/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The association of the individual and combined effects of moderate-to-vigorous physical activity (MVPA) and sleep quality with physical frailty in community-dwelling older adults is still unknown. SUBJECTS AND METHODS A cross-sectional study was conducted with a sample of older adults who had not required nursing care or support services. Physical frailty was assessed using Liu's definition based on Fried's concept. MVPA was measured by a triaxial accelerometer, and individuals who met either moderate physical activity (MPA) for ≥300 min/week, vigorous physical activity (VPA) for ≥150 min/week, or both were defined as "MVA+". "SLP+" was defined as a Pittsburgh Sleep Quality Index score of <5.5 points. RESULTS A total of 811 participants were included in the final analysis. After adjusting for the multivariable confounding factors, the odds ratios (ORs) and 95% confidence intervals (CIs) for physical pre-frailty and frailty in the MVA-SLP+ (OR, 2.56; 95%CI, 1.80-3.62) and the MVA-SLP- group (OR, 3.97; 95%CI, 2.33-6.74) were significantly higher compared with the MVA+SLP+ group. CONCLUSION Community-dwelling older adults who did not meet the MVPA criteria, regardless of sleep quality, had a higher prevalence of physical frailty.
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Affiliation(s)
- Tsubasa Yokote
- Department of Behavior and Health Sciences, Graduate School of Human-Environment Studies, Kyushu University, Fukuoka 819-0395, Japan; (T.Y.); (T.C.); (L.W.)
| | - Harukaze Yatsugi
- Faculty of Arts and Science, Kyushu University, Fukuoka 819-0395, Japan;
| | - Tianshu Chu
- Department of Behavior and Health Sciences, Graduate School of Human-Environment Studies, Kyushu University, Fukuoka 819-0395, Japan; (T.Y.); (T.C.); (L.W.)
| | - Xin Liu
- Epidemiological Study Group, Medical Evidence Division, Intage Healthcare Inc., Tokyo 101-0062, Japan;
| | - Lefei Wang
- Department of Behavior and Health Sciences, Graduate School of Human-Environment Studies, Kyushu University, Fukuoka 819-0395, Japan; (T.Y.); (T.C.); (L.W.)
| | - Hiro Kishimoto
- Department of Behavior and Health Sciences, Graduate School of Human-Environment Studies, Kyushu University, Fukuoka 819-0395, Japan; (T.Y.); (T.C.); (L.W.)
- Faculty of Arts and Science, Kyushu University, Fukuoka 819-0395, Japan;
- Center for Health Science and Counseling, Kyushu University, Fukuoka 819-0395, Japan
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Iacobescu R, Antoniu SA, Popa AD, Pavel-Tanase M, Stratulat TA. Preoperative frailty screening in elderly patients with non-small cell lung cancer surgery: an essential step for a good surgical outcome. Expert Rev Respir Med 2024; 18:99-110. [PMID: 38690646 DOI: 10.1080/17476348.2024.2349579] [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: 01/03/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Non-small cell lung cancer (NSCLC) is a disease commonly diagnosed in the elderly, often in advanced stages. However, elderly patients with lung cancer can benefit from surgery, provided that postoperative risks are assessed appropriately before surgery. Frailty is a measure of age-related impaired functional status and a predictor of mortality and morbidity. However, its importance as a preoperative marker is not well defined. AREAS COVERED This systematic review discusses the importance of preoperative frailty screening in elderly patients with NSCLC. A literature search was performed on the MEDLINE database in June 2023, and relevant studies on frailty or preoperative assessment of NSCLC which were published between 2000 and 2023 were retained and discussed in this review. EXPERT OPINION Among the types of existing methods used to assess frailty those on the geriatric assessment seem to be the most appropriate; however, they are unable to fully capture the 'surgical' frailty; thus, other instruments should be developed and validated in NSCLC.
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Affiliation(s)
- Radu Iacobescu
- Medicine II, Nursing/Palliative Care, University of Medicine and Pharmacy, Grigore T. Popa, Iasi, Romania
| | - Sabina Antonela Antoniu
- Medicine II, Nursing/Palliative Care, University of Medicine and Pharmacy, Grigore T. Popa, Iasi, Romania
| | - Alina Delia Popa
- Medicine II, Nursing/Palliative Care, University of Medicine and Pharmacy, Grigore T. Popa, Iasi, Romania
| | - Mariana Pavel-Tanase
- Medicine II, Nursing/Palliative Care, University of Medicine and Pharmacy, Grigore T. Popa, Iasi, Romania
| | - Teodora Alexa Stratulat
- Medicine II, Nursing/Palliative Care, University of Medicine and Pharmacy, Grigore T. Popa, Iasi, Romania
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Lenoir KM, Paul R, Wright E, Palakshappa D, Pajewski NM, Hanchate A, Hughes JM, Gabbard J, Wells BJ, Dulin M, Houlihan J, Callahan KE. The Association of Frailty and Neighborhood Disadvantage with Emergency Department Visits and Hospitalizations in Older Adults. J Gen Intern Med 2024; 39:643-651. [PMID: 37932543 PMCID: PMC10973290 DOI: 10.1007/s11606-023-08503-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Risk stratification and population management strategies are critical for providing effective and equitable care for the growing population of older adults in the USA. Both frailty and neighborhood disadvantage are constructs that independently identify populations with higher healthcare utilization and risk of adverse outcomes. OBJECTIVE To examine the joint association of these factors on acute healthcare utilization using two pragmatic measures based on structured data available in the electronic health record (EHR). DESIGN In this retrospective observational study, we used EHR data to identify patients aged ≥ 65 years at Atrium Health Wake Forest Baptist on January 1, 2019, who were attributed to affiliated Accountable Care Organizations. Frailty was categorized through an EHR-derived electronic Frailty Index (eFI), while neighborhood disadvantage was quantified through linkage to the area deprivation index (ADI). We used a recurrent time-to-event model within a Cox proportional hazards framework to examine the joint association of eFI and ADI categories with healthcare utilization comprising emergency visits, observation stays, and inpatient hospitalizations over one year of follow-up. KEY RESULTS We identified a cohort of 47,566 older adults (median age = 73, 60% female, 12% Black). There was an interaction between frailty and area disadvantage (P = 0.023). Each factor was associated with utilization across categories of the other. The magnitude of frailty's association was larger than living in a disadvantaged area. The highest-risk group comprised frail adults living in areas of high disadvantage (HR 3.23, 95% CI 2.99-3.49; P < 0.001). We observed additive effects between frailty and living in areas of mid- (RERI 0.29; 95% CI 0.13-0.45; P < 0.001) and high (RERI 0.62, 95% CI 0.41-0.83; P < 0.001) neighborhood disadvantage. CONCLUSIONS Considering both frailty and neighborhood disadvantage may assist healthcare organizations in effectively risk-stratifying vulnerable older adults and informing population management strategies. These constructs can be readily assessed at-scale using routinely collected structured EHR data.
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Affiliation(s)
- Kristin M Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Elena Wright
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Deepak Palakshappa
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of General Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Amresh Hanchate
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jaime M Hughes
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Gabbard
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Brian J Wells
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Michael Dulin
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jennifer Houlihan
- Value Based Care and Population Health, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Kathryn E Callahan
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Nakane C, Yokote T, Nishimura T, Furukawa S, Inoue S. Association between Active Hobby before Hospitalization and Frailty at Discharge in Patients with Acute Cardiovascular Disease. Prog Rehabil Med 2024; 9:20240007. [PMID: 38389791 PMCID: PMC10878813 DOI: 10.2490/prm.20240007] [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: 11/19/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Objectives It is essential to identify the factors that reduce the risk of frailty at discharge in patients with cardiovascular disease. We sought to verify the association between pre-admission hobbies and frailty at discharge in patients hospitalized for acute cardiovascular diseases. Methods We retrospectively analyzed the cases of the 269 patients admitted to our hospital with cardiovascular diseases, excluding those who required assistance with activities of daily living before admission or had missing data on hobbies or frailty. The patients' pre-admission hobbies (if any) were recorded, and the patients were then classified into the no-hobby group, inactive-hobby group, or active-hobby group. Frailty was assessed using the Cardiovascular Health Study criteria (Japanese version) on the day before discharge. We conducted a multinomial logistic regression analysis to investigate the relationship between hobbies and frailty. Results Compared with the no-hobby group, the inactive-hobby group did not show a significantly lower odds ratio (OR) for pre-frailty and frailty. In contrast, the active-hobby group showed a significantly lower OR for pre-frailty and frailty even after adjustment (OR: 0.41, 95% confidence interval: 0.17-0.90). Regarding the components of frailty, the active-hobby group had lower ORs for slow gait speed, exhaustion, and low physical activity relative to the no-hobby group. Conclusions Even if patients had hobbies before admission, if those hobbies were non-active, they did not reduce the risk of frailty, suggesting the need for reconsidering rehabilitation approaches during hospitalization.
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Affiliation(s)
- Chihiro Nakane
- Department of Rehabilitation, Aso Iizuka Hospital, Iizuka, Japan
| | - Tsubasa Yokote
- Department of Rehabilitation, Aso Iizuka Hospital, Iizuka, Japan
| | | | | | - Shujiro Inoue
- Department of Cardiology, Aso Iizuka Hospital, Iizuka, Japan
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Skubiszewska A, Broczek K, Maruniak-Chudek I, Oledzka G, Jonas MI, Puzianowska-Kuznicka M, Mossakowska M. Frailty and Survivability of Polish Caucasian Nonagenarians and Centenarians. Geriatrics (Basel) 2024; 9:14. [PMID: 38247989 PMCID: PMC10801576 DOI: 10.3390/geriatrics9010014] [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: 11/30/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Frailty is a major geriatric problem leading to an increased risk of disability and death. Prevention, identification, and treatment of frailty are important challenges in gerontology and public health. The study aimed to estimate the prevalence of the frailty phenotype (FP) among the oldest-old Polish Caucasians and investigate the relationship between the FP and mortality. Baseline data were collected from 289 long-lived individuals, including 87 centenarians and 202 subjects aged 94-99. Mortality was obtained from population registers over the following 5 years. Sixty percent of subjects were classified as frail, 33% as prefrail, and 7% as robust. Frailty was more common in women than men and among centenarians than nonagenarians. During the 5-year observation period, 92.6% of the frail women and all frail men died, while mortality rates were lower among prefrail, 78.8% and 66.7%, and robust individuals, 60% and 54.5%, respectively. In the survival analysis, frailty was the strongest negative risk factor: HR = 0.328 (95% CI: 0.200-0.539). The inability to perform handgrip strength measurement was an additional predictor of short survival. In conclusion, the FP is prevalent in nonagenarians and centenarians and correlates with lower survivability. Future studies should address differences between unavoidable age-associated frailty and reversible disability in long-lived individuals.
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Affiliation(s)
- Agnieszka Skubiszewska
- Department of Medical Biology, Medical University of Warsaw, 00-575 Warsaw, Poland
- Study on Ageing and Longevity, International Institute of Molecular and Cell Biology, 02-109 Warsaw, Poland
| | - Katarzyna Broczek
- Mazovia Branch, Polish Society of Gerontology, 01-826 Warsaw, Poland
| | | | - Gabriela Oledzka
- Department of Medical Biology, Medical University of Warsaw, 00-575 Warsaw, Poland
| | - Marta Izabela Jonas
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Monika Puzianowska-Kuznicka
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
- Department of Geriatrics and Gerontology, Medical Centre of Postgraduate Education, 01-826 Warsaw, Poland
| | - Malgorzata Mossakowska
- Study on Ageing and Longevity, International Institute of Molecular and Cell Biology, 02-109 Warsaw, Poland
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Goshen A, Goldbourt U, Benyamini Y, Shimony T, Keinan-Boker L, Gerber Y. Diet Quality and Incident Frailty in Adults 65 Years or Older: The Israeli Longitudinal Study on Aging. Mayo Clin Proc 2023; 98:1774-1784. [PMID: 38043995 DOI: 10.1016/j.mayocp.2023.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To prospectively examine the association between diet quality and frailty incidence in the oldest-old age group. METHODS We studied an older adult (65+ years) cohort participating in the Israeli National Health and Nutrition Survey of Older Adults in 2005-2006 (T1 [N=1799]). Survivors of T1 were contacted, and between 2017 and 2019, an extensive interview and a functional assessment were conducted (T2) of 604 past participants. A 24-hour dietary recall, assessed at T1, was used to calculate the Healthy Eating Index (HEI-2015) score. A frailty index based on an accumulation of deficits, including clinical, functional, and cognitive measures, was computed. Frail participants at T1 were excluded from the analysis. Logistic regression models were constructed to assess the association of HEI-2015 score with frailty incidence. Inverse probability weighting was used to minimize selection bias due to attrition. RESULTS Of the 479 T2 participants analyzed (mean [SD] age, 84 [5] years; 50% women), 225 (46%) were classified as frail. Frail participants were older, were less educated, and had a lower household income and a higher comorbidity burden at baseline than non-frail participants. After adjustment for sociodemographic and lifestyle factors, a higher HEI-2015 score was associated with decreased odds of incident frailty (odds ratio, 0.57 [95% CI, 0.35 to 0.91] for the upper tertile and 0.66 [95% CI, 0.42 to 1.06] for the middle tertile compared with the lower tertile; Ptrend=.02). CONCLUSION In this cohort study of oldest-old participants, improved diet quality was inversely associated with frailty incidence in a dose-dependent manner.
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Affiliation(s)
- Abigail Goshen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Longevity Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Uri Goldbourt
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Tal Shimony
- Israel Center for Disease Control, Israel Ministry of Health, Tel Hashomer, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Israel Ministry of Health, Tel Hashomer, Israel; School of Public Health, University of Haifa, Haifa, Israel
| | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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12
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Uemura K, Kamitani T, Yamada M. Frailty and Environmental Attributes in Older Adults: Insight from an Ecological Model. Phys Ther Res 2023; 26:71-77. [PMID: 38125292 PMCID: PMC10730123 DOI: 10.1298/ptr.r0027] [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: 09/26/2023] [Accepted: 10/26/2023] [Indexed: 12/23/2023]
Abstract
Many studies on frailty have primarily focused on individual-level risk factors such as demographics and lifestyle. While guidelines for frailty management recommend modifications to an individual's lifestyle, their lifestyle behaviors are significantly influenced by their surroundings. Recently, the association between frailty and environmental attributes has drawn attention as a result of the increase in evidence that multiple factors affect health conditions and behaviors associated with frailty. These findings can be organized based on an ecological model involving five nested levels that influence an individual's behaviors, namely, an intrapersonal/individual core (age, education, and attitude), an interpersonal level (persons and groups), an organizational/institutional level (organization and workplace), a community level (natural, built, and social environments), and a system/public policy level (public policies from local to national). This study reviewed possible factors associated with frailty from the onset and its progression at each level of the ecological model and their implications regarding frailty prevention. Additionally, we introduce a policy-level approach for frailty prevention in Japan-which encourages residents to engage in the local society by participating in community places or groups that are referred to as "Kayoi-no-ba"-and aggregate its status from a government report. This perspective on community building is consistent with the concept of an ecological model. However, few studies have verified the effects of policy- or system-level approaches on disability and frailty prevention. Further studies from an ecological perspective are needed to fulfill multilevel interventions for frailty prevention.
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Affiliation(s)
- Kazuki Uemura
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Japan
| | - Tsukasa Kamitani
- Section of Education for Clinical Research, Kyoto University Hospital, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, Japan
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13
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Assouan D, Paillaud E, Caillet P, Broussier A, Kempf E, Frelaut M, Brain E, Lorisson E, Chambraud C, Bastuji‐Garin S, Hanon O, Canouï‐Poitrine F, Laurent M, Martinez‐Tapia C. Cancer mortality and competing causes of death in older adults with cancer: A prospective, multicentre cohort study (ELCAPA-19). Cancer Med 2023; 12:20940-20952. [PMID: 37937731 PMCID: PMC10709739 DOI: 10.1002/cam4.6639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/15/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND In older patients with cancer, comorbidities compete with cancer for cause of death. The objectives were to evaluate cancer mortality and factors associated, according to metastatic status. METHODS Between 2007 and 2014, patients with cancer aged ≥70 referred for pre-therapeutic geriatric assessment (GA) were included through the ELCAPA prospective cohort study. The underlying cause of death was defined according to the International Classification of Diseases, 10th Revision. The World Health Organisation definition was used to categorise the cause of death as cancer versus another disease (e.g. cardiovascular disease, infectious disease, etc.) Competing risk models were used. RESULTS Mean (SD) age of the 1445 included patients was 80.2 (5.8) and 48% were women. Most common tumour sites were colorectal (19%), breast (17%) and urinary (15%); 773 patients (49%) had metastases. After a 34-month median follow-up, 706 cancer deaths were observed among 843 deaths. The 6-month and 3-year cancer mortality rates (95% CI) were 12% (9-15) and 34% (29-38) for non-metastatic patients and 43% (39-47) and 79% (75-82) for metastatic patients, respectively. Dependency in activities of daily living and comorbidities were associated with 6-month and 3-year cancer mortality in non-metastatic (adjusted subhazard ratio [aSHR] = 1.68 [0.99-2.85] and 1.69 [1.16-2.45]; and 1.98 [1.08-3.63] and 3.38 [1.47-7.76], respectively) and metastatic patients (aSHR = 2.81 [2.01-3.93] and 2.95 [2.14-4.07]; and 1.63 [1.18-2.25] and 2.06 [1.39-3.05], respectively). Impaired Timed-Get-Up-and-Go test was associated with 6-month and 3-year cancer mortality in metastatic patients (aSHR = 1.5 [1.06-2.12] and 1.38 [1.06-1.81], respectively). Obesity was negatively associated with 3-year cancer death in non-metastatic (aSHR = 0.53 [0.29-0.97]) and metastatic patients (aSHR = 0.71 [0.51-1.00]). CONCLUSIONS The majority of older adults with cancer referred for pre-therapeutic GA die from cancer. Geriatric parameters are independently associated with cancer mortality and should be considered for prognosis assessment, decision-making and care.
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Affiliation(s)
- Déborah Assouan
- Univ Paris Est Creteil, INSERM, IMRBCreteilFrance
- Department of HematologyAmiens University HospitalAmiensFrance
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRBCreteilFrance
- Department of GeriatricsAPHP (Assistance Publique–Hôpitaux de Paris), Georges Pompidou European HospitalParisFrance
| | - Philippe Caillet
- Univ Paris Est Creteil, INSERM, IMRBCreteilFrance
- Department of GeriatricsAPHP (Assistance Publique–Hôpitaux de Paris), Georges Pompidou European HospitalParisFrance
| | - Amaury Broussier
- Univ Paris Est Creteil, INSERM, IMRBCreteilFrance
- Department of GeriatricsAPHP, Henri Mondor/Emile Roux HospitalsLimeil‐BrevannesFrance
| | - Emmanuelle Kempf
- Department of Medical OncologyAPHP, Henri‐Mondor HospitalCreteilFrance
| | - Maxime Frelaut
- Department of Medical OncologyGustave RoussyVillejuifFrance
| | - Etienne Brain
- Department of Medical OncologyInstitut CurieSaint‐CloudFrance
| | | | - Clelia Chambraud
- Univ Paris Est Creteil, INSERM, IMRBCreteilFrance
- Clinical Research UnitAPHP, Henri‐Mondor HospitalCreteilFrance
| | - Sylvie Bastuji‐Garin
- Univ Paris Est Creteil, INSERM, IMRBCreteilFrance
- Public Health DepartmentAPHP, Henri‐Mondor HospitalCreteilFrance
| | | | - Florence Canouï‐Poitrine
- Univ Paris Est Creteil, INSERM, IMRBCreteilFrance
- Public Health DepartmentAPHP, Henri‐Mondor HospitalCreteilFrance
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Chen C, Li X, Wang J, Zhou J, Wei Y, Luo Y, Xu L, Liu Z, Lv Y, Shi X. Longitudinal Changes of Cognition and Frailty With All-Cause and Cause-Specific Mortality in Chinese Older Adults: An 11-Year Cohort Study. Innov Aging 2023; 7:igad114. [PMID: 38024331 PMCID: PMC10681360 DOI: 10.1093/geroni/igad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Objectives Physical function deterioration is always accompanied by a cognitive decline in older adults. However, evidence is lacking for the long-term simultaneous changing patterns of cognition and physical frailty and their associations with mortality among older adults. Research Design and Methods This study included 8,231 adults aged ≥65 with a baseline and at least one follow-up assessment of both cognition and physical frailty from the 2007-2018 Chinese Longitudinal Healthy Longevity Survey. Physical frailty (FRAIL phenotype) and cognition (Mini-Mental State Examination) were applied. Group-based joint trajectory modeling was used to fit the joint trajectories of cognition and physical frailty. Cox proportional hazards model was used to evaluate the trajectory-mortality associations. Results Three distinct joint trajectories were identified: no joint progression (34.4%), moderate joint progression (47.0%), and rapid joint progression (18.6%). During a median follow-up of 8.3 years, the rapid joint progression group, compared to the no joint progression, had the highest risk for all-cause mortality (hazard ratio (HR), 3.37 [95% CI: 2.99-3.81]), cardiovascular (CVD) mortality (3.21 [2.08-4.96]) and non-CVD mortality (2.99 [2.28-3.92]), respectively. Joint trajectory was found to be more predictive of mortality as compared to baseline measures of cognition and/or frailty (C-statistic ranged from 0.774 to 0.798). Higher changing rates of cognition and frailty were observed among all-cause decedents compared to CVD and non-CVD decedents over a 45-year span (aged 65-110) before death. Discussion and Implications Our study suggested that subjects with the worst cognitive decline and severest physical frailty progression were at the highest risk for all-cause and cause-specific mortality. Our findings expand the limited prior knowledge on the dynamic course of cognition and frailty.
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Affiliation(s)
- Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinwei Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Jun Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Wei
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yufei Luo
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Lanjing Xu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zuyun Liu
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
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Santamaría-Ulloa C, Lehning AJ, Cortés-Ortiz MV, Méndez-Chacón E. Frailty as a predictor of mortality: a comparative cohort study of older adults in Costa Rica and the United States. BMC Public Health 2023; 23:1960. [PMID: 37817140 PMCID: PMC10563325 DOI: 10.1186/s12889-023-16900-4] [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: 06/29/2023] [Accepted: 10/04/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Frailty is a common condition among older adults that results from aging-related declines in multiple systems. Frailty increases older adults' vulnerability to negative health outcomes, including loss of mobility, falls, hospitalizations, and mortality. The aim of this study is to examine the association between frailty and mortality in older adults from Costa Rica and the United States. METHODS This prospective cohort study uses secondary nationally-representative data of community-dwelling older adults from the Costa Rican Longevity and Healthy Aging Study (CRELES, n = 1,790) and the National Health & Aging Trends Study (NHATS, n = 6,680). Frailty status was assessed using Physical Frailty Phenotype, which includes the following five criteria: shrinking, exhaustion, low physical activity, muscle weakness, and slow gait. We used Cox proportional hazard models to examine the association between frailty and all-cause mortality, including sociodemographic characteristics and health behaviors as covariates in the models. Mortality follow-up time was right censored at 8 years from the date at baseline interview. RESULTS The death hazard for frail compared to non-frail older adults was three-fold in Costa Rica (HR = 3.14, 95% CI: 2.13-4.62) and four-fold in the White US (HR = 4.02, 95% CI: 3.04-5.32). Older age, being male, and smoking increased mortality risk in both countries. High education was a protective factor in the US, whereas being married/in union was a protective factor in Costa Rica. In the US, White older adults had a lower risk of death compared to all other races and ethnicities. CONCLUSIONS Results indicate that frailty can have a differential impact on mortality depending on the country. Access to universal health care across the life course in Costa Rica and higher levels of stress and social isolation in the US may explain differences observed in end-of-life trajectories among frail older adults.
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Affiliation(s)
| | - Amanda J Lehning
- School of Social Work, University of Maryland Baltimore, Maryland, United States of America
| | - Mónica V Cortés-Ortiz
- Graduate School Student Fellow, University of Maryland Baltimore, Maryland, United States of America
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Langsetmo L, Schousboe JT, Taylor BC, Cauley JA, Fink HA, Cawthon PM, Kado DM, Ensrud KE. Advantages and Disadvantages of Random Forest Models for Prediction of Hip Fracture Risk Versus Mortality Risk in the Oldest Old. JBMR Plus 2023; 7:e10757. [PMID: 37614297 PMCID: PMC10443071 DOI: 10.1002/jbm4.10757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/21/2023] [Indexed: 08/25/2023] Open
Abstract
Targeted fracture prevention strategies among late-life adults should balance fracture risk versus competing mortality risk. Models have previously been constructed using Fine-Gray subdistribution methods. We used a machine learning method adapted for competing risk survival time to evaluate candidate risk factors and create models for hip fractures and competing mortality among men and women aged 80 years and older using data from three prospective cohorts (Study of Osteoporotic Fractures [SOF], Osteoporotic Fracture in Men study [MrOS], Health Aging and Body Composition study [HABC]). Random forest competing risk models were used to estimate absolute 5-year risk of hip fracture and absolute 5-year risk of competing mortality (excluding post-hip fracture deaths). Models were constructed for both outcomes simultaneously; minimal depth was used to rank and select variables for smaller models. Outcome specific models were constructed; variable importance was used to rank and select variables for inclusion in smaller random forest models. Random forest models were compared to simple Fine-Gray models with six variables selected a priori. Top variables for competing risk random forests were frailty and related components in men while top variables were age, bone mineral density (BMD) (total hip, femoral neck), and frailty components in women. In both men and women, outcome specific rankings strongly favored BMD variables for hip fracture prediction while frailty and components were strongly associated with competing mortality. Model discrimination for random forest models varied from 0.65 for mortality in women to 0.81 for hip fracture in men and depended on model choice and variables included. Random models performed slightly better than simple Fine-Gray model for prediction of competing mortality, but similarly for prediction of hip fractures. Random forests can be used to estimate risk of hip fracture and competing mortality among the oldest old. Modest gains in performance for mortality without hip fracture compared to Fine-Gray models must be weighed against increased complexity. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
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Affiliation(s)
- Lisa Langsetmo
- Center for Care Delivery and Outcomes Research, VA Health Care SystemMinneapolisMNUSA
- Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
| | - John T. Schousboe
- Rheumatology ResearchHealthPartners InstituteBloomingtonMNUSA
- Division of Health Policy & Management, School of Public HealthUniversity of MinnesotaMinneapolisMNUSA
| | - Brent C. Taylor
- Center for Care Delivery and Outcomes Research, VA Health Care SystemMinneapolisMNUSA
- Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
- Division of Epidemiology & Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMNUSA
| | - Jane A. Cauley
- Department of Epidemiology, School of Public HealthUniversity of PittsburghPittsburghPAUSA
| | - Howard A. Fink
- Center for Care Delivery and Outcomes Research, VA Health Care SystemMinneapolisMNUSA
- Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
- Geriatric Research Education and Clinical Center, VA Health Care SystemMinneapolisMNUSA
| | - Peggy M. Cawthon
- California Pacific Medical Center Research InstituteSan FranciscoCAUSA
| | - Deborah M. Kado
- Department of MedicineStanford UniversityStanfordCAUSA
- Geriatric Research Education and Clinical Center, VA Health Care SystemPalo AltoCAUSA
| | - Kristine E. Ensrud
- Center for Care Delivery and Outcomes Research, VA Health Care SystemMinneapolisMNUSA
- Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
- Division of Epidemiology & Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMNUSA
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Wu A, Setiawan VW, Stram D, Crimmins E, Tseng CC, Lim U, Park SY, White K, Cheng I, Haiman C, Wilkens L, Le Marchand L. Racial, Ethnic, and Socioeconomic Differences in a Deficit Accumulation Frailty Index in the Multiethnic Cohort Study. J Gerontol A Biol Sci Med Sci 2023; 78:1246-1257. [PMID: 36255109 PMCID: PMC11255091 DOI: 10.1093/gerona/glac216] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Frailty status has been sparsely studied in some groups including Native Hawaiians and Asian Americans. METHODS We developed a questionnaire-based deficit accumulation frailty index (FI) in the Multiethnic Cohort (MEC) and examined frailty status (robust, FI 0 to <0.2, prefrail, FI 0.2 to <0.35, and frail FI ≥ 0.35) among 29 026 men and 40 756 women. RESULTS After adjustment for age, demographic, lifestyle factors, and chronic conditions, relative to White men, odds of being frail was significantly higher (34%-54%) among African American, Native Hawaiian, and other Asian American men, whereas odds was significantly lower (36%) in Japanese American men and did not differ in Latino men. However, among men who had high school or less, none of the groups displayed significantly higher odds of prefrail or frail compared with White men. Relative to White women, odds of being frail were significantly higher (14%-33%) in African American and Latino women, did not differ for other Asian American women and lower (14%-36%) in Native Hawaiian and Japanese American women. These racial and ethnic differences in women were observed irrespective of education. Risk of all-cause mortality was higher in prefrail and frail men than robust men (adjusted hazard ratio [HR] = 1.69, 1.59-1.81; HR = 3.27, 3.03-3.53); results were similar in women. All-cause mortality was significantly positively associated with frailty status and frailty score across all sex, race, and ethnic groups. CONCLUSIONS Frailty status differed significantly by race and ethnicity and was consistently associated with all-cause mortality. The FI may be a useful tool for aging studies in this multiethnic population.
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Affiliation(s)
- Anna H Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - V Wendy Setiawan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel O Stram
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Chiu-Chen Tseng
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Unhee Lim
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Song-Yi Park
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Kami K White
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Christopher A Haiman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lynne R Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
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Trias-Llimós S, Barbieri M, Egidi V, Frova L, Grippo F, Meslé F, Pappagallo M, Désesquelles A. Frailty at death: An examination of multiple causes of death in four low mortality countries in 2017. DEMOGRAPHIC RESEARCH 2023; 49:13-30. [PMID: 38288270 PMCID: PMC10824539 DOI: 10.4054/demres.2023.49.2] [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] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The increasing prevalence of frailty in aging populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process. OBJECTIVE To examine frailty-related mortality as reported on the death certificate in France, Italy, Spain and the United States in 2017. METHODS We identify frailty at death for the population aged 50 years and over in France, Italy, Spain and the United States. We estimate the proportions of deaths by sex, age group and country with specific frailty-related ICD-codes on the death certificate 1) as the underlying cause of death (UC), 2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and 3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death). RESULTS The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0%), then in France (24.1%) and Spain (17.3%), and lowest in the United States (14.0%). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code. CONCLUSIONS Notable cross-country differences were found in the prevalence and the type of frailty-related symptoms at death even after adjusting for differential age distributions.
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Affiliation(s)
| | - Magali Barbieri
- Institut National d’Études Démographiques (France) and University of California, Berkeley (United States)
| | - Viviana Egidi
- Dipartimento di Scienze Statistiche, Sapienza Università di Roma (Italy)
| | - Luisa Frova
- Istituto nazionale di statistica – ISTAT (Italy)
| | | | - France Meslé
- Institut National d’Études Démographiques (France)
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19
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Delgado-Velandia M, Maroto-Rodríguez J, Ortolá R, Rodríguez-Artalejo F, Sotos-Prieto M. The role of lifestyle in the association between frailty and all-cause mortality amongst older adults: a mediation analysis in the UK Biobank. Age Ageing 2023; 52:afad092. [PMID: 37368869 DOI: 10.1093/ageing/afad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE frailty is a syndrome characterised by increased vulnerability to stressors, which manifests as higher death risk. Whilst guidelines for frailty management usually entails lifestyle modifications (e.g. physical exercise, diet), the mediating role of lifestyle on the excess mortality associated with frailty is unclear. This study estimates the death risk due to frailty that could be avoided with a healthy lifestyle in older adults. SUBJECTS AND METHODS we analysed data from 91,906 British individuals aged ≥60 years recruited between 2006 and 2010. At baseline, frailty was identified according to Fried's phenotype, and a four-item Healthy Lifestyle Index (HLS) was calculated based on physical activity, diet, smoking and alcohol consumption. Mortality was ascertained from baseline through 2021. A mediation analysis under the counterfactual framework was performed adjusting for the main confounders. RESULTS during a median follow-up of 12.5 years, 9,383 deaths occurred. Frailty was directly associated with all-cause mortality (hazard ratio: 2.30 [95% confidence interval {CI} 2.07, 2.54]), and inversely associated with the HLS (ß: -0.45 points [-0.49, -0.40]). The hazard ratio [95%CI] for the direct effect of frailty on mortality was 2.12 [1.91, 2.34], whilst for the indirect effect (mediated by HLS) was 1.08 [1.07, 1.10]. The mediated proportion of HLS on mortality was 13.55% [11.26, 16.20], with physical activity having the highest proportion amongst the four HLS items (7.69% [5.00, 10.40]). CONCLUSIONS a healthy lifestyle partly mediates the association between frailty and mortality in British older adults. Since this was an exploratory mediation analysis, these results should be specifically tested in future research.
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Affiliation(s)
- Mario Delgado-Velandia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Javier Maroto-Rodríguez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
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20
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Cano-Escalera G, Graña M, Irazusta J, Labayen I, Gonzalez-Pinto A, Besga A. Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital. J Clin Med 2023; 12:jcm12093103. [PMID: 37176544 PMCID: PMC10179017 DOI: 10.3390/jcm12093103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/11/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Frailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality. MATERIALS Two cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR. METHODS Kaplan-Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0-05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years. RESULTS Frailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29-0.66)), age (1.05 (1.01-1.09)), weight (0.98 (0.96-1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41-0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33-0.74)), SPPB sit and stand (0.62 (0.45-0.85)), heart failure (0.67 (0.46-0.98)), use of antiplatelets (1.80 (1.19-2.71)), and quetiapine (0.31 (0.12-0.81)). Specific high-risk factors in the pre-frail cohort are Barthel's score (120 (7.7-1700)), Pfeiffer test (8.4; (2.3-31)), Mini Nutritional Assessment (MNA) (1200 (18-88,000)), constipation (0.025 (0.0027-0.24)), falls (18,000 (150-2,200,000)), deep venous thrombosis (8400 (19-3,700,000)), cerebrovascular disease (0.01 (0.00064-0.16)), diabetes (360 (3.4-39,000)), thyroid disease (0.00099 (0.000012-0.085)), and the use of PPIs (0.062 (0.0072-0.54)), Zolpidem (0.000014 (0.0000000021-0.092)), antidiabetics (0.00015 (0.00000042-0.051)), diuretics (0.0003 (0.000004-0.022)), and opiates (0.000069 (0.00000035-0.013)). CONCLUSIONS Frailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.
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Affiliation(s)
- Guillermo Cano-Escalera
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Manuel Graña
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain
- BioCruces Health Research Institute, 48903 Barakaldo, Spain
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006 Pamplona, Spain
| | - Ana Gonzalez-Pinto
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
| | - Ariadna Besga
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
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21
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Frailty and all-cause and cause-specific mortality in Japan. Arch Gerontol Geriatr 2023; 107:104906. [PMID: 36563613 DOI: 10.1016/j.archger.2022.104906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In aging societies, there is an increasing focus on the concept of frailty. However, there is no consistent means to assess this concept. We assessed frailty using the Kihon Checklist (KCL), which is widely used in Japan, and examined the association between frailty and all-cause and cause-specific mortality in Japan, the most aged society in the world. METHODS This was a retrospective cohort study, and we analyzed 43,312 participants aged ≥ 65 years who were enrolled in basic health checkups in Okayama City, Japan. We defined the frailty status of the participants using the KCL. To assess the association of frailty status with all-cause and cause-specific mortality, we used cause-specific Cox proportional hazard models to estimate hazard ratios (HRs), adjusting for individual potential confounders. Mean follow-up time was 9.3 years. RESULTS The fully adjusted HR for all-cause mortality was 1.34 (95% confidence interval [CI]: 1.27-1.41) for the prefrail group and 2.22 (95% CI: 2.11-2.33) for the frail group. A similar pattern was observed for cardiovascular disease, respiratory disease, and cancer mortality. Younger people (65-74 years) and women tended to have higher effect estimates than older people (≥ 75 years) and men. CONCLUSION Prefrailty and frailty can increase the risk of both all-cause and cause-specific mortality. Our study suggests that to support frail patients, it could be effective to focus on the prevention and management of cardiovascular and respiratory disease, and that the KCL may be useful as a method of screening for frailty.
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22
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The national burden of frailty and disproportionate distribution of its components-the predominance of slow gait speed: a 2018-19 face-to-face epidemiologic assessment representative of population of older Poles. Aging Clin Exp Res 2023; 35:571-579. [PMID: 36633779 PMCID: PMC9835732 DOI: 10.1007/s40520-022-02331-5] [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: 11/13/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The prevalence of frailty and its components may be affected by age, diseases and geriatric deficits. However, the current operational definition of frailty assigns equal weight to the five components of frailty. AIMS To perform a population-based assessment of physical frailty, its prevalence, and distribution of its components across different age, disease and deficit spectrum. METHODS From 2018 to 2019, we conducted a face-to-face cross-sectional assessment of a representative sample of older Poles. We obtained data on frailty components, chronic disease burden, and prevalence of particular diseases and geriatric deficits. We calculated weighted population estimates, representative of 8.5 million older Poles, of prevalence of frailty and its components across the disease burden, associated with the particular diseases and the geriatric deficits present. RESULTS Of 10,635 screened persons ≥ 60 years, 5987 entered the face-to-face assessment. Data of 5410 have been used for the present analysis. Seventy-two percent of the population are burdened with at least one frailty component. The estimated weighted population prevalence (95% CI) of frailty was 15.9% (14.6-17.1%), and of pre-frailty 55.8% (53.3-58.2%). Slow gait speed predominated across disease burden, specific diseases, geriatric deficits and the age spectrum. Overall, the prevalence of slow gait speed was 56.3% (52.7-60.0%), followed by weakness 26.9% (25.4-28.4%), exhaustion 19.2% (17.6-20.8%), low physical activity 16.5% (14.8-18.3%), and weight loss 9.4% (8.4-10.3%). CONCLUSIONS Slow gait speed predominates among the components of frailty in older Poles. This may affect the component-tailored preventive and therapeutic actions to tackle frailty.
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23
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Hwang AC, Chen LY, Tang TC, Peng LN, Lin MH, Chou YJ, Hsiao FY, Chen LK. Transitions in Frailty and 4-Year Mortality Risk in Taiwan Longitudinal Study on Aging. J Am Med Dir Assoc 2023; 24:48-56.e5. [PMID: 36370752 DOI: 10.1016/j.jamda.2022.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To explore the associations of (1) the frailty phenotype or frailty index transition with cause-specific mortality, and (2) different combinations of transition in frailty phenotype and frailty index with all-cause mortality. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Data from 3529 respondents aged >50 years who completed the 1999 and 2003 surveys of the Taiwan Longitudinal Study on Aging were analyzed. METHODS Cox regression and subdistribution hazard models were constructed to investigate frailty phenotype or frailty index transitions (by categories of frailty phenotype, absolute and percentage changes in frailty index, and combined categories of the 2 measurements) and subsequent 4-year all-cause and cause-specific mortality, respectively. RESULTS Among the frailty phenotype transition groups, the improved frailty group had overall mortality risk comparable to that of the maintained robustness/prefrailty group [hazard ratio (HR): 0.9; 95% CI: 0.7-1.2] and lower risk of mortality due to organ failure (HR: 0.4; 95% CI: 0.2-0.8; P = .015), whereas the worsened frailty group had the highest risk of all-cause mortality and death from infection, malignancy, cardiometabolic/cerebrovascular diseases, and other causes (HR: 1.8-3.7; all P < .03). The rapidly increased frailty index group had significantly higher all-cause and every cause-specific mortality than the decreased frailty index group (HR: 1.8-7.7; all P < .05). When frailty phenotype and frailty index transition groups were combined, participants with worsened frailty/rapidly increased frailty index had increased risk under the same frailty index/frailty phenotype transition condition, particularly for large changes in each factor (HR: 1.5-2.2; P < .01 for worsened frailty; 1.7-4.5, P < .03 for rapidly increased frailty index). CONCLUSIONS AND IMPLICATIONS We found that considering both frailty phenotype and frailty index provided best mortality prediction. These associations were independent of baseline frailty status and comorbidities. Nevertheless, even capturing transitions in frailty phenotype or frailty index only can provide good mortality prediction, which supported adopting these approaches in different clinical settings.
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Affiliation(s)
- An-Chun Hwang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Ching Tang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan.
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan.
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24
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Zhang Q, Wang Z, Song M, Liu T, Ding J, Deng L, Zhang X, Qian L, Ge Y, Xie H, Ruan G, Song C, Yao Q, Xu H, Ju H, Shi H. Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study. Front Immunol 2023; 14:936904. [PMID: 36891320 PMCID: PMC9986529 DOI: 10.3389/fimmu.2023.936904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
Background Frailty and systemic inflammation are parameters, which are easy to evaluate, can be used to predict disease outcomes, and are potentially modifiable. The combination of frailty and inflammation-based data may help identify elderly cancer patients predisposed to adverse clinical outcomes. The aim of this study was to examine the association of systemic inflammation and frailty at admission, and to determine whether these risk factors interact and may predict the survival of elderly cancer patients. Methods A prospective Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) with 5,106 elderly cancer patients admitted from 2013 through 2020 was included in this study. The primary marker of inflammation was the neutrophil-to-lymphocyte ratio (NLR), with the reference group having NLR<3, which indicated no inflammation. Frailty was assessed using the FRAIL scale, and patients with≥3 positives out of a total of five components were assumed to be frail. The primary outcome was all-cause mortality. We classified participants according to the presence (or absence) of frailty and high inflammation and assessed their association with overall survival using the Cox proportional hazards models adjusted for demographic, tumor, and treatment factors. Results Among the 5,106 patients enrolled in the study, 3396 individuals (66.51%) were male and the mean( ± SD) age at diagnosis was 70.92( ± 5.34). Over a median of 33.5 months follow-up, we observed 2,315 deaths. Increasing NLR was associated with frailty (compared with NLR<3, odds ratio=1.23, 95%CI=1.08-1.41 for NLR≥3). An NLR≥3 and frailty independently predicted the overall survival [hazard ratio(HR)=1.35, 95%CI=1.24-1.47 and HR=1.38, 95%CI=1.25-1.52, respectively). Patients with both frailty and NLR≥3 had the lowest overall survival(HR=1.83, 95%CI=1.59-2.04) than patients with no risk factors. The mortality rate increased with the presence of the frailty components. Conclusions Systemic inflammation was positively associated with frailty. Frail elderly cancer patients with elevated systemic inflammation had low survival rate.
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Affiliation(s)
- Qi Zhang
- Department of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Hangzhou, Zhejiang, China.,Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China.,Integrated Traditional Chinese and Western Medicine Oncology Laboratory, Key Laboratory of Traditional Chinese Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Ziwen Wang
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China.,Department of Cardiology, Geriatric Cardiovascular Disease Research and Treatment Center, the 82nd Group Army Hospital of PLA (252 Hospital of PLA), Baoding, Hebei, China.,Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Mengmeng Song
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Tong Liu
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jiashan Ding
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Li Deng
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xi Zhang
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Liang Qian
- Department of Obstetrics and Gynecology, Hangzhou Women's Hospital, Hangzhou Maternal and Child Health Hospital, Hangzhou First People's Hospital Qianjiang, Hangzhou, China
| | - Yizhong Ge
- Department of Oncology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hailun Xie
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Guotian Ruan
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chunhua Song
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Qinghua Yao
- Department of Integrated Chinese and Western Medicine, Cancer Hospital of University of Chinese Academy of Science, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Hongxia Xu
- Department of Clinical Nutrition, Daping Hospital, Army Medical University, Chongqing, China
| | - Haixing Ju
- Department of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Hangzhou, Zhejiang, China
| | - Hanping Shi
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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25
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Passias PG, Kummer N, Williamson TK, Moattari K, Lafage V, Lafage R, Kim HJ, Daniels AH, Gum JL, Diebo BG, Protopsaltis TS, Mundis GM, Eastlack RK, Soroceanu A, Scheer JK, Hamilton DK, Klineberg EO, Line B, Hart RA, Burton DC, Mummaneni P, Chou D, Park P, Schwab FJ, Shaffrey CI, Bess S, Ames CP, Smith JS. Highest Achievable Outcomes for Patients Undergoing Cervical Deformity Corrective Surgery by Frailty. Neurosurgery 2022; 91:693-700. [PMID: 36084195 DOI: 10.1227/neu.0000000000002091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Frailty is influential in determining operative outcomes, including complications, in patients with cervical deformity (CD). OBJECTIVE To assess whether frailty status limits the highest achievable outcomes of patients with CD. METHODS Adult patients with CD with 2-year (2Y) data included. Frailty stratification: not frail (NF) <0.2, frail (F) 0.2 to 0.4, and severely frail (SF) >0.4. Analysis of covariance established estimated marginal means based on age, invasiveness, and baseline deformity, for improvement, deterioration, or maintenance in Neck Disability Index (NDI), Modified Japanese Orthopaedic Association (mJOA), and Numerical Rating Scale Neck Pain. RESULTS One hundred twenty-six patients with CD included 29 NF, 83 F, and 14 SF. The NF group had the highest rates of deterioration and lowest rates of improvement in cervical Sagittal Vertical Axis and horizontal gaze modifiers. Two-year improvements in NDI by frailty: NF: -11.2, F: -16.9, and SF: -14.6 (P = .524). The top quartile of NF patients also had the lowest 1-year (1Y) NDI (7.0) compared with F (11.0) and SF (40.5). Between 1Y and 2Y, 7.9% of patients deteriorated in NDI, 71.1% maintained, and 21.1% improved. Between 1Y and 2Y, SF had the highest rate of improvement (42%), while NF had the highest rate of deterioration (18.5%). CONCLUSION Although frail patients improved more often by 1Y, SF patients achieve most of their clinical improvement between 1 and 2Y. Frailty is associated with factors such as osteoporosis, poor alignment, neurological status, sarcopenia, and other medical comorbidities. Similarly, clinical outcomes can be affected by many factors (fusion status, number of pain generators within treated levels, integrity of soft tissues and bone, and deformity correction). Although accounting for such factors will ultimately determine whether frailty alone is an independent risk factor, these preliminary findings may suggest that frailty status affects the clinical outcomes and improvement after CD surgery.
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Affiliation(s)
- Peter G Passias
- Department of Orthopedic and Neurosurgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Nicholas Kummer
- Department of Orthopedic and Neurosurgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Tyler K Williamson
- Department of Orthopedic and Neurosurgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Kevin Moattari
- Department of Orthopedic and Neurosurgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Virginie Lafage
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Renaud Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Han Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, Louisville, Kentucky, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Themistocles S Protopsaltis
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, New York, USA
| | - Gregory M Mundis
- Division of Orthopaedic Surgery, Scripps Clinic Medical Group, La Jolla, California, USA
| | - Robert K Eastlack
- Department of Orthopaedic Surgery, Scripps Clinic, San Diego, California, USA
| | - Alexandra Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - D Kojo Hamilton
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, UC Davis Health System, Sacramento, California, USA
| | - Breton Line
- Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's Medical Center/Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Praveen Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Frank J Schwab
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Christopher I Shaffrey
- Division of Spine, Departments of Neurosurgery and Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's Medical Center/Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Justin S Smith
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
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Peng Y, Zhong GC, Zhou X, Guan L, Zhou L. Frailty and risks of all-cause and cause-specific death in community-dwelling adults: a systematic review and meta-analysis. BMC Geriatr 2022; 22:725. [PMID: 36056319 PMCID: PMC9437382 DOI: 10.1186/s12877-022-03404-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The associations of frailty with all-cause and cause-specific mortality remain unclear. Therefore, we performed this meta-analysis to fill this gap. METHODS We searched the PubMed and Embase databases through June 2022. Prospective cohort studies or clinical trials examining frailty were evaluated, and the multiple adjusted risk estimates of all-cause and cause-specific mortality, such as death from cardiovascular disease (CVD), cancer, respiratory illness, dementia, infection, and coronavirus disease 2019 (COVID-19), were included. A random effects model was used to calculate the summary hazard ratio (HR). RESULTS Fifty-eight studies were included for the qualitative systematic review, of which fifty-six studies were eligible for the quantitative meta-analysis, and the studies included a total of 1,852,951 individuals and more than 145,276 deaths. Compared with healthy adults, frail adults had a significantly higher risk of mortality from all causes (HR 2.40; 95% CI 2.17-2.65), CVD (HR 2.64; 95% CI 2.20-3.17), respiratory illness (HR 4.91; 95% CI 2.97-8.12), and cancer (HR 1.97; 95% CI 1.50-2.57). Similar results were found for the association between prefrail adults and mortality risk. In addition, based on the studies that have reported the HRs of the mortality risk per 0.1 and per 0.01 increase in the frailty index, we obtained consistent results. CONCLUSIONS The present study demonstrated that frailty was not only significantly related to an increased risk of all-cause mortality but was also a strong predictor of cause-specific mortality from CVD, cancer, and respiratory illness in community-dwelling adults. More studies are warranted to clarify the relationship between frailty and cause-specific mortality from dementia, infection, and COVID-19. TRIAL REGISTRATION PROSPERO (CRD42021276021).
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Affiliation(s)
- Yang Peng
- Geriatric Diseases Institute of Chengdu, Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, 611137, China.
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Guo-Chao Zhong
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoli Zhou
- Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Lijuan Guan
- Geriatric Diseases Institute of Chengdu, Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, 611137, China
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Lihua Zhou
- Geriatric Diseases Institute of Chengdu, Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, 611137, China
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
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Lohman MC, Mezuk B, Fairchild AJ, Resciniti NV, Merchant AT. The role of frailty in the association between depression and fall risk among older adults. Aging Ment Health 2022; 26:1805-1812. [PMID: 35993919 PMCID: PMC9395731 DOI: 10.1080/13607863.2021.1950616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Although there is a recognized association between depression and greater fall risk among older adults, the mechanisms explaining this association are unclear. This study evaluated the role of frailty, a common geriatric syndrome, in determining greater risk of falls among older adults with depression. METHOD We used longitudinal data from three biennial waves of the Health and Retirement Study (HRS; 2010-2014). The sample included community-dwelling survey respondents age ≥ 65 who participated in objective physiological measures. Major Depression (MD) was measured using Composite International Diagnostic Interview for depression short form. Frailty was measured using criteria outlined in the frailty phenotype model. Causal mediation analysis was used to differentiate the direct effect of depression and indirect effect mediated by frailty on falls, fall injuries, and multiple falls. RESULTS Major depression was associated with significantly greater odds of experiencing a fall (OR: 1.91; 95% CI: 1.31, 2.77), fall injury (OR: 1.86; 95% CI: 1.17, 2.95), and multiple falls (OR: 2.26; 95% CI: 1.52, 3.37) over a two-year period. Frailty was a significant mediator of the effects of depression on falls and multiple falls, accounting for approximately 18.9% and 21.3% of the total effects, respectively. We found no evidence of depression-frailty interaction. Sensitivity analyses showed that results were robust to unmeasured confounding and alternative operationalizations of depression. CONCLUSION Frailty explains a significant proportion of increased likelihood of falls among older adults with depression. Treatment and management of frailty symptoms may be an important components of fall prevention among older adults with depression.
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Affiliation(s)
- Matthew C. Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Briana Mezuk
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Nicholas V. Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Anwar T. Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
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Wu SE, Chen WL. Sarc-frailty: towards an integrated view of ageing. Maturitas 2022; 165:85-93. [PMID: 35940026 DOI: 10.1016/j.maturitas.2022.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 06/14/2022] [Accepted: 07/16/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Sarcopenia and frailty have both been related to adverse events in ageing, but have long been studied in parallel. The purpose of this study was to provide a better depiction of ageing by taking the advantages of both entities. STUDY DESIGN 2532 participants were enrolled from the National Health and Nutrition Examination Survey 1999-2002. A new diagnostic entity, sarc-frailty, was established by merging the diagnostic elements of both sarcopenia and frailty. MAIN OUTCOME MEASURES Cox proportional hazard models, Kaplan-Meier curve, and receiver operating characteristic (ROC) curve analysis were utilized to compare the hazard ratios and predictive power in relation to mortality of sarcopenia, frailty, and sarc-frailty. Two different classification strategies, categorical and scoring, were used as alternative assessment methods. RESULTS The median follow-up duration was 67.49 months, and no participants were lost to follow-up. ROC analysis revealed the highest area under curves (AUC) in sarc-frailty by both categorical and scoring classification (AUC = 0.660, p value <0.001 and AUC = 0.697, p value <0.001, respectively), indicating the best predictive ability in relation to mortality. Kaplan-Meier analysis also demonstrated the shortest overall survival for sarc-frailty with both classifications (p value both <0.001). In addition, hazard ratios (HRs) of sarc-frailty with both classifications were higher than their counterparts for sarcopenia and frailty (HR = 12.599, 95 % CI = 7.780 to 20.403, p < 0.001 by categorical method, and HR = 20.121, 95 % CI = 8.101 to 49.973, p < 0.001 by scoring classification). Moreover, the scoring classification revealed a more delicate hierarchical structure of mortality levels than the categorical classification. CONCLUSIONS Sarc-frailty had a better predictive ability in relation to mortality. Considering that ageing well is a holistic health-care issue, our new entity, along with the scoring method, provides clinicians with more effective tools in geriatric assessment.
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Affiliation(s)
- Shou-En Wu
- Department of Dermatology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei City, Taiwan, ROC
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei City, Taiwan, ROC; Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei City, Taiwan, ROC; Department of Biochemistry, National Defense Medical Center, Taipei City, Taiwan, ROC.
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Hax V, Tessari J, Pena E, Santo RCDE, dos Santos LP, Gasparin AA, Bredemeier M, Fighera TM, Spritzer PM, Xavier RM, Chakr RMDS. Physical frailty in patients with systemic sclerosis. Semin Arthritis Rheum 2022; 56:152077. [DOI: 10.1016/j.semarthrit.2022.152077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022]
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Sha S, Pan Y, Xu Y, Chen L. Associations between loneliness and frailty among older adults: Evidence from the China Health and Retirement Longitudinal Study. BMC Geriatr 2022; 22:537. [PMID: 35773656 PMCID: PMC9247968 DOI: 10.1186/s12877-022-03044-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background Previous studies have demonstrated the associations between loneliness and frailty in late life. However, there is a lack of consensus on the direction of the relationship. The present study aimed to examine the interdependencies between loneliness and frailty over time. Methods Data on participants aged 60 years old and above were collected from the 2011, 2013, and 2015 samples of the China Health and Retirement Longitudinal Study (CHARLS). Loneliness was measured by a single question from the Centre for Epidemiological Studies Depression scale, and frailty was assessed by the Physical Frailty Phenotype (PFP) scale. Cross-lagged panel models were utilized to examine the potential bidirectional relationship between loneliness and frailty. Results Reciprocal associations were found between loneliness and frailty. Furthermore, we found that baseline frailty and early change in frailty had a significant predictive effect on late change in loneliness. Higher baseline loneliness in older adults may create a potentially vicious cycle that influenced early change in frailty and continued to cause late change in loneliness. Conclusion A bidirectional relationship may exist between loneliness and frailty among older Chinese adults over 60 years old. Lonely older adults should be alerted to the potential self-reinforcing cycle of loneliness that affects their health. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03044-0.
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Affiliation(s)
- Sha Sha
- School of Sociology and Population Studies, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Yao Pan
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Yuebin Xu
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Lin Chen
- Beijing Normal University at Zhuhai, Zhuhai, China.
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Kim YS, Yao Y, Lee SW, Veronese N, Ma SJ, Park YH, Ju SY. Association of frailty with fall events in older adults: A 12-year longitudinal study in Korea. Arch Gerontol Geriatr 2022; 102:104747. [PMID: 35700558 DOI: 10.1016/j.archger.2022.104747] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/18/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence has shown that frailty is associated with the risk of falls in older people. However, the components of frailty that have the highest association with fall events are largely unknown. METHODS This study analyzed panel data from the Korean Longitudinal Study of Aging. We used the Korean Frailty Instrument, which includes domains for social isolation, exhaustion and weakness estimated by grip strength, to assess frailty. Fall event data were collected during follow-up visits. RESULTS A total of 3122 community-dwelling adults aged 65 years or older were included at baseline in 2006 and were followed up every 2 years until 2018. The participants with frailty had a higher risk of falls than those without frailty (OR=1.31, 95% CI=1.11-1.54, P = 0.001; fully adjusted model). We found that three components of frailty, namely, social isolation, exhaustion, and weakness, were independently and significantly related to fall events in the unadjusted model. In the fully adjusted model, social isolation and exhaustion were significantly associated with fall events (OR=1.38, 95% CI=1.18-1.61, P < 0.001 and OR=1.28, 95% CI=1.10-1.51, P = 0.006, respectively), and there was no significant association between weakness and the risk of falls (OR=1.11, 95% CI=0.91-1.34, P = 0.307). CONCLUSIONS AND IMPLICATIONS Frailty was associated with more fall events in Korean older adults. Social isolation and exhaustion but not weakness were significantly associated with fall events. Our study suggests that interventions should be tailored to older adults with social and psychological frailty.
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Affiliation(s)
- Young-Sang Kim
- Department of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China
| | - So-Won Lee
- Department of Social Welfare, Catholic University of Korea, Bucheon, Republic of Korea
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy; Chair for Biomarkers of Chronic Diseases, King Saud University, Saudi Arabia
| | - Soo-Jin Ma
- Department of Family Medicine, Veterans Health Service Medical Center, Department of Hospital Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon-Hee Park
- Department of Nursing, Daejeon Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sang-Yhun Ju
- Department of Family Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Family Medicine, Seongnam Central Hospital, Seongnam, Republic of Korea.
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Prevalence of Undernutrition, Frailty and Sarcopenia in Community-Dwelling People Aged 50 Years and Above: Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14081537. [PMID: 35458101 PMCID: PMC9032775 DOI: 10.3390/nu14081537] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023] Open
Abstract
The world’s population aged ≥65 is expected to rise from one in eleven in 2019 to one in six by 2050. People aged ≥65 are at a risk of undernutrition, frailty, and sarcopenia. The association between these conditions is investigated in a hospital setting. However, there is little understanding about the overlap and adverse health outcomes of these conditions in community-dwelling people. This systematic review aims to quantify the reported prevalence and incidence of undernutrition, frailty, and sarcopenia among older people aged ≥50 living in community dwellings. Searches were conducted using six databases (AMED, CENTRAL, EMBASE, Web of Science, MEDLINE, and CINAHL), and 37 studies were included. Meta-analyses produced weighted combined estimates of prevalence for each condition (Metaprop, Stata V16/MP). The combined undernutrition prevalence was 17% (95% CI 0.01, 0.46, studies n = 5; participants = 4214), frailty was 13% (95% CI 0.11, 0.17 studies n = 28; participants = 95,036), and sarcopenia was 14% (95% CI 0.09, 0.20, studies n = 9; participants = 7656). Four studies reported incidence rates, of which three included data on frailty. Nearly one in five of those aged ≥50 was considered either undernourished, frail, or sarcopenic, with a higher occurrence in women, which may reflect a longer life expectancy generally observed in females. Few studies measured incidence rates. Further work is required to understand population characteristics with these conditions and the overlap between them. PROSPERO registration No. CRD42019153806.
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Roberts MH, Mapel DW, Ganvir N, Dodd MA. Frailty Among Older Individuals with and without COPD: A Cohort Study of Prevalence and Association with Adverse Outcomes. Int J Chron Obstruct Pulmon Dis 2022; 17:701-717. [PMID: 35411140 PMCID: PMC8994612 DOI: 10.2147/copd.s348714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/12/2022] [Indexed: 12/14/2022] Open
Abstract
Rationale Frailty prevalence estimates among individuals with COPD have varied widely, and few studies have investigated relationships between frailty and adverse outcomes in a COPD population. Objective(s) Describe frailty prevalence among individuals with and without COPD and examine associations between frailty and mortality and other adverse outcomes in the next two years. Methods This was an observational cohort study using Health and Retirement Study data (2006–2018) of community living individuals ages 50–64 and ≥65 with and without COPD (non-COPD). Frailty (Fried phenotype [5 items], and a modified Frailty Index-Comprehensive Geriatric Assessment [Enhanced FI-CGA] [37 items], and debility (modified BODE Index [4 items]) were assessed. Two-year post-assessment outcomes (mortality, ≥1 inpatient stay, home health and skilled nursing facility (SNF) use) were reviewed in a population matched 3:1 (non-COPD: COPD) on age, sex, race, and year using univariate and multivariate logistic regression (adjusted for morbidities). Area-under-the-curve (AUC) was used to evaluate regressions. Results The study included 18,979 survey observations for age 50–64, and 24,162 age ≥65; 7.8% and 12.0% respectively reporting a diagnosis of COPD. Fried phenotype frailty prevalence for age ≥65 was 23.1% (COPD) and 9.4% (non-COPD), and for the Enhanced FI-CGA, 45.9% (COPD) and 22.4% (non-COPD). Two-year mortality for COPD was more than double non-COPD for age 50–64 (95% CI: 3.8–5.9% vs 0.7–1.3%) and age ≥65 (95% CI: 11.9–14.3% vs 5.6–6.6%). Inpatient utilization, home health care use, or at least temporary SNF placement were also more frequent for COPD. Measures were predictive of adverse outcomes. In adjusted models, the Fried phenotype and modified BODE score performed similarly, and both performed better than the Enhanced FI-CGA index. AUC values were higher for morality regressions. Conclusion Frailty prevalence among individuals with COPD in this national survey is substantially greater than without COPD, even at pre-retirement (50–64 years). These measures identify patients with increased risk of poor outcomes.
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Affiliation(s)
- Melissa H Roberts
- College of Pharmacy, The University of New Mexico, Albuquerque, NM, USA
- Correspondence: Melissa H Roberts, College of Pharmacy, The University of New Mexico, 2502 Marble Ave, Albuquerque, NM, 87106, USA, Tel +1 505 925 0953, Fax +1 505 272 6749, Email
| | - Douglas W Mapel
- College of Pharmacy, The University of New Mexico, Albuquerque, NM, USA
- Northern Arizona Pulmonary Associates/Critical Care Consultants of Arizona, Flagstaff, AZ, USA
| | - Nikhil Ganvir
- Department of Economics, The University of New Mexico, Albuquerque, NM, USA
| | - Melanie A Dodd
- College of Pharmacy, The University of New Mexico, Albuquerque, NM, USA
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Chuy V, Gentreau M, Artero S, Berticat C, Rigalleau V, Pérès K, Helmer C, Samieri C, Féart C. Simple carbohydrate intake and higher risk for physical frailty over 15 years in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2021; 77:10-18. [PMID: 34417799 DOI: 10.1093/gerona/glab243] [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: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
Insulin resistance is a major mechanism involved in the onset of physical frailty (PF). Although rich carbohydrate diets may promote insulin resistance, few studies have examined their association with PF risk. This study aimed to investigate the spectrum of carbohydrate exposure, including carbohydrate intake (simple, complex, and total), glycemic load (measure of the diet-related insulin-demand), and adherence to a low-carbohydrate diet with the incident risk of PF in community-dwelling older adults. Baseline carbohydrate exposure was assessed in non-frail participants of the Three-City-Bordeaux cohort using a 24H dietary recall. Over 15 years of follow-up, participants were screened for PF, defined by the FRAIL scale (≥3 criteria out of Fatigue, Resistance, Ambulation, Illnesses, and weight Loss). Associations were estimated using mixed-effects logistic models adjusted for sex, age, education, smoking status, alcohol consumption, depressive symptomatology, global cognitive performances, and protein and energy intakes. The sample included 1,210 participants (62% females, mean age 76 years). Over the follow-up, 295 (24%) incident cases of PF were documented (28% in females, 18% in males). Higher intake of simple carbohydrates was significantly associated with greater odds of incident PF (per 1-SD increased: OR = 1.29; 95% CI = 1.02-1.62), specifically among males (OR = 1.52; 95% CI = 1.04-2.22). No association was observed with complex or total carbohydrate intake, glycemic load, or low-carbohydrate diet. Among the whole carbohydrate exposure, only higher consumption of simple carbohydrates in older age was associated with a higher risk of developing PF. Further studies are required to explore underlying mechanisms.
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Affiliation(s)
- Virginie Chuy
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France.,Univ. Bordeaux, CHU Bordeaux, Department of Dentistry and Oral Health, Bordeaux, France
| | - Mélissa Gentreau
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Sylvaine Artero
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Claire Berticat
- ISEM, University of Montpellier, CNRS, EPHE, IRD, Montpellier, France
| | - Vincent Rigalleau
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France.,Univ. Bordeaux, CHU Bordeaux, Department of Endocrinology, Bordeaux, France
| | - Karine Pérès
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France
| | - Catherine Helmer
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France.,Clinical and Epidemiological Research Unit, INSERM CIC1401, Bordeaux, France
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Nyul-Toth A, DelFavero J, Mukli P, Tarantini A, Ungvari A, Yabluchanskiy A, Csiszar A, Ungvari Z, Tarantini S. Early manifestation of gait alterations in the Tg2576 mouse model of Alzheimer's disease. GeroScience 2021; 43:1947-1957. [PMID: 34160781 PMCID: PMC8492885 DOI: 10.1007/s11357-021-00401-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
There is strong clinical evidence that multifaceted gait abnormalities may be manifested at early stages of Alzheimer's disease (AD), are related to cognitive decline, and can be used as an early biomarker to identify patients at risk of progressing to full-blown dementia. Despite their importance, gait abnormalities have not been investigated in mouse models of AD, which replicate important aspects of the human disease. The Tg2576 is frequently used in AD research to test therapeutic interventions targeting cellular mechanisms contributing to the genesis of AD. This transgenic mouse strain overexpresses a mutant form of the 695 amino acid isoform of human amyloid precursor protein with K670N and M671L mutations (APPK670/671L) linked to early-onset familial AD. Tg2576 mice exhibit impaired cognitive functions and increased cortical and hippocampal soluble β-amyloid levels starting from 5 months of age and increased insoluble β-amyloid levels and amyloid plaques that resemble senile plaques associated with human AD by 13 months of age. To demonstrate early manifestations of gait dysfunction in this relevant preclinical model, we characterized gait and motor performance in 10-month-old Tg2576 mice and age-matched littermate controls using the semi-automated, highly sensitive, Catwalk XT system. We found that Tg2576 mice at the pre-plaque stage exhibited significantly altered duty cycle and step patterns and decreased stride length and stride time. Base-of-support, stride time variability, stride length variability, cadence, phase dispersions and gait symmetry indices were unaltered. The presence of measurable early gait abnormalities during the pre-plaque stages of AD in this relevant preclinical mouse model has direct translational relevance and supports the view that longitudinal monitoring of gait performance could be used in addition to behavioral testing to evaluate progression of the disease and to assess treatment efficacy.
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Affiliation(s)
- Adam Nyul-Toth
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Institute of Biophysics, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
| | - Jordan DelFavero
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Peter Mukli
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Physiology, Semmelweis University, Budapest, Hungary
| | - Amber Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Anna Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
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Complications as a Mediator of the Perioperative Frailty-Mortality Association. Anesthesiology 2021; 134:577-587. [PMID: 33529334 DOI: 10.1097/aln.0000000000003699] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preoperative frailty is strongly associated with postoperative complications and mortality. However, the pathways between frailty, postoperative complications, and mortality are poorly described. The authors hypothesized that the occurrence of postoperative complications would mediate a substantial proportion of the total effect of frailty on mortality after elective noncardiac surgery. METHODS Following protocol registration, the authors conducted a retrospective cohort study of intermediate- to high-risk elective noncardiac surgery patients (2016) using National Surgical Quality Improvement Program data. The authors conducted Bayesian mediation analysis of the relationship between preoperative frailty (exposure, using the Risk Analysis Index), serious complications (mediator), and 30-day mortality (outcome), comprehensively adjusting for confounders. The authors estimated the total effect of frailty on mortality (composed of the indirect effect mediated by complications and the remaining direct effect of frailty) and estimated the proportion of the frailty-mortality association mediated by complications. RESULTS The authors identified 205,051 patients; 1,474 (0.7%) died. Complications occurred in 20,211 (9.9%). A 2 SD increase in frailty score resulted in a total association with mortality equal to an odds ratio of 3.79 (95% credible interval, 2.48 to 5.64), resulting from a direct association (odds ratio, 1.76; 95% credible interval, 1.34 to 2.30) and an indirect association mediated by complications (odds ratio, 2.15; 95% credible interval, 1.58 to 2.96). Complications mediated 57.3% (95% credible interval, 40.8 to 73.8) of the frailty-mortality association. Cardiopulmonary complications were the strongest mediators among complication subtypes. CONCLUSIONS Complications mediate more than half of the association between frailty and postoperative mortality in elective noncardiac surgery. EDITOR’S PERSPECTIVE
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