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Nocera A, Senigagliesi L, Ciattaglia G, Raimondi M, Gambi E. ML-Based Edge Node for Monitoring Peoples' Frailty Status. SENSORS (BASEL, SWITZERLAND) 2024; 24:4386. [PMID: 39001165 PMCID: PMC11244600 DOI: 10.3390/s24134386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/25/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
The development of contactless methods to assess the degree of personal hygiene in elderly people is crucial for detecting frailty and providing early intervention to prevent complete loss of autonomy, cognitive impairment, and hospitalisation. The unobtrusive nature of the technology is essential in the context of maintaining good quality of life. The use of cameras and edge computing with sensors provides a way of monitoring subjects without interrupting their normal routines, and has the advantages of local data processing and improved privacy. This work describes the development an intelligent system that takes the RGB frames of a video as input to classify the occurrence of brushing teeth, washing hands, and fixing hair. No action activity is considered. The RGB frames are first processed by two Mediapipe algorithms to extract body keypoints related to the pose and hands, which represent the features to be classified. The optimal feature extractor results from the most complex Mediapipe pose estimator combined with the most complex hand keypoint regressor, which achieves the best performance even when operating at one frame per second. The final classifier is a Light Gradient Boosting Machine classifier that achieves more than 94% weighted F1-score under conditions of one frame per second and observation times of seven seconds or more. When the observation window is enlarged to ten seconds, the F1-scores for each class oscillate between 94.66% and 96.35%.
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Affiliation(s)
- Antonio Nocera
- Department of Information Engineering, Università Politecnica delle Marche, via Brecce Bianche 12, 60131 Ancona, Italy
| | - Linda Senigagliesi
- Department of Information Engineering, Università Politecnica delle Marche, via Brecce Bianche 12, 60131 Ancona, Italy
| | - Gianluca Ciattaglia
- Department of Information Engineering, Università Politecnica delle Marche, via Brecce Bianche 12, 60131 Ancona, Italy
| | - Michela Raimondi
- Department of Information Engineering, Università Politecnica delle Marche, via Brecce Bianche 12, 60131 Ancona, Italy
| | - Ennio Gambi
- Department of Information Engineering, Università Politecnica delle Marche, via Brecce Bianche 12, 60131 Ancona, Italy
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Richter A, Ulbricht S, Brockhaus S. Categorization of continuous covariates and complex regression models-friends or foes in intersectionality research. J Clin Epidemiol 2024; 171:111368. [PMID: 38657875 DOI: 10.1016/j.jclinepi.2024.111368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To reduce health inequities, it is important to identify intersections in characteristics of individuals subject to privilege or disadvantage. Different proposals for that have recently been published. One approach (1) considers models specified with first- and all second-order effects and another (2) the stratification based on multiple covariates; both categorize continuous covariates. A simulation study was conducted in order to review both methods with regard to identification of intersections showing true differences, rate of false-positive results, and generalizability to independent data compared to an established approach (3) of backward variable elimination according to Bayesian information criterion (BE-BIC) combined with splines. STUDY DESIGN AND SETTING R software has been used to simulate the covariates age, sex, body mass index, education, and diabetes to examine their association with a continuous frailty score for osteoporosis using multiple linear regression. In setting 1, none of the covariates was associated with the frailty score, that is, only noise is present in the data. In setting 2, the covariates age, sex, and their interaction were associated with the frailty score, such that only females above 55 years formed an intersection associated with an increased frailty score. All approaches were compared under varying sample sizes (N = 200-3000) and signal-to-noise ratios (SNRs, 0.5-4) in 1000 replications. For model evaluation, bootstrap resampling was used. The models were fitted in internal learning data and then used to predict outcomes in the internal validation data. The mean squared error (MSE) was used for comparison and the frequency of false-positive findings calculated. RESULTS In setting 1, approaches 1 and 2 generated spurious effects in more than 90% of simulations across all sample sizes. In a smaller sample size, approach 3 (BE-BIC) selected 36.5% of the correct model, in larger sample size in 89.8% and always had a lower number of spurious effects. MSE in independent data was generally higher for approaches 1 and 2 when compared to 3. In setting 2, approach 1 selected most frequently the correct interaction but frequently showed spurious effects (>75%). Across all sample sizes and SNR, approach 3 generated least often spurious results and had lowest MSE in independent data. CONCLUSION Categorization of continuous covariates is detrimental to studies on intersectionality. Due to high and unrestricted model complexity, such approaches are prone to spurious effects and often lack interpretability. Approach 3 (BE-BIC) is considerably more robust against spurious findings, showed better generalizability to independent data, and can be used with most statistical software. For intersectionality research, we consider it most important to describe relevant differences between intersections and to avoid nonreproducible and spurious findings.
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Affiliation(s)
- Adrian Richter
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Sabina Ulbricht
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sarah Brockhaus
- Faculty of Computer Science and Mathematics, University of Applied Sciences Munich, Munich, Germany
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Farah E, Al Abbas A, Abreu AA, Cheng M, Yopp A, Wang S, Mansour J, Porembka M, Zeh HJ, Polanco PM. Minimally invasive pancreaticoduodenectomy: A favorable approach for frail patients with pancreatic cancer. Surgery 2024; 175:1168-1175. [PMID: 38307784 DOI: 10.1016/j.surg.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/17/2023] [Accepted: 12/16/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Within the past decade, minimally invasive pancreaticoduodenectomy has been increasingly adopted in high-volume cancer centers. Amid broader trends of a growing older population, the numbers of frail patients with cancer are expected to increase. In this study, we compared the postoperative outcomes of open pancreaticoduodenectomy and minimally invasive pancreaticoduodenectomy in frail patients with pancreatic ductal adenocarcinoma. METHODS Using the pancreatectomy-targeted American College of Surgeons-National Surgical Quality Improvement Program database (2014-2021), we identified pancreaticoduodenectomy cases for pancreatic ductal adenocarcinoma. Patients with a modified frailty index ≥2 were considered frail. We performed 2:1 (open pancreaticoduodenectomy to minimally invasive pancreaticoduodenectomy) optimal pair propensity score matching for both patient- and disease-specific characteristics. We evaluated baseline covariate balance for homogeneity and assessed 30-day postoperative outcomes: complications, discharge destination, major morbidity, and mortality. RESULTS We identified 3,143 frail patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Of those, 275 (9%) underwent minimally invasive pancreaticoduodenectomy. Minimally invasive pancreaticoduodenectomy was associated with a lower rate of any complications compared with open pancreaticoduodenectomy (43% vs 54%; P < .001), major morbidity (29% vs 35%; P = .042), and nonhome discharge (12% vs 17%; P = .022). When comparing the 2 minimally invasive pancreaticoduodenectomy approaches, robotic surgery was associated with fewer complications compared with laparoscopy (39% vs 51%; P = .040) and a lower mortality rate (1% vs 4%; P = .041) CONCLUSION: In frail patients with pancreatic cancer, minimally invasive pancreaticoduodenectomy was associated with better postoperative outcomes than open pancreaticoduodenectomy. This study builds on growing literature reporting that, when properly implemented, minimally invasive pancreaticoduodenectomy is associated with more favorable postoperative outcomes. Given the particularly high risk of complication in frail patients, implementing a preoperative frailty assessment can provide valuable insights to inform patient counseling.
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Affiliation(s)
- Emile Farah
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX. http://www.twitter.com/EmileFarah5
| | - Amr Al Abbas
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andres A Abreu
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX. http://www.twitter.com/AndresAbreuMd
| | - Mingyuan Cheng
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Adam Yopp
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sam Wang
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - John Mansour
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew Porembka
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Herbert J Zeh
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Patricio M Polanco
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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Alizai Q, Colosimo C, Hosseinpour H, Stewart C, Bhogadi SK, Nelson A, Spencer AL, Ditillo M, Magnotti LJ, Joseph B. It is not all black and white: The effect of increasing severity of frailty on outcomes of geriatric trauma patients. J Trauma Acute Care Surg 2024; 96:434-442. [PMID: 37994092 DOI: 10.1097/ta.0000000000004217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Frailty is associated with poor outcomes in trauma patients. However, the spectrum of physiologic deficits, once a patient is identified as frail, is unknown. The aim of this study was to assess the dynamic association between increasing frailty and outcomes among frail geriatric trauma patients. METHODS This is a secondary analysis of the American Association of Surgery for Trauma Frailty Multi-institutional Trial. Patients 65 years or older presenting to one of the 17 trauma centers over 3 years (2019-2022) were included. Frailty was assessed within 24 hours of presentation using the Trauma-Specific Frailty Index (TSFI) questionnaire. Patients were stratified by TSFI score into six groups: nonfrail (<0.12), Grade I (0.12-0.19), Grade II (0.20-0.29), Grade III (0.30-0.39), Grade IV (0.40-0.49), and Grade V (0.50-1). Our Outcomes included in-hospital and 3-month postdischarge mortality, major complications, readmissions, and fall recurrence. Multivariable regression analyses were performed. RESULTS There were 1,321 patients identified. The mean (SD) age was 77 years (8.6 years) and 49% were males. Median [interquartile range] Injury Severity Score was 9 [5-13] and 69% presented after a low-level fall. Overall, 14% developed major complications and 5% died during the index admission. Among survivors, 1,116 patients had a complete follow-up, 16% were readmitted within 3 months, 6% had a fall recurrence, 7% had a complication, and 2% died within 3 months postdischarge. On multivariable regression, every 0.1 increase in the TSFI score was independently associated with higher odds of index-admission mortality and major complications, and 3 months postdischarge mortality, readmissions, major complications, and fall recurrence. CONCLUSION The frailty syndrome goes beyond a binary stratification of patients into nonfrail and frail and should be considered as a spectrum of increasing vulnerability to poor outcomes. Frailty scoring can be used in developing guidelines, patient management, prognostication, and care discussions with patients and their families. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Qaidar Alizai
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
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Ungvari A, Gulej R, Csik B, Mukli P, Negri S, Tarantini S, Yabluchanskiy A, Benyo Z, Csiszar A, Ungvari Z. The Role of Methionine-Rich Diet in Unhealthy Cerebrovascular and Brain Aging: Mechanisms and Implications for Cognitive Impairment. Nutrients 2023; 15:4662. [PMID: 37960316 PMCID: PMC10650229 DOI: 10.3390/nu15214662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
As aging societies in the western world face a growing prevalence of vascular cognitive impairment and Alzheimer's disease (AD), understanding their underlying causes and associated risk factors becomes increasingly critical. A salient concern in the western dietary context is the high consumption of methionine-rich foods such as red meat. The present review delves into the impact of this methionine-heavy diet and the resultant hyperhomocysteinemia on accelerated cerebrovascular and brain aging, emphasizing their potential roles in cognitive impairment. Through a comprehensive exploration of existing evidence, a link between high methionine intake and hyperhomocysteinemia and oxidative stress, mitochondrial dysfunction, inflammation, and accelerated epigenetic aging is drawn. Moreover, the microvascular determinants of cognitive deterioration, including endothelial dysfunction, reduced cerebral blood flow, microvascular rarefaction, impaired neurovascular coupling, and blood-brain barrier (BBB) disruption, are explored. The mechanisms by which excessive methionine consumption and hyperhomocysteinemia might drive cerebromicrovascular and brain aging processes are elucidated. By presenting an intricate understanding of the relationships among methionine-rich diets, hyperhomocysteinemia, cerebrovascular and brain aging, and cognitive impairment, avenues for future research and potential therapeutic interventions are suggested.
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Affiliation(s)
- Anna Ungvari
- Department of Public Health, Semmelweis University, 1089 Budapest, Hungary
| | - Rafal Gulej
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (R.G.); (B.C.); (P.M.); (S.N.); (S.T.); (A.Y.); (A.C.); (Z.U.)
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Boglarka Csik
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (R.G.); (B.C.); (P.M.); (S.N.); (S.T.); (A.Y.); (A.C.); (Z.U.)
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- International Training Program in Geroscience, Department of Public Health, Doctoral School of Basic and Translational Medicine, Semmelweis University, 1089 Budapest, Hungary
| | - Peter Mukli
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (R.G.); (B.C.); (P.M.); (S.N.); (S.T.); (A.Y.); (A.C.); (Z.U.)
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- International Training Program in Geroscience, Department of Public Health, Doctoral School of Basic and Translational Medicine, Semmelweis University, 1089 Budapest, Hungary
| | - Sharon Negri
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (R.G.); (B.C.); (P.M.); (S.N.); (S.T.); (A.Y.); (A.C.); (Z.U.)
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Stefano Tarantini
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (R.G.); (B.C.); (P.M.); (S.N.); (S.T.); (A.Y.); (A.C.); (Z.U.)
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- International Training Program in Geroscience, Department of Public Health, Doctoral School of Basic and Translational Medicine, Semmelweis University, 1089 Budapest, Hungary
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (R.G.); (B.C.); (P.M.); (S.N.); (S.T.); (A.Y.); (A.C.); (Z.U.)
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- International Training Program in Geroscience, Department of Public Health, Doctoral School of Basic and Translational Medicine, Semmelweis University, 1089 Budapest, Hungary
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Zoltan Benyo
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary;
- Cerebrovascular and Neurocognitive Disorders Research Group, Eötvös Loránd Research Network, Semmelweis University, 1094 Budapest, Hungary
| | - Anna Csiszar
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (R.G.); (B.C.); (P.M.); (S.N.); (S.T.); (A.Y.); (A.C.); (Z.U.)
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- International Training Program in Geroscience, Department of Translational Medicine, Doctoral School of Basic and Translational Medicine, Semmelweis University, 1089 Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (R.G.); (B.C.); (P.M.); (S.N.); (S.T.); (A.Y.); (A.C.); (Z.U.)
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- International Training Program in Geroscience, Department of Public Health, Doctoral School of Basic and Translational Medicine, Semmelweis University, 1089 Budapest, Hungary
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Ge ML, Chu NM, Simonsick EM, Kasper JD, Xue QL. Order of Onset of Physical Frailty and Cognitive Impairment and Risk of Repeated Falls in Community-Dwelling Older Adults. J Am Med Dir Assoc 2023; 24:482-488.e4. [PMID: 36852758 PMCID: PMC10167733 DOI: 10.1016/j.jamda.2023.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES To examine whether physical frailty onset before, after, or in concert with cognitive impairment is differentially associated with fall incidence in community-dwelling older adults. DESIGN A longitudinal observational study. SETTING AND PARTICIPANTS Data from 1337 older adults age ≥65 years and free of physical frailty or cognitive impairment at baseline were obtained from the National Health Aging Trends Study (2011‒2017), a nationally representative cohort study of US older adult Medicare beneficiaries. METHODS Participants were assessed annually for frailty (physical frailty phenotype) and cognitive impairment (bottom quintile of clock drawing test or immediate and delayed recall; or proxy-report of diagnosis of dementia or AD8 score of ≥2). Incident falls were ascertained annually via self-report. Multinomial logistic regression was performed to estimate the association between order of first onset of cognitive impairment and/or frailty and incident single or repeated falls in the 1-year interval following their first onset. RESULTS Of the 1,337, 832 developed cognitive impairment first (termed "CI first"), 286 developed frailty first (termed "frailty first") and 219 had co-occurrence of cognitive impairment and frailty within one year (termed "CI-frailty co-occurrence") over 5 years. Overall, 491 (34.5%) had at least 1 fall during the 1-year interval following the onset of physical frailty and/or cognitive impairment. After adjustment, "CI-frailty co-occurrence" was associated with a more than 2-fold increased risk of repeated falls than "CI first" (odds ratio 2.35, 95% confidence interval 1.51‒3.67; P < .001). No significant difference was found between participants with "frailty first" and "CI first" (P = .07). In addition, the order of onset was not associated with risk of a single fall. CONCLUSIONS AND IMPLICATIONS Older adults experiencing "CI-frailty co-occurrence" had the greatest risk of repeated falls compared with those with "CI first" and "frailty first". Fall risk screening should consider the order and timing of onset of physical frailty and cognitive impairment.
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Affiliation(s)
- Mei-Ling Ge
- The Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, China
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Eleanor M Simonsick
- Intramural Research Program, Longitudinal Studies Section, the National Institute on Aging, Baltimore, MD, USA
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Qian-Li Xue
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Das S, Prasad J. Gender Differences in Determinants of the Components of the Frailty Phenotype among Older Adults in India: Findings from LASI Wave-1. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3055. [PMID: 36833748 PMCID: PMC9965095 DOI: 10.3390/ijerph20043055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
This study examines the gender-specific determinants of the components of frailty in a community-dwelling setting in India. Using data from the Longitudinal Ageing Study in India (LASI) Wave-1, this study employed 30,978 (14,885 male and 16,093 female) older adults (aged 60+) to fulfil the study objective. The modified Fried frailty phenotype criteria defines frailty by the five components: exhaustion, weak grip strength, slow walking speed, unintentional weight loss, and low physical activity. The result showed grip strength (79.1%) as the most discriminant component among males, and physical activity (81.6%) as the most discriminant component among females. The results also indicated that grip strength (male: 98.0%, female: 93.5%) and physical activity (male: 94.8%, female: 96.9%) showed a sensitivity of more than 90%, which appears to be a good indicator of frailty. Combining this dual marker increased the accuracy to 99.97% among male and 99.98% among female samples. The findings suggested adding grip strength and physical activity as a proxy measure of frailty, which can increase the precision of screening without a large additional investment of time, training, or cost.
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Affiliation(s)
- Sayani Das
- International Institute of Health Management Research, Delhi 110075, India
| | - Jitender Prasad
- International Institute for Population Sciences, Mumbai 400088, India
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Leroy V, Martinet V, Nunkessore O, Dentel C, Durand H, Mockler D, Puisieux F, Fougère B, Chen Y. The Nebulous Association between Cognitive Impairment and Falls in Older Adults: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2628. [PMID: 36767992 PMCID: PMC9915123 DOI: 10.3390/ijerph20032628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND In older people, dementia is a well-established risk factor for falls. However, the association and the causal relationship between falls and the earlier stages of cognitive impairment remains unclear. The purpose of the study was to review the literature data on the association between falls and cognitive impairment, no dementia, including Mild Cognitive Impairment. METHODS According to PRISMA guidelines, we searched five electronic databases (EMBASE, Web of Science, Medline, CINAHL, and PsychINFO) for articles published between January 2011 and August 2022 on observational studies of older people with a cognitive assessment and/or cognitive impairment diagnosis and a recording of falls. Their quality was reviewed according to the STROBE checklist. RESULTS We selected 42 of the 4934 initially retrieved publications. In 24 retrospective studies, a statistically significant association between falls and cognitive status was found in only 15 of the 32 comparisons (47%). Of the 27 cross-sectional analyses in prospective studies, only eight (30%) were positive and significant. We counted four longitudinal analyses, half of which suggested a causal relationship between falls and cognitive impairment. The investigational methods varied markedly from one study to another. CONCLUSION It is still not clear whether falls are associated with cognitive impairment, no dementia. Data in favor of a causal relationship are scarce. Further studies are needed to clarify their relationship.
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Affiliation(s)
- Victoire Leroy
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
- Memory Clinic, Tours University Hospital, 37000 Tours, France
| | - Valérie Martinet
- Department of Geriatrics, Saint-Pierre Hospital, ULB, 1000 Brussels, Belgium
| | | | | | - Hélène Durand
- Department of Neurology, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - David Mockler
- Medical Library, Trinity Centre for the Health Sciences, St James’ Hospital, D08 W9RT Dublin, Ireland
| | - François Puisieux
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- EA2694, Lille University, 59000 Lille, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
| | - Yaohua Chen
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- INSERM UMR-S 1172, Vascular and Degenerative Cognitive Disorders, University of Lille, 59000 Lille, France
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
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9
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Chen H, Huang L, Xiang W, Liu Y, Xu JW. Association between cognitive frailty and falls among older community dwellers in China: A Chinese longitudinal healthy longevity survey-based study. Front Aging Neurosci 2023; 14:1048961. [PMID: 36711208 PMCID: PMC9880264 DOI: 10.3389/fnagi.2022.1048961] [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: 09/20/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
Background The combined effect of cognitive impairment (CoI) and frailty on falls is controversial. This study aimed to explore whether older adults with cognitive frailty (CF) were at a higher risk of falls than those with only CoI or frailty and to present a fall prediction model based on CF. Methods A total of 4,067 adults aged ≥ 60 years were included from the Chinese Longitudinal Healthy Longevity Survey through face-to-face interviews. Cognitive function and frailty were assessed using the mini-mental state examination scale and frailty index, respectively. Logistic regression was used to determine fall-associated risk factors and develop a fall prediction model. A nomogram was then plotted. The model performance was evaluated using the area under the curve (AUC), concordance index (C-index), and calibration curve. All analyses were performed using SPSS and R statistical packages. Results The prevalence of CF and falls were 1.4 and 19.4%, respectively. After adjusting for covariates, the odds ratio of CF, frailty only, and CoI only for falls were 2.27 (95% CI: 1.29-3.97), 1.41 (95% CI: 1.16-1.73), and 0.99 (95% CI: 0.43-2.29), respectively. CF, sex, age, hearing difficulty, depression, anxiety, disability in instrumental activities of daily living, and serious illness in the past 2 years were independently associated with falls. A prediction model based on these factors yielded an AUC of 0.646 and a C-index of 0.641. Conclusion Cognitive frailty (CF) exerted a cumulative effect on falls than did CoI or frailty alone. Joint assessments of cognitive function and frailty status may be beneficial for fall risk screening in community. A prediction model using CF as a factor could be helpful for this process.
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Affiliation(s)
- Huihe Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China,*Correspondence: Huihe Chen,
| | - Lanhui Huang
- Department of Geriatric Endocrinology and Metabolism, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wei Xiang
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yu Liu
- Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jian-Wen Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China,Jian-Wen Xu,
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10
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Choi NG, Marti CN, Choi BY, Kunik MM. Recurrent Falls over Three Years among Older Adults Age 70+: Associations with Physical and Mental Health Status, Exercise, and Hospital Stay. J Appl Gerontol 2023; 42:1089-1100. [PMID: 36629139 PMCID: PMC10081943 DOI: 10.1177/07334648221150884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We used the 2019-2021 U.S. National Health and Aging Trend Study (N = 3,063, age 70+) and multinomial logistic regression and generalized linear models with Poisson and log link to identify correlates of (1) recurrent falls (2 + falls) over 3 years (2019-2021); and (2) any subsequent fall among those who had a fall in 2019. We also examined the associations between falls and hospitalization in 2021. Results show that those with recurrent falls had greater physical/functional and psychological health problems in 2019, while single fallers over the 3 years were not significantly different from those without a fall. Exercise was associated with a lower likelihood of a subsequent fall among those who fell in 2019. Both a single fall and recurrent falls over the 3 years were associated with a higher risk of hospitalization in 2021. Multifactorial fall preventions including exercise and depression/anxiety treatment are needed to mitigate recurrent fall risks.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, 441903University of Texas at Austin, Austin, TX, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, 441903University of Texas at Austin, Austin, TX, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, 6556Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, USA
| | - Mark M Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, VA South Central Mental Illness Research, Education and Clinical Center, Baylor College of Medicine, Houston, TX, USA
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11
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Guo X, Pei J, Ma Y, Cui Y, Guo J, Wei Y, Han L. Cognitive Frailty as a Predictor of Future Falls in Older Adults: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:38-47. [PMID: 36423679 DOI: 10.1016/j.jamda.2022.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine the association between cognitive frailty and the risk of future falls among older adults. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Older people aged ≥60 years with cognitive frailty from community, hospital, or both. METHODS PubMed, EMBASE, Web of Science, the Cochrane Library, Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched for relevant studies published from the inception of the database until June 14, 2022. Stata 16.0 software was used to perform the meta-analysis. A random effects model was used to pool the prevalence of falls in older adults over age 60 years with cognitive frailty and the strength of the association between cognitive frailty and falls [odds ratios (ORs) and 95% CIs]. Quality assessment, heterogeneity, and sensitivity analyses were also conducted. A study protocol was registered in PROSPERO (CRD42022331323). RESULTS The review included 18 studies in qualitative synthesis, 14 of which were in meta-analysis. Eleven sets of cross-sectional data involving 23,025 participants and 5 sets of longitudinal data involving 11,924 participants were used in the meta-analysis. The results showed that the overall prevalence of falls in 1742 people with cognitive frailty was 36.3% (95% CI 27.9-44.8, I2 = 93.4%). Longitudinal study results showed that cognitively frail individuals had a higher risk of falls (OR 3.02, 95% CI 2.11-4.32, I2 = 0.0%, P = .406), compared to robust participants without cognitive impairment; physically frail people (alone) had a moderate risk of falls (OR 2.16, 95% CI 1.42-3.30, I2 = 9.7%, P = .351); cognitively impaired people (alone) had a lower risk of falls (OR 1.36, 95% CI 1.03-1.79, I2 = 0.0%, P = .440). Among cross-sectional studies, cognitive frailty was associated with the risk of falls (OR 2.74, 95% CI 2.20-3.40, I2 = 53.1%, P = .019). Although high heterogeneity was noted among 11 cross-sectional studies reporting ORs, the sensitivity analysis showed that no single study significantly affected the final pooled results. CONCLUSIONS AND IMPLICATIONS This systematic review and meta-analysis confirms the findings that cognitive frailty was demonstrated to be a significant predictor of future falls in older adults. However, further prospective investigations are warranted.
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Affiliation(s)
- Xiaojing Guo
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Juhong Pei
- The First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Yutong Cui
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Jiali Guo
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Yuting Wei
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Lin Han
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China.
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12
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Nutrition Strategies Promoting Healthy Aging: From Improvement of Cardiovascular and Brain Health to Prevention of Age-Associated Diseases. Nutrients 2022; 15:nu15010047. [PMID: 36615705 PMCID: PMC9824801 DOI: 10.3390/nu15010047] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND An increasing number of studies suggest that diet plays an important role in regulating aging processes and modulates the development of the most important age-related diseases. OBJECTIVE The aim of this review is to provide an overview of the relationship between nutrition and critical age-associated diseases. METHODS A literature review was conducted to survey recent pre-clinical and clinical findings related to the role of nutritional factors in modulation of fundamental cellular and molecular mechanisms of aging and their role in prevention of the genesis of the diseases of aging. RESULTS Studies show that the development of cardiovascular and cerebrovascular diseases, neurodegenerative diseases, cognitive impairment and dementia can be slowed down or prevented by certain diets with anti-aging action. The protective effects of diets, at least in part, may be mediated by their beneficial macro- (protein, fat, carbohydrate) and micronutrient (vitamins, minerals) composition. CONCLUSIONS Certain diets, such as the Mediterranean diet, may play a significant role in healthy aging by preventing the onset of certain diseases and by improving the aging process itself. This latter can be strengthened by incorporating fasting elements into the diet. As dietary recommendations change with age, this should be taken into consideration as well, when developing a diet tailored to the needs of elderly individuals. Future and ongoing clinical studies on complex anti-aging dietary interventions translating the results of preclinical investigations are expected to lead to novel nutritional guidelines for older adults in the near future.
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Zeng XK, Shen SS, Guan HL, Chen LY, Chen XJ. Coexisting Frailty and Cognitive Impairment as a Predictor of Adverse Outcomes in Older Inpatients After Discharge: Results from a One-Year Follow-Up Study. Clin Interv Aging 2022; 17:1697-1706. [DOI: 10.2147/cia.s376691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/17/2022] [Indexed: 11/30/2022] Open
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Sánchez-Sánchez JL, Udina C, Medina-Rincón A, Esbrí-Victor M, Bartolomé-Martín I, Moral-Cuesta D, Marín-Epelde I, Ramon-Espinoza F, Latorre MS, Idoate F, Goñi-Sarriés A, Martínez-Martínez B, Bonet RE, Librero J, Casas-Herrero Á. Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial. BMC Geriatr 2022; 22:612. [PMID: 35870875 PMCID: PMC9308197 DOI: 10.1186/s12877-022-03214-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/15/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult's population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up. METHODS This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated. DISCUSSION This trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes. TRIAL REGISTRATION NCT04911179 02/06/2021.
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Affiliation(s)
- Juan Luis Sánchez-Sánchez
- grid.7759.c0000000103580096MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cadiz, Spain ,grid.410476.00000 0001 2174 6440Health Sciences Department, Universidad Pública de Navarra (UPNA), Pamplona, Spain ,grid.411175.70000 0001 1457 2980Insitut de Viellissement, CHU Toulouse, Gerontopole de Toulouse, Toulouse, France
| | - Cristina Udina
- grid.510965.eParc Sanitari Pere Virgili, Barcelona, Spain ,grid.430994.30000 0004 1763 0287RE-FiT Bcn Research Group, Vall Hebron Research Institute, Barcelona, Spain
| | - Almudena Medina-Rincón
- grid.510965.eParc Sanitari Pere Virgili, Barcelona, Spain ,grid.430994.30000 0004 1763 0287RE-FiT Bcn Research Group, Vall Hebron Research Institute, Barcelona, Spain
| | - Mariano Esbrí-Victor
- grid.411839.60000 0000 9321 9781Geriatrics Department, Complejo Hospitalario Universitario de Albacete (CHUA), Albacete, Spain
| | - Irene Bartolomé-Martín
- grid.411098.50000 0004 1767 639XGeriatrics Department, Hospital Universitario de Guadalajara (HUG), Guadalajara, Spain
| | - Débora Moral-Cuesta
- grid.411730.00000 0001 2191 685XGeriatrics Department, Hospital Universitario de Navarra (HUN), C/Irunlarrea s/n 31008, Pamplona, Spain
| | - Itxaso Marín-Epelde
- grid.411730.00000 0001 2191 685XGeriatrics Department, Hospital Universitario de Navarra (HUN), C/Irunlarrea s/n 31008, Pamplona, Spain
| | | | - Marina Sánchez- Latorre
- grid.411730.00000 0001 2191 685XGeriatrics Department, Hospital Universitario de Navarra (HUN), C/Irunlarrea s/n 31008, Pamplona, Spain
| | | | | | | | | | - Julián Librero
- grid.410476.00000 0001 2174 6440Health Sciences Department, Universidad Pública de Navarra (UPNA), Pamplona, Spain ,grid.508840.10000 0004 7662 6114Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Álvaro Casas-Herrero
- grid.410476.00000 0001 2174 6440Health Sciences Department, Universidad Pública de Navarra (UPNA), Pamplona, Spain ,grid.411730.00000 0001 2191 685XGeriatrics Department, Hospital Universitario de Navarra (HUN), C/Irunlarrea s/n 31008, Pamplona, Spain ,grid.508840.10000 0004 7662 6114Navarra Institute for Health Research (IdiSNA), Pamplona, Spain ,grid.413448.e0000 0000 9314 1427CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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15
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Vargas-Torres-Young DA, Salazar-Talla L, Cuba-Ruiz S, Urrunaga-Pastor D, Runzer-Colmenares FM, Parodi JF. Cognitive Frailty as a Predictor of Mortality in Older Adults: A Longitudinal Study in Peru. Front Med (Lausanne) 2022; 9:910005. [PMID: 35814770 PMCID: PMC9256954 DOI: 10.3389/fmed.2022.910005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the role of cognitive frailty and its components as risk factors of mortality in older adults of the Centro Médico Naval (CEMENA) in Callao, Peru during 2010-2015. Methods We performed a secondary analysis of data from a prospective cohort that included older adults (60 years and older) treated at the CEMENA Geriatrics service between 2010–2015. Frailty was defined as the presence of three or more criteria of the modified Fried Phenotype. Cognitive impairment was assessed using the Peruvian version of the Mini Mental State Examination (MMSE), considering a score <21 as cognitive impairment. Cognitive frailty was defined as the coexistence of both. In addition, we included sociodemographic characteristics, medical and personal history, as well as the functional evaluation of each participant. Results We included 1,390 older adults (mean follow-up: 2.2 years), with a mean age of 78.5 ± 8.6 years and 59.6% (n = 828) were male. Cognitive frailty was identified in 11.3% (n = 157) and 9.9% (n = 138) died during follow-up. We found that cognitive frailty in older adults (aHR = 3.57; 95%CI: 2.33–5.49), as well as its components, such as sedentary behavior and cognitive impairment (aHR = 7.05; 95%CI: 4.46–11.13), weakness and cognitive impairment (aHR = 6.99; 95%CI: 4.41–11.06), and exhaustion and cognitive impairment (aHR = 4.51; 95%CI: 3.11–6.54) were associated with a higher risk of mortality. Conclusion Cognitive frailty and its components were associated with a higher risk of mortality in older adults. It is necessary to develop longitudinal studies with a longer follow-up and that allow evaluating the effect of interventions in this vulnerable group of patients to limit adverse health outcomes, including increased mortality.
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Affiliation(s)
| | - Leslie Salazar-Talla
- Grupo Estudiantil de Investigación en Salud Mental (GISAM), Sociedad Científica de Estudiantes de Medicina de la Universidad de San Martin de Porres, Lima, Peru
- Facultad de Medicina Humana, Universidad de San Martin de Porres, Lima, Peru
| | - Sofia Cuba-Ruiz
- Facultad de Medicina Humana, Universidad de San Martin de Porres, Lima, Peru
| | - Diego Urrunaga-Pastor
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Carrera de Medicina Humana, Lima, Peru
- *Correspondence: Diego Urrunaga-Pastor
| | | | - Jose F. Parodi
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Peru
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16
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Rech RS, Padovani MMP, Oliveira NF, Souza Alós BG, Ayres A, Olchik MR. Factors associated with frailty in patients with neurodegenerative diseases. Codas 2022; 34:e20200214. [PMID: 35730871 PMCID: PMC9886181 DOI: 10.1590/2317-1782/20212020214] [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: 07/09/2020] [Accepted: 09/28/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To identify the factors associated with frailty in patients with neurodegenerative diseases. METHODS Cross-sectional study, whose sample consisted of 150 patients diagnosed with neurodegenerative diseases seen at a speech-language therapy clinic in a reference hospital in southern Brazil. A secondary exploratory analysis of the medical records of patients treated at this clinic between April 2016 and May 2019 was performed. The information collected was sex, age, education, type of neurodegenerative disease, time of disease, frailty (Edmonton Frail Scale-EFS), swallowing (Northwestern Dysphagia Patient CheckSheet-NDPCS, Eating Assessment Tool-EAT 10), and cognition (Mini-Mental State Examination-MMSE and Montreal Cognitive Assessment-MoCA). Continuous quantitative variables were analyzed using mean and standard deviation and categorical quantitative variables from absolute and relative frequency, as well as their association with the outcome using the Chi-square test. Crude and adjusted Prevalence Ratios were assessed using Poisson regression with robust variance. All statistical tests were considered significant at a level of 5%. RESULTS The significant factors associated with frailty were the presence of oropharyngeal dysphagia and altered cognitive performance. Individuals with frailty have a higher prevalence of oropharyngeal dysphagia (PR= 1.772(1.094-2.872)), while cognition alteration presented a lower prevalence (PR= 0.335(0.128-0.873). CONCLUSION Oropharyngeal dysphagia can be an important clinical predictive factor for consideration in cases of frailty in patients with neurodegenerative diseases.
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Affiliation(s)
- Rafaela Soares Rech
- Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil.
| | | | | | | | - Annelise Ayres
- Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
| | - Maira Rozenfeld Olchik
- Universidade Federal do Rio Grande do Sul – UFRGS - Porto Alegre (RS), Brasil.,Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
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Frailty in Aging and the Search for the Optimal Biomarker: A Review. Biomedicines 2022; 10:biomedicines10061426. [PMID: 35740447 PMCID: PMC9219911 DOI: 10.3390/biomedicines10061426] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 01/09/2023] Open
Abstract
In the context of accelerated aging of the population worldwide, frailty has emerged as one of the main risk factors that can lead to loss of self-sufficiency in older people. This syndrome is defined as a reduced state of physiological reserve and functional capacity. The main diagnostic tools for frailty are based on scales that show deficits compared to their clinical application, such as the Fried frailty phenotype, among others. In this context, it is important to have one or more biomarkers with clinical applicability that can objectively and precisely determine the degree or risk of frailty in older people. The objective of this review was to analyze the biomarkers associated with frailty, classified according to the pathophysiological components of this syndrome (inflammation, coagulation, antioxidants, and liver function, among others). The evidence demonstrates that biomarkers associated with inflammation, oxidative stress, skeletal/cardiac muscle function, and platelet function represent the most promising markers of frailty due to their pathophysiological association with this syndrome. To a lesser extent but with the possibility of greater innovation, biomarkers associated with growth factors, vitamins, amino acids, and miRNAs represent alternatives as markers of this geriatric syndrome. Likewise, the incorporation of artificial intelligence represents an interesting approach to strengthening the diagnosis of frailty by biomarkers.
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Aprahamian I, Borges MK, Hanssen DJC, Jeuring HW, Oude Voshaar RC. The Frail Depressed Patient: A Narrative Review on Treatment Challenges. Clin Interv Aging 2022; 17:979-990. [PMID: 35770239 PMCID: PMC9234191 DOI: 10.2147/cia.s328432] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
Although the public importance of frailty is widely acknowledged by the World Health Organization, physical frailty is still largely neglected in geriatric mental health care. Firstly in this narrative review, we summarize the knowledge on the epidemiology of the association between depression and frailty, whereafter implications for treatment will be discussed. Even though frailty and depression have overlapping diagnostic criteria, epidemiological studies provide evidence for distinct constructs which are bidirectionally associated. Among depressed patients, frailty has predictive validity being associated with increased mortality rates and an exponentially higher fall risk due to antidepressants. Nonetheless, guidelines on the treatment of depression neither consider frailty for risk stratification nor for treatment selection. We argue that frailty assessment enables clinicians to better target the pharmacological and psychological treatment of depression as well as the need for interventions targeting primarily frailty, for instance, lifestyle interventions and reduction of polypharmacy. Applying a frailty informed framework of depression treatment studies included in a meta-analysis reveals that the benefit–harm ratio of antidepressants given to frail depressed patients can be questioned. Nonetheless, frail-depressed patients should not withhold antidepressants as formal studies are not available yet, but potential adverse effects should be closely monitored. Dopaminergic antidepressants might be preferable when slowness is a prominent clinical feature. Psychotherapy is an important alternative for pharmacological treatment, especially psychotherapeutic approaches within the movement of positive psychology, but this approach needs further study. Finally, geriatric rehabilitation, including physical exercise and nutritional advice, should also be considered. In this regard, targeting ageing-related abnormalities underlying frailty that may also be involved in late-life depression such as low-grade inflammation might be a promising target for future studies. The lack of treatment studies precludes firm recommendations, but more awareness for frailty in mental health care will open a plethora of alternative treatment options to be considered.
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Affiliation(s)
- Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Department of Internal Medicine, Jundiaí Medical School, Jundiaí, Brazil
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
- Correspondence: Ivan Aprahamian, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School, Jundiaí, Brazil, Email
| | - Marcus K Borges
- Federal University of Paraná, Department of Psychiatry, Curitiba, Brazil
| | - Denise J C Hanssen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Hans W Jeuring
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
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Das S. Cognitive frailty among community-dwelling rural elderly population of West Bengal in India. Asian J Psychiatr 2022; 70:103025. [PMID: 35189474 DOI: 10.1016/j.ajp.2022.103025] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/06/2022] [Accepted: 02/11/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES There has been growing interest in the links between physical frailty and cognitive impairment: both can increase the risk of emerging life-threatening health problems and are currently prominent within the global geriatric health agenda. A recent consensus proposes the idea of 'cognitive frailty' defined by the presence of both physical frailty and cognitive impairment in the absence of dementia. Present study is intended to determine the prevalence of cognitive frailty and its associated factors. METHODS Cross-sectional survey was conducted among the rural community-dwelling elderly population of West Bengal, India (n = 510), without diagnosed dementia at baseline. An Interview-based questionnaire was administered to obtain information on sociodemographic, physical and psychosocial characteristics. Study participants were categorized as non-cognitive impairment (NCI) and cognitive impairment (CI) by Bangla Adaptation of Mini-Mental State Exam (BMSE ≤ 25) scale, as non-physical frailty (NPF) and physical frailty (PF) using Modified Fried Frailty Phenotype (FP ≥ 3) scale, as robust (NPF + NCI), pre-cognitive frailty (NPF + CI or PF + NCI) and cognitive frailty (PF + CI). RESULTS The overall prevalence of cognitive frailty was 21.8%. In multinomial regression analysis, final model indicated that increasing age, being woman, out-of-wedlock, poor education and non-working sociodemographic status had significant association with cognitive frailty. Poor nutritional status, low health-related quality of life and depression are also prone among the cognitively frail participants. CONCLUSIONS Present study allows us to understand complementary relationships between sociodemographic, physical, psychosocial characteristics and cognitive frailty. There is a dire need for multidimensional approach for providing appropriate and comprehensive geriatric health care for developing countries like India.
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Affiliation(s)
- Sayani Das
- Biological Anthropology Unit, Indian Statistical Institute, Kolkata, India.
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Cao X, Chen C, He L, Zheng Z, Zhang J, Hoogendijk EO, Liu X, Li S, Wang X, Zhu Y, Liu Z. Development and Validation of a New Simple Functional Score in the Older Chinese Population. Front Public Health 2022; 10:813323. [PMID: 35284388 PMCID: PMC8907530 DOI: 10.3389/fpubh.2022.813323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Existing aging metrics incorporating cognitive and physical function are often not feasible for application in research and clinical practice. Therefore, this study aimed to develop and validate a new simple functional score based on self-reported cognitive and physical function in the older Chinese population. Methods The development sample included 3,929 older adults aged 60–95 years from the China Health and Retirement Longitudinal Study (CHARLS). The validation sample included 1,345 older adults aged 60–87 years from the Rugao Longitudinal Aging study (RLAS). Logistic regression models and receiver operating characteristic curves were used to examine the associations of the new functional score with all-cause mortality risk. Results Six items were selected to construct the new functional score in CHARLS. This functional score was associated with all-cause mortality risk, with an adjusted odds ratio of 1.10 (95% confidence interval = 1.07, 1.13). This functional score presented additional predictive utility beyond age and sex, as demonstrated by the significantly increased C-statistic, integrated discrimination improvement (IDI), and continuous net reclassification improvement (NRI) (all P < 0.001). Furthermore, this functional score was further validated in RLAS, such that adding the new functional score to a model of age and sex improved all-cause mortality risk discrimination (IDI = 0.036, P < 0.001; NRI = 0.485, P < 0.001). To facilitate the quick screening of the older population with deteriorations in cognitive and physical function, we introduced a publicly available online tool designed for this new functional score. Conclusions A new functional score based on six self-reported items was developed and validated in the older Chinese population, and was demonstrated to be a simple and practical tool to assess functional deterioration, showing good feasibility, and performance.
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Affiliation(s)
- Xingqi Cao
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Chen Chen
- National Center for Acquired Immunodeficiency Syndrome/Sexually Transmitted Disease (AIDS/STD) Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liu He
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhoutao Zheng
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingyun Zhang
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Emiel O. Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, Amsterdam, Netherlands
| | - Xiaoting Liu
- School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Shujuan Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Wang
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, and Human Phenome Institute, Fudan University, Shanghai, China
- Xiaofeng Wang
| | - Yimin Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
- Yimin Zhu
| | - Zuyun Liu
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Zuyun Liu
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Zhang XM, Wu XJ, Cao J, Jiao J, Chen W. Association between Cognitive Frailty and Adverse Outcomes among Older Adults: A Meta-Analysis. J Nutr Health Aging 2022; 26:817-825. [PMID: 36156673 DOI: 10.1007/s12603-022-1833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to pool the effect size of the association between cognitive frailty and adverse outcomes (e.g., falls, disability, and hospitalization) among older adults. DESIGN Systematic review and meta-analysis. METHODS PubMed, ScienceDirect, and Embase were searched from their respective inceptions to June 1, 2022. We extracted prospective cohort studies that reported the association between cognitive frailty and adverse outcomes. Random or fixed-effects models based on heterogeneity were used to pool the effect sizes of independent associations of cognitive frailty, frailty only, and cognitive impairment only with each adverse outcome. RESULTS Fifteen studies involving 49,122 older adults were included in the meta-analysis. Older adults with cognitive frailty had higher odds ratios (OR) for falls (1.82, 95% confidence interval [CI]: 1.29-2.58), disability (3.17, 95%CI: 2.24-4.48), and hospitalization (1.78, 95%CI: 1.48-2.14) compared with those without frailty and cognitive impairment. Older adults with frailty only demonstrated a high risk for falls (pooled OR 1.76, 95%CI: 1.25-2.48), disability (pooled OR 1.82, 95%CI: 1.43-2.33), and hospitalization (pooled OR 1.64, 95% CI: 1.45-1.85). The influence of cognitive impairment only on adverse outcomes was lower compared with cognitive frailty or frailty. Subgroup analyses showed that those with cognitive frailty (defined by the frailty phenotype plus Mini-Mental State Examination) were at greater risk for developing adverse outcomes. CONCLUSION Our findings indicate that cognitive frailty is an independent risk factor for adverse outcomes (e.g., falls, disability, and hospitalization). Early screening and comprehensive intervention may improve cognitive frailty and reduce the risk for adverse outcomes among older adults.
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Affiliation(s)
- X M Zhang
- Xiao-Ming Zhang, Xin-Juan Wu, Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China, ,
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22
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Zhang XM, Yuan L, Guo N, Bo HX, Jiao J, Wu XJ, Xu T. Cognitive Frailty and Falls in a National Cohort of Older Chinese Inpatients. J Nutr Health Aging 2021; 25:993-998. [PMID: 34545919 DOI: 10.1007/s12603-021-1670-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Previous studies have investigated the association between cognitive frailty and falls among older adults in community; however, no study investigated this relationship among older patients living in hospital. This study aimed to examine the relationship of cognitive frailty with falls among older inpatients in Chinese hospital. METHODS This analysis consisted of 9192 older inpatients aged 65 years or over from six hospitals in China. We used FRAIL scale and Mini-Cog to assess frailty and cognitive impairment, respectively. A generalized estimating equation was used to examine the relationship between cognitive frailty and falls at 30-day follow-up. RESULTS Among 9192 older inpatients enrolled in this present study, the mean (SD) age was 72.40(5.72) years, with 3850(41.88%) women. The cross-sectional analysis found that after controlling for variables (age, gender, education, depression, and hospital ward cluster effect), hospitalized patients with cognitive frailty, frailty only, or cognitive impairment only at baseline were all associated with history of falls (P<0.05). At 30-day follow-up, generalized estimating equation with full-adjustment showed that inpatients with cognitive frailty were at greater risk of falls than those of non-frail and cognitive intact (OR=3.0,95%CI:1.32-6.83). This association was also observed in individuals with frailty only (OR=2.11,95%CI:1.04-4.27) but not for patients with cognitive impairment only((OR=1.11,95%CI:0.43-2.85). CONCLUSION Our study suggested that hospitalized Chinese older adults with cognitive frailty were independently associated with falls. Early screening frailty and cognitive impairment were significant for older patients by clinicians, and corresponding interventions, exercise training and nutritional programs, should be implemented to prevent falls.
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Affiliation(s)
- X-M Zhang
- Xinjuan Wu, Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, China, E-mail: .; Tao-Xu, Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, 5 Dongdan Santiao, Dongcheng District, Beijing, 100005, China, E-mail:
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