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Wang C, Fang X, Tang Z, Hua Y, Zhang Z, Gu X, Liu B, Yang K, Ji X, Song X. Frailty in relation to the risk of carotid atherosclerosis and cardiovascular events in Chinese community-dwelling older adults: A five-year prospective cohort study. Exp Gerontol 2023; 180:112266. [PMID: 37536575 DOI: 10.1016/j.exger.2023.112266] [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: 06/07/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To investigate the frailty, as estimated by accumulated health deficits, in association with the symptomatic carotid atherosclerosis and in relation to five-year cardiovascular (CVD) outcomes. METHODS This is a five-year prospective cohort study. Secondary analysis of data from the Beijing Longitudinal Study on Aging. Community-dwelling people aged 55+ years (n = 1257) have been followed between 2009 and 2014, and having carotid ultrasonography examinations with no CVD events at baseline. Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 37 health deficits assessed at baseline. The association between the degree of frailty and carotid atherosclerosis was examined using odds ratios (OR) with multivariate logistic regression analyses. Effects of frailty on the probability of five-year cardiovascular events and mortality were evaluated using Cox proportional hazard ratios (HR). The analyses were adjusted for demographics, baseline carotid atherosclerosis status, and CVD risk factors. RESULTS The FI showed characteristic properties and was independently associated with the major carotid atherosclerosis symptoms, including carotid artery intima-media thickening (the most frail vs. the least frail: OR = 4.39: 1.98-7.82), carotid plaque (OR = 3.41: 1.28-6.54), and carotid plaque stability (OR = 1.19, 95 % CI: 1.01-3.59). Compared with the least frail, the most frail individuals were more likely to develop a cardiovascular event in five years, including myocardial infarction (HR = 3.38, 95 % CI = 1.84-6.19), stroke (HR = 1.26, 95 % CI = 1.00-5.87), CVD death (HR = 6.33, 95 % CI = 1.69-11.02), and all-cause death (HR = 5.95, 95 % CI = 2.74-8.95). CONCLUSION Deficit accumulation was closely associated with carotid atherosclerosis risks and strongly predicted five-year CVD events. The frailty index can be used to help identify older adults at high risks of CVD for improved preventive healthcare.
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Affiliation(s)
- Chunxiu Wang
- Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, China
| | - Xianghua Fang
- Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, China
| | - Zhe Tang
- Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongying Zhang
- Geriatric Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang Gu
- Geriatric Department, Youyi Hospital, Capital Medical University, Beijing, China
| | - Beibei Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kun Yang
- Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, China
| | - Xunming Ji
- Department of Neurological Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Xiaowei Song
- Health Sciences and Innovation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada.
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Walsh B, Fogg C, Harris S, Roderick P, de Lusignan S, England T, Clegg A, Brailsford S, Fraser SDS. Frailty transitions and prevalence in an ageing population: longitudinal analysis of primary care data from an open cohort of adults aged 50 and over in England, 2006-2017. Age Ageing 2023; 52:7147101. [PMID: 37140052 PMCID: PMC10158172 DOI: 10.1093/ageing/afad058] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/16/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION frailty is common in older adults and is associated with increased health and social care use. Longitudinal information is needed on population-level incidence, prevalence and frailty progression to plan services to meet future population needs. METHODS retrospective open cohort study using electronic health records of adults aged ≥50 from primary care in England, 2006-2017. Frailty was calculated annually using the electronic Frailty Index (eFI). Multistate models estimated transition rates between each frailty category, adjusting for sociodemographic characteristics. Prevalence overall for each eFI category (fit, mild, moderate and severe) was calculated. RESULTS the cohort included 2,171,497 patients and 15,514,734 person-years. Frailty prevalence increased from 26.5 (2006) to 38.9% (2017). The average age of frailty onset was 69; however, 10.8% of people aged 50-64 were already frail in 2006. Estimated transitions from fit to any level of frailty were 48/1,000 person-years aged 50-64, 130/1,000 person-years aged 65-74, 214/1,000 person-years aged 75-84 and 380/1,000 person-years aged ≥ 85. Transitions were independently associated with older age, higher deprivation, female sex, Asian ethnicity and urban dwelling. Mean time spent in each frailty category decreased with age, with the longest period spent in severe frailty at all ages. CONCLUSIONS frailty is prevalent in adults aged ≥50 and time spent in successive frailty states is longer as frailty progresses, resulting in extended healthcare burden. Larger population numbers and fewer transitions in adults aged 50-64 present an opportunity for earlier identification and intervention. A large increase in frailty over 12 years highlights the urgency of informed service planning in ageing populations.
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Affiliation(s)
- Bronagh Walsh
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Carole Fogg
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Scott Harris
- School of Primary Care, Population Science & Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Roderick
- School of Primary Care, Population Science & Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tracey England
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Andrew Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
| | - Sally Brailsford
- Southampton Business School, University of Southampton, Southampton, UK
| | - Simon D S Fraser
- School of Primary Care, Population Science & Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Wang C, Fang X, Tang Z, Hua Y, Zhang Z, Gu X, Liu B, Ji X. A frailty index based on routine laboratory data predicts increased risk of mortality in Chinese community-dwelling adults aged over 55 years: a five-year prospective study. BMC Geriatr 2022; 22:679. [PMID: 35978284 PMCID: PMC9382755 DOI: 10.1186/s12877-022-03374-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Frailty can be operationalized based on the accumulation of deficits using a frailty index (FI) and is associated with an increased risk of adverse health outcomes. Here, we aim to compare validity of a FI from laboratory data with that of the common clinical FI for prediction of mortality in adults aged 55 + years, also examine whether combined FI could improve identification of adults aged 55 + years at increased risk of death. Methods Data for this analysis were obtained from the Beijing Longitudinal Study of Aging that involved 1,257 community-dwelling Chinese people, aged 55 + years at baseline. The main outcome measure was 5-year mortality. An FI-self-report based on 30 self-reported health-related data was constructed. An FI-lab was developed using laboratory data, in addition to pulse, systolic and diastolic blood pressure, pulse pressure, body mass index (BMI) and waist. A combined FI comprised all items from each FI. Kaplan–Meier survival curve and Cox proportional hazards models were performed to evaluate the risk of each FI on death. The area under receiver operating characteristic(ROC) curves were used to compare the discriminative performance of each FI. Results Of 1257 participants, 155 died and 156 lost at the end of the 5-year follow-up. The mean FI-self-report score was 0.11 ± 0.10, the FI-lab score was 0.33 ± 0.14 and FI-combined score was 0.19 ± 0.09. Higher frailty level defined by each FI was associated with higher risk of death. After adjustment for age and sex, Cox proportional hazards models showed that the higher scores of frailty were associated with a higher risk of mortality for each FI, the hazard ratios for the FI-self-report and FI-lab and FI-combined were 1.04 (1.03 to 1.05) and 1.02 (1.01 to 1.03) and 1.05 (1.04 to 1.07), respectively. The areas under the ROC curve were 0.79 (0.77–0.82) for the FI-self-report, 0.77(0.75–0.80) for the FI-lab and 0.81(0.78–0.82) for FI-combined. Conclusions A FI from laboratory data can stratify older adults at increased risk of death alone and in combination with FI based on self-report data. Assessment in clinical settings of creating an FI using routine collected laboratory data needs to be further developed. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03374-z.
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Affiliation(s)
- Chunxiu Wang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng district, Beijing, China.
| | - Xianghua Fang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng district, Beijing, China
| | - Zhe Tang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng district, Beijing, China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongying Zhang
- Geriatric Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang Gu
- Geriatric Department, Affiliated Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Beibei Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurological Surgery, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng district, Beijing, China.
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Mendonça N, Kingston A, Yadegarfar M, Hanson H, Duncan R, Jagger C, Robinson L. Transitions between frailty states in the very old: the influence of socioeconomic status and multi-morbidity in the Newcastle 85+ cohort study. Age Ageing 2020; 49:974-981. [PMID: 32342980 PMCID: PMC7583524 DOI: 10.1093/ageing/afaa054] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Indexed: 11/12/2022] Open
Abstract
Background Using Newcastle 85+ Study data, we investigated transitions between frailty states from age 85 to 90 years and whether multi-morbidities and socioeconomic status (SES) modify transitions. Methods The Newcastle 85+ Study is a prospective, longitudinal cohort study of all people born in 1921 in Newcastle and North Tyneside. Data included: a multidimensional health assessment; general practice record review (GPRR) and date of death. Using the Fried phenotype (participants defined as robust, pre-frail or frail), frailty was measured at baseline, 18, 36 and 60 months. Results Frailty scores were available for 82% (696/845) of participants at baseline. The prevalence of frailty was higher in women (29.7%, 123/414) than men (17.7%, 50/282) at baseline and all subsequent time points. Of those robust at baseline, 44.6% (50/112) remained robust at 18 months and 28% (14/50) at age 90. Most (52%) remained in the same state across consecutive interviews; only 6% of the transitions were recovery (from pre-frail to robust or frail to pre-frail), and none were from frail to robust. Four or more diseases inferred a greater likelihood of progression from robust to pre-frail even after adjustment for SES. SES did not influence the likelihood of moving from one frailty state to another. Conclusions Almost half the time between age 85 and 90, on average, was spent in a pre-frail state; multi-morbidity increased the chance of progression from robust and to frail; greater clinical intervention at the onset of a first chronic illness, to prevent transition to multi-morbidity, should be encouraged.
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Affiliation(s)
- Nuno Mendonça
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
- EpiDoC Unit, CHRC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisbon, Portugal
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
| | - Mohammad Yadegarfar
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds University, UK
| | - Helen Hanson
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, NE1 4LP, UK
| | - Rachel Duncan
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, NE1 4LP, UK
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, NE2 4AX, UK
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Ye B, Chen H, Huang L, Ruan Y, Qi S, Guo Y, Huang Z, Sun S, Chen X, Shi Y, Gao J, Jiang Y. Changes in frailty among community-dwelling Chinese older adults and its predictors: evidence from a two-year longitudinal study. BMC Geriatr 2020; 20:130. [PMID: 32272903 PMCID: PMC7146912 DOI: 10.1186/s12877-020-01530-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background It is important to clarify the transitions and related factors of frailty for prevention of frailty. We evaluated the transitions of frailty among community-dwelling older adults and examined the predictors of the transitions. Methods A cohort study was conducted among 3988 community residents aged ≥60 years during 2015 and 2017. A multiple deficits approach was used to construct the Frailty Index (FI) according to the methodology of FI construction, and sociodemographic characteristics and lifestyles were also collected in 2015. After 2-year follow-up, the transitions of frailty between baseline and were evaluated. Multinomial logistic regressions were used to examine associations between predictors and the transitions of frailty. Results The proportion of robust, prefrail, and frail was 79.5, 16.4, and 4.1% among 3988 participants at baseline, which changed to 68.2, 23.0, and 8.8% after 2 years with 127 deaths and 23 dropped out. Twelve kinds of transitions from the three frailty statuses at baseline to four outcomes at follow-up (including death) significantly differed within each of gender and age group, as well between genders and age groups. Among these, 7.8% of prefrail or frail elders improved, 70.0% retained their frailty status, and 22.2% of robust or prefrail elders worsened in frailty status. In multivariable models, age was significantly associated with changes in frailty except for in the frail group; higher educational level and working predicted a lower risk of robust worsening. Of the lifestyle predictors, no shower facilities at home predicted a higher risk of robust worsening; more frequent physical exercise predicted a lower risk of robust worsening and a higher chance of frailty improvement; more frequent neighbor interaction predicted a lower risk of robust worsening and prefrail worsening; and more frequent social participation predicted a higher chance of prefrail improvement. Conclusions The status of frailty was reversible among community-dwelling elderly, and sociodemographic and lifestyle factors were related to changes in frailty. These findings help health practitioners to recognize susceptible individuals in a community and provide health promotional planning to target aged populations.
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Affiliation(s)
- Bo Ye
- School of Public Health, Fudan University, PO Box 248, 138 Yixueyuan Road, Shanghai, 200032, China
| | - Hao Chen
- School of Public Health, Fudan University, PO Box 248, 138 Yixueyuan Road, Shanghai, 200032, China
| | - Limei Huang
- Songjiang Center of Disease Prevention and Control, Shanghai, 201620, China
| | - Ye Ruan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Shige Qi
- The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, 100050, China
| | - Yanfei Guo
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Zhezhou Huang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Shuangyuan Sun
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Xiuqin Chen
- Songjiang Center of Disease Prevention and Control, Shanghai, 201620, China
| | - Yan Shi
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Junling Gao
- School of Public Health, Fudan University, PO Box 248, 138 Yixueyuan Road, Shanghai, 200032, China.
| | - Yonggen Jiang
- Songjiang Center of Disease Prevention and Control, Shanghai, 201620, China.
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Yang Z, Wang C, Tang Z, Song X. Sex differences in the relative heterogeneity of frailty in relation to age, frailty, health protection, and five-year mortality. Aging Med (Milton) 2019; 2:207-215. [PMID: 32055762 PMCID: PMC7003709 DOI: 10.1002/agm2.12090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Previous studies have suggested that the relative heterogeneity of frailty declines with increases in age and the level of the frailty index (FI). In this study, we investigated the sex difference in the relative heterogeneity of frailty and its response to health-protective factors, in a Chinese community sample. METHODS Data used for this secondary analysis were obtained from the Beijing Longitudinal Study of Aging that involved 3257 community-dwelling Chinese people aged 55 years and older at baseline. An FI was constructed for each indicial using 35 variables assessing health-related problems. A protection index (PI) consisting of 27 variables assessing lifestyle and social engagement was also built. The relative heterogeneity of frailty, as measured by the coefficient of variation (CV) of the FI, was calculated as the ratio of the standard deviation to the mean FI for different age, FI, and PI groups, and for the five-year survival status. RESULTS The CV decreased with the increase in age (F = 20.60, P = .006) and the FI (F = 57.59, P = .001), consistent in both sexes. In each age group, the CV was higher in men than in women (t = 3.25, P = .018). A great level of protection was associated with a significantly reduced mortality, and an increased CV (t = 2.91, P = .027). CONCLUSIONS Our data demonstrate that a gender difference exists in the relative heterogeneity of frailty, which is negatively related to age and frailty as well as positively associated with health protection and the five-year survival.
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Affiliation(s)
- Zhan Yang
- Department of Science in BiologyCrandall UniversityMonctonNBCanada
| | - Chunxiu Wang
- Department of Evidence‐based MedicineBeijing Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Zhe Tang
- Department of Evidence‐based MedicineBeijing Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xiaowei Song
- Health Sciences and InnovationSurrey Memorial HospitalFraser Health AuthoritySurreyBCCanada
- Department of Biomedical Physiology and KinesiologySimon Fraser UniversityBurnabyBCCanada
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Gregorevic KJ, Peel NM, Lim WK, Hubbard RE. Do health assets have a protective effect for hospitalized frail older adults? QJM 2018; 111:785-789. [PMID: 30099504 DOI: 10.1093/qjmed/hcy172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although increasing frailty is predictive of increased mortality and length of stay for hospitalized older adults, this approach ignores health assets that individuals can utilize to recover following hospital admission. AIM To examine whether health assets mitigate the effect of frailty on outcomes for older adults admitted to hospital. DESIGN Patients of 1418 aged ≥ 70 years admitted to 11 hospitals in Australia were evaluated at admission using the interRAI assessment system for Acute Care, which surveys a large number of domains, including cognition, communication, mood and behaviour, activities of daily living, continence, nutrition, skin condition, falls and medical diagnosis. METHODS The data set was interrogated for potential health assets and a multiple logistic regression adjusted for frailty index, age and gender as covariates was performed for the outcomes mortality, length of stay, re-admission and new need for residential care. RESULTS Inpatient mortality was 3% and 4.5% of patients died within 28 days of discharge. Median length of stay was 7 days (IQR 4-11). In multivariate analysis that includes frailty, being able to walk further [OR 0.08 (0.01-0.63)], ability to leave the house [OR 0.35 (0.17-0.74)] and living alone [OR 0.28 (0.10-0.79)] were protective against mortality. The presence of a support person was associated with a decreased length of stay [OR 0.14 (0.08-0.25)]. CONCLUSION The inclusion of health assets in predictive models can improve prognostication and highlights potential interventions to improve outcomes for hospitalized older adults.
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Affiliation(s)
- K J Gregorevic
- Department of Aged Care, Northern Health, 185 Cooper St Epping, Victoria, Australia
- Department of Medicine, University of Melbourne, Grattan St, Parkville, Victoria, Australia
- Department of Aged Care, Melbourne Health, Grattan St, Parkville, Victoria, Australia
| | - N M Peel
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - W K Lim
- Department of Medicine, University of Melbourne, Grattan St, Parkville, Victoria, Australia
- Department of Aged Care, Melbourne Health, Grattan St, Parkville, Victoria, Australia
| | - R E Hubbard
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Maxwell CJ, Campitelli MA, Diong C, Mondor L, Hogan DB, Amuah JE, Leslie S, Seitz D, Gill S, Thavorn K, Wodchis WP, Gruneir A, Teare G, Bronskill SE. Variation in the health outcomes associated with frailty among home care clients: relevance of caregiver distress and client sex. BMC Geriatr 2018; 18:211. [PMID: 30208884 PMCID: PMC6134755 DOI: 10.1186/s12877-018-0899-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022] Open
Abstract
Background The identification of contextual factors that modify associations between client frailty and their health and service use outcomes is essential for informed home health care and policy planning. Our objective was to examine variation in the associations between frailty and select 1-year health outcomes by caregiver distress and client sex among community-residing older care recipients. Methods We conducted a retrospective cohort study using linked population-based clinical and health administrative databases for all long-stay home care clients (n = 234,552) aged 66+ years assessed during April 2010–2013 in Ontario, Canada. Frailty was assessed using a previously validated 72-item frailty index (FI). Presence of caregiver distress was derived from clinical assessment items administered by trained home care assessors. Multivariable log-binomial regression models were used to examine variations in the associations between frailty and outcomes of interest (mortality, nursing home [NH] placement, all-cause and prolonged hospitalization) by caregiver distress, with further model stratification by client sex. Results Frailty prevalence varied little by sex (19.3% women, 19.9% men) despite significant sex-differences in clients’ sociodemographic and health characteristics. In both sexes, frailty was significantly associated with all outcomes, particularly NH placement (RR = 3.84, 95%CI 3.75–3.93) and death (RR = 2.32, 95%CI 2.27–2.37), though risk ratios were greater for women. Caregiver distress was more common with increasing frailty and for male clients, and a significant independent predictor of NH placement and prolonged hospitalization in both sexes. The association between frailty and NH placement (but not other outcomes) varied by caregiver distress for both men and women (p < 0.001 interaction terms), showing a greater magnitude of association among clients without (vs. with) a distressed caregiver. Conclusions As caregiver distress varies by client sex, represents a key driver of NH placement (even among relatively robust clients), and modifies the impact of other risk factors such as frailty, it should be routinely assessed. Further, sex-differences should be considered when developing and evaluating community-based services for older adults and their caregivers. Electronic supplementary material The online version of this article (10.1186/s12877-018-0899-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colleen J Maxwell
- Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada. .,Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
| | - Michael A Campitelli
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Christina Diong
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Luke Mondor
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Health System Performance Research Network, Toronto, ON, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, HSC-3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Joseph E Amuah
- School of Epidemiology, Public Health & Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Sarah Leslie
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada
| | - Dallas Seitz
- Division of Geriatric Psychiatry, Queen's University & Providence Care Hospital, 752 King Street W, Kingston, ON, K7L 4X3, Canada
| | - Sudeep Gill
- Department of Medicine, Queen's University & Providence Care Hospital, 752 King Street W, Kingston, ON, K7L 4X3, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, 501 Smyth Road, PO Box201B, Ottawa, ON, K1H 8L6, Canada
| | - Walter P Wodchis
- Institute of Health Policy Management & Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Gary Teare
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Health Science Building, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
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Mousa A, Savva GM, Mitnitski A, Rockwood K, Jagger C, Brayne C, Matthews FE. Is frailty a stable predictor of mortality across time? Evidence from the Cognitive Function and Ageing Studies. Age Ageing 2018; 47:721-727. [PMID: 29905755 PMCID: PMC6108394 DOI: 10.1093/ageing/afy077] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 12/02/2022] Open
Abstract
Background age-specific mortality reduction has been accompanied by a decrease in the prevalence of some diseases and an increase in others. Whether populations are becoming ‘healthier’ depends on which aspect of health is being considered. Frailty has been proposed as an integrative measure to quantify health status. Objective to investigate changes in the near-term lethality of frailty before and after a 20-year interval using the frailty index (FI), a summary of age-related health deficit accumulation. Design baseline data from the Cognitive Function and Ageing Studies (CFAS) in 1991 (n = 7,635) and 2011 (n = 7,762). Setting three geographically distinct UK centres (Newcastle, Cambridgeshire and Nottingham). Subjects individuals aged 65 and over (both institutionalised and community-living). Methods a 30-item frailty score was used, which includes morbidities, risk factors and subjective measures of disability. Missing items were imputed using multiple imputations by chained equations. Binomial regression was used to investigate the relationship between frailty, age, sex and cohort. Two-year mortality was modelled using logistic regression. Results mean frailty was slightly higher in CFAS II (0.19, 95% confidence interval (CI): 0.19–0.20) than CFAS I (0.18, 95% CI: 0.17–0.18). Two-year mortality in CFAS I was higher than in CFAS II (odds ratio (OR) = 1.16, 95% CI: 1.03–1.30). The association between frailty and 2-year mortality was non-linear with an OR of ~1.6 for each 0.10 increment in the FI. Conclusions the relationship between frailty and mortality did not significantly differ across the studies. Severe frailty as an indicator of mortality is shown to be a stable construct.
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Affiliation(s)
- Andria Mousa
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Arnold Mitnitski
- Department of Medicine, Dalhousie University, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Carol Jagger
- Institute of Health and Society, Newcastle University Institute for Ageing, Newcastle University, Newcastle, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, Cambridge, UK
| | - Fiona E Matthews
- Institute of Health and Society, Newcastle University Institute for Ageing, Newcastle University, Newcastle, UK
- MRC Biostatistics Unit, Cambridge University, Cambridge, UK
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Gregorevic K, Hubbard RE, Peel NM, Lim WK. Validation of the health assets index in the Australian inpatient setting: a multicentre prospective cohort protocol study. BMJ Open 2018; 8:e021135. [PMID: 29748346 PMCID: PMC5950646 DOI: 10.1136/bmjopen-2017-021135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION It is well known that frail older adults are at increased risk for mortality and functional decline on admission to hospital. Systematic review demonstrates that health assets are associated with improved outcomes for hospitalised older adults. The health assets index (HAI) has been developed to measure health assets in the hospital setting. A protocol has been developed to determine the predictive validity of the HAI for frail older adults. METHODS AND ANALYSIS The HAI was developed based on a systematic review and secondary analysis of the interRAI-Acute Care (interRAI-AC) dataset. A pilot study was undertaken to refine the tool.The validation study will be a multicentre prospective cohort. Participants will be adults aged 70 years and older with an unplanned admission to hospital. Frailty, illness severity and demographic data will also be recorded. The primary outcomes are mortality at 28 days postdischarge and functional decline at the time of discharge from hospital. The primary hypothesis is that a higher score on the HAI will mitigate the effects of frailty for hospitalised older adults. The secondary outcomes to be recorded are length of stay, readmission at 28 days and functional status at 28 days postdischarge. The correlation between HAI and frailty will be explored. A multivariate analysis will be undertaken to determine the relationship between the HAI and the outcomes of interest. ETHICS AND DISSEMINATION Ethical approval has been obtained from Austin Health Human High Risk Ethics Committee. The results will be disseminated in peer-reviewed journals and research conferences. This study will determine whether the HAI has predictive validity for mortality and functional decline for hospitalised, frail older adults.
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Affiliation(s)
| | - Ruth E Hubbard
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nancye May Peel
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged care, Melbourne Health, Parkville, Victoria, Australia
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Brothers TD, Kirkland S, Theou O, Zona S, Malagoli A, Wallace LMK, Stentarelli C, Mussini C, Falutz J, Guaraldi G, Rockwood K. Predictors of transitions in frailty severity and mortality among people aging with HIV. PLoS One 2017; 12:e0185352. [PMID: 28981535 PMCID: PMC5628822 DOI: 10.1371/journal.pone.0185352] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND People aging with HIV show variable health trajectories. Our objective was to identify longitudinal predictors of frailty severity and mortality among a group aging with HIV. METHODS Exploratory analyses employing a multistate transition model, with data from the prospective Modena HIV Metabolic Clinic Cohort Study, based in Northern Italy, begun in 2004. Participants were followed over four years from their first available visit. We included all 963 participants (mean age 46.8±7.1; 29% female; 89% undetectable HIV viral load; median current CD4 count 549, IQR 405-720; nadir CD4 count 180, 81-280) with four-year data. Frailty was quantified using a 31-item frailty index. Outcomes were frailty index score or mortality at four-year follow-up. Candidate predictor variables were baseline frailty index score, demographic (age, sex), HIV-disease related (undetectable HIV viral load, current CD4+ T-cell count, nadir CD4 count, duration of HIV infection, and duration of antiretroviral therapy [ARV] exposure), and behavioral factors (smoking, injection drug use (IDU), and hepatitis C virus co-infection). RESULTS Four-year mortality was 3.0% (n = 29). In multivariable analyses, independent predictors of frailty index at follow-up were baseline frailty index (RR 1.06, 95% CI 1.05-1.07), female sex (RR 0.93, 95% CI 0.87-0.98), nadir CD4 cell count (RR 0.96, 95% CI 0.93-0.99), duration of HIV infection (RR 1.06, 95% CI 1.01-1.12), duration of ARV exposure (RR 1.08, 95% CI 1.02-1.14), and smoking pack-years (1.03, 1.01-1.05). Independent predictors of mortality were baseline frailty index (OR 1.19, 1.02-1.38), current CD4 count (0.34, 0.20-0.60), and IDU (2.89, 1.30-6.42). CONCLUSIONS Demographic, HIV-disease related, and social and behavioral factors appear to confer risk for changes in frailty severity and mortality among people aging with HIV.
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Affiliation(s)
- Thomas D. Brothers
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan Kirkland
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stefano Zona
- Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Andrea Malagoli
- Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Lindsay M. K. Wallace
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chiara Stentarelli
- Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Cristina Mussini
- Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Julian Falutz
- McGill University Hospital Centre, Montreal, Quebec, Canada
| | - Giovanni Guaraldi
- Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Campos ACV, Rezende GPD, Ferreira EFE, Vargas AMD, Gonçalves LHT. Funcionalidade familiar de idosos brasileiros residentes em comunidade. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Avaliar a funcionalidade familiar de idosos brasileiros; testar a influência de fatores determinantes. Métodos Estudo transversal com 2.052 idosos, a partir de dados coletados da linha base referente ao estudo “Aging, Gender and Quality of Life (AGEQOL)”, responderam questionários sobre funcionamento familiar; atividades básicas e instrumentais de vida diária (AVD e AIVD); estado cognitivo; e características sociodemográficas. Modelos multivariados de regressão ordinal e análise de correspondência múltipla identificaram fatores associados à boa funcionalidade familiar. Resultados A maior parte dos idosos gozava de boa funcionalidade familiar (76,3%), era casada e vivendo com cônjuge (55,5%), tinha mais de seis filhos e netos (85,4% e 76,7%, respectivamente) e independente para AIVD (71,5%). Análise de correspondência resultou em três grupos: alta, moderada e baixa funcionalidade familiar e perfil de idosos com distintas condições socioeconômicas. Conclusão Infere-se dos resultados implicações para a prática e política de atenção à família com membros idosos segundo seu funcionamento e distintas condições de vida e saúde das pessoas idosas.
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Pereira AA, Borim FSA, Neri AL. Absence of association between frailty index and survival in elderly Brazilians: the FIBRA Study. CAD SAUDE PUBLICA 2017; 33:e00194115. [PMID: 28614455 DOI: 10.1590/0102-311x00194115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 07/08/2016] [Indexed: 01/10/2023] Open
Abstract
In Brazil, the frailty index has not been evaluated previously for its capacity to predict mortality in community-dwelling elderly. The objective of the current study was to evaluate the association between frailty index and mortality in the elderly. This was a prospective study consisting of data from the FIBRA Network-2008-2009 in Campinas, São Paulo State, with information on community-dwelling older adults from the urban area and through the Mortality Information System. Comparisons and statistical associations were performed with the following tests: Mann-Whitney, Kruskal-Wallis, chi-square, and Cox regression with 95% confidence intervals. A total of 689 older adults participated 72.1 ± 5.3 years), of whom 68.8% were women. The prevalence rate for frailty was 38.8%, compared to 51.6% for pre-frailty and 9.6% for fit elders; overall mean frailty index was higher in women. There was no association between frailty index and chronological age. Cox regression showed that the variables age HR: 1.10; 95%CI: 1.05-1.15) and gender HR: 0.57; 95%CI: 0.33-0.99) were significantly associated with mortality. No association was found between frailty index and mortality HR: 3.02; 95%CI: 0.24-37.64). Frailty index was not capable of predicting mortality in community-dwelling elderly Brazilians.
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Hornby-Turner YC, Peel NM, Hubbard RE. Health assets in older age: a systematic review. BMJ Open 2017; 7:e013226. [PMID: 28515182 PMCID: PMC5777471 DOI: 10.1136/bmjopen-2016-013226] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Finding ways to optimise health in older age is key to reducing the impact of population ageing on health and social care systems. A salutogenic approach takes into account an individual's health assets-internal or external strengths or accessible resources which improve and preserve physical, social and mental wellness, independence and quality of life. The aim of this narrative systematic review was to provide a summary and appraisal of the evidence for factors that act as health assets within personal, social, economic and environmental domains. METHODS Systematic searches of databases were conducted for literature published in peer-reviewed journals between January 2000 and November 2016. Selection criteria included community dwelling populations aged 65 years and over and publications written in English. Data on study population, design, measures of health status, factors within the four previously stated domains and results were extracted. Study quality was independently assessed using an appraisal instrument. RESULTS Twenty-three publications, including 78 422 participants, from more than 13 different countries were identified for inclusion in this review. There was strong evidence that higher scores of self-rated health, psychological well-being and life satisfaction were associated with better health in older age. Social network and contact with family and friends, and engagement in leisure and social activities were important support mechanisms. Education and financial resources consistently proved to be key economic health assets for older adults. CONCLUSIONS Implementing an asset-based approach to health promotion uncovers the skills, knowledge, connections and potential of the individual and the community. This approach is an ideal opportunity for government health bodies and their partners to respond to the challenges faced by global ageing.Factors are often interdependent and cumulative, suggesting the potential for an instrument to measure the accumulated effect of health assets on health status in older adults.
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Affiliation(s)
- Yvonne Claire Hornby-Turner
- Centre for Research in Geriatric Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nancye May Peel
- Centre for Research in Geriatric Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ruth Eleanor Hubbard
- Centre for Research in Geriatric Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Wang C, Fang X, Hua Y, Liu Y, Zhang Z, Gu X, Wu X, Tang Z, Guan S, Liu H, Liu B, Guo X, Ji X. Lipoprotein-Associated Phospholipase A2 and Risk of Carotid Atherosclerosis and Cardiovascular Events in Community-Based Older Adults in China. Angiology 2017; 69:49-58. [PMID: 28429599 DOI: 10.1177/0003319717704554] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We explored the associations between lipoprotein-associated phospholipase A2 (Lp-PLA2) level and carotid atherosclerosis with all phenotypes and cardiovascular disease (CVD) events in Chinese older adults. A total of 1257 adults aged ≥55 years who were free of CVD were enrolled in this cohort study. Lipoprotein-associated phospholipase A2 level was evaluated in 3 categories: Lp-PLA2 < 175, 175≤ Lp-PLA2 < 223, and Lp-PLA2 ≥ 223 ng/mL. The highest level of Lp-PLA2 was independently associated with common carotid artery intima-media thickening (≥1.0 mm; odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.14-2.26) and carotid plaque (OR: 1.42, 95% CI: 1.01-1.99) in individuals without carotid artery stenosis. At the end of the 5-year follow-up, after adjustment for CVD risk factors and carotid atherosclerosis status, Lp-PLA2 had remained an independent predictor for myocardial infarction (MI; hazard ratio [HR]: 1.90, 95% CI: 1.02-3.55) and CVD death (HR: 1.78, 95% CI: 1.02-3.13). However, no association was found with stroke. Therefore, elevated Lp-PLA2 level in the older adults studied was associated with an increased risk of carotid atherosclerosis and MI and CVD mortality. Lipoprotein-associated phospholipase A2 assessment might be used for MI and CVD death risk prediction.
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Affiliation(s)
- Chunxiu Wang
- 1 Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xianghua Fang
- 1 Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Hua
- 2 Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yutong Liu
- 3 Department of Applied Mathematics, School of Mathematics and System Science, Beihang University, Beijing, China
| | - Zhongying Zhang
- 4 Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang Gu
- 5 Department of Geriatrics, Youyi Hospital, Capital Medical University, Beijing, China
| | - Xiaoguang Wu
- 1 Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhe Tang
- 1 Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shaochen Guan
- 1 Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongjun Liu
- 1 Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Beibei Liu
- 2 Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiuhai Guo
- 6 Department of Neurological, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- 7 Department of Neurological Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Wang C, Ji X, Wu X, Tang Z, Zhang X, Guan S, Liu H, Fang X. Frailty in Relation to the Risk of Alzheimer's Disease, Dementia, and Death in Older Chinese Adults: A Seven-Year Prospective Study. J Nutr Health Aging 2017; 21:648-654. [PMID: 28537328 DOI: 10.1007/s12603-016-0798-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore the relationship of general health decline assessed by frailty and risk of dementia and Alzheimer's disease (AD). DESIGN A seven-year prospective cohort study. SETTING Secondary analysis of data from the Beijing Longitudinal Study on Aging. PARTICIPANTS Urban and rural community-dwelling people aged 60 and older at baseline. MEASUREMENTS Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 40 health deficits at baseline. Dementia was diagnosed by DSM-IIIR. AD and vascular dementia (VaD) were diagnosed by NINCDS-ADRDA and NINDS-AIREN. The relationships between frailty and the risk of dementia, AD and death were evaluated through multivariable models. RESULTS Of 2788 participants at baseline (1997), 171 (11.1%) reported a history of dementia. In seven years, 351 people developed dementia (13%: 223 AD and 128 other types of dementia) and 813 died (29%). After adjustment for age, sex, education, and baseline cognition, baseline frailty status significantly associated with Alzheimer's disease and dementia and death. For each deficit accumulated, the odds ratio of death increased by 5.7%, and the odds ratio of dementia increased by 2.9% (p < 0.001). CONCLUSION Frailty was associated with Alzheimer's disease and dementia over a seven years period. Frailty index might facilitate the identification of older adults at high risk of dementia for the application of the most effective, targeted prevention strategies.
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Affiliation(s)
- C Wang
- Prof Xianghua Fang, Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University. No 45 Changchun street, Xicheng district, Beijing, China. Tel: +861083199295; fax: +861063153439 E-mail address: (Xianghua Fang)
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Wang C, Liu C, Gao H, Liu H. Order of aging of major human organs or systems and evaluation of health status based on aging. Biomarkers 2016; 22:145-148. [PMID: 27800690 DOI: 10.1080/1354750x.2016.1252951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To determine the functional age of an individual, a quantitative system for the assessment of aging status was developed in the present study. A total of 1579 subjects were selected randomly from patients undergoing physical examination. The index of organic mild impairment (IOMI) and IOMI corrected for age (COMI) were calculated. By receiver operating characteristic (ROC) curve analysis of the IOMIs of younger and elderly subjects, a cutoff value for COMI of 30% was obtained. About 95% of <30-year-old subjects were healthy. These data suggest that organs and systems reflect the aging status of an individual and may be a useful tool for evaluating health status.
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Affiliation(s)
- Chengfang Wang
- a Health Management Center, First Affiliated Hospital of Dalian Medical University , Dalian , China
| | - Chunqing Liu
- b College of Medical Laboratory , Dalian Medical University , Dalian , China
| | - Hanboya Gao
- a Health Management Center, First Affiliated Hospital of Dalian Medical University , Dalian , China
| | - Hui Liu
- b College of Medical Laboratory , Dalian Medical University , Dalian , China
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18
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The Identification of Hereditary and Environmental Determinants of Frailty in a Cohort of UK Twins. Twin Res Hum Genet 2016; 19:600-609. [DOI: 10.1017/thg.2016.72] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Our study examines the contribution of genetic and environmental factors (both shared and unique) to frailty, measured using the Rockwood Frailty Index (FI) in a sample of twins from the St Thomas’ UK Adult Twin Registry. The FI was based on 39 items of potential health deficit. Study participants were 3,375 volunteer adult twins (840 monozygotic and 802 dizygotic twin-pairs) 40.0–84.5 years old. First, we used structural equation modeling to estimate the relative contribution of genetics and of the shared and unique environment to variance in FI adjusted for age. In a second analysis, multiple linear regression was used to examine variance in FI as a function of father's occupational class (a component of shared environment and a measure of childhood socioeconomic status [SES]), adjusting for age, birth weight, marital status, and health behaviors (smoking, alcohol consumption, and physical activity). Statistical analyses were conducted using IBM SPSS® Version 22 software and Mx open source software. Findings showed that 45% (95% confidence intervals [CIs] 30–53%) of the inter-individual variation in FI was heritable and 52% (95% CIs 47–57%) was due to the individual's unique environment. Multiple linear regression also showed a small but statistically significant inverse association between father's occupational class and FI, mediated by one's own educational attainment and birth weight. Our results indicate that frailty is both genetically and environmentally determined. Thus, its prevention and management call for a multifaceted approach that includes addressing deleterious environmental factors, some of which, like childhood SES, may act across the life course.
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Gray WK, Richardson J, McGuire J, Dewhurst F, Elder V, Weeks J, Walker RW, Dotchin CL. Frailty Screening in Low- and Middle-Income Countries: A Systematic Review. J Am Geriatr Soc 2016; 64:806-23. [PMID: 27100577 DOI: 10.1111/jgs.14069] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To conduct a systematic review of frailty screening tools used in low- and middle-income countries (LMICs). DESIGN Systematic review. SETTING LMICs, as defined by the World Bank on June 30, 2014. PARTICIPANTS Elderly adults (as defined by the authors) living in LMICs. MEASUREMENTS Studies were included if the population under consideration lived in a LMIC, the study involved an assessment of frailty, the study population was elderly adults, and the full text of the study was available in English. The Medline, Embase, CINAHL and PsychINFO databases were searched up to June 30, 2014. RESULTS Seventy studies with data from 22 LMICs were included in the review. Brazil, Mexico, and China provided data for 60 of the 70 studies (85.7%), and 15 countries contributed data to only one study. Thirty-six studies used the Fried criteria to assess frailty, 20 used a Frailty Index, and eight used the Edmonton Frailty Scale; none of the assessment tools used had been fully validated for use in a LMIC. CONCLUSION There has been a rapid increase in the number of published studies of frailty in LMICs over the last 5 years. Further validation of the assessment tools used to identify frail elderly people in LMICs is needed if they are to be efficient in identifying those most in need of health care in such settings.
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Affiliation(s)
- William K Gray
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Jenny Richardson
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Jackie McGuire
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | | | - Vasanthi Elder
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Julie Weeks
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Richard W Walker
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine L Dotchin
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
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Are health assets associated with improved outcomes for hospitalised older adults? A systematic review. Arch Gerontol Geriatr 2016; 67:14-20. [PMID: 27395376 DOI: 10.1016/j.archger.2016.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Health assets are protective factors that support health and wellbeing, rather than risk factors that are associated with disease. This concept was developed in the community setting. In hospitalised older adults, the dominant approach has been to identify risk factors, with little examination of health assets. The purpose of this systematic review was to determine whether, in hospitalised older people, individual health assets decrease the risk of post hospital mortality, functional decline, new need for residential care, readmission or longer length of stay. METHODS MEDLINE, EMBASE, CINAHL and PsycINFO were searched to identify studies examining outcomes for hospitalised older adults. Included studies examined at least one potential individual health asset, which was a psychosocial characteristic or health characteristic. Study quality was assessed, and findings are narratively described. RESULTS Nine prospective cohort and two retrospective cohort studies were identified. subjective, functional and biological health assets were identified. Health assets were associated with decreased risk of post-hospital mortality, functional decline, new need for residential care and readmission. CONCLUSION The complex interplay between health status and psychological and social factors is incompletely understood. Health assets are associated with improved outcomes for hospitalised older adults. The small number of studies suitable for inclusion indicates the need for further research in this area.
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Gregorevic KJ, Hubbard RE, Lim WK, Katz B. The clinical frailty scale predicts functional decline and mortality when used by junior medical staff: a prospective cohort study. BMC Geriatr 2016; 16:117. [PMID: 27250650 PMCID: PMC4890513 DOI: 10.1186/s12877-016-0292-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing frailty is associated with risk of mortality and functional decline in hospitalized older adults, but there is no consensus on the best screening method for use by non-geriatricians. The objective of this study is to determine whether the clinical frailty scale (CFS) can be used to identify patient baseline frailty status in the acute general medical setting when used by junior medical staff using information obtained on routine clinical assessment. METHODS This was a prospective cohort study in an acute general medical unit. All patients aged 65 and over admitted to a general medical unit during August and September 2013 were eligible for the study. CFS score at baseline was documented by a member of the treating medical team. Demographic information and outcomes were obtained from medical records. The primary outcomes were functional decline and death within three months. RESULTS Frailty was assessed in 95 % of 179 eligible patients. 45 % of patients experienced functional decline and 11 % died within three months. 40 % of patients were classified as vulnerable/mildly frail, and 41 % were moderately to severely frail. When patients in residential care were excluded, increasing frailty was associated with functional decline (p = 0.011). Increasing frailty was associated with increasing mortality within three months (p = 0.012). CONCLUSIONS A high proportion of eligible patients had the frailty measure completed, demonstrating the acceptability of the CFS to clinicians. Despite lack of training for medical staff, increasing frailty was correlated with functional decline and mortality supporting the validity of the CFS as a frailty screening tool for clinicians.
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Affiliation(s)
- Kate J Gregorevic
- Department of Aged Care, Northern Hospital, 185 Cooper St, Epping, Vic, 3076, Australia. .,North West Academic Centre, University of Melbourne, Melbourne, Australia.
| | - Ruth E Hubbard
- Geriatric Medicine Deputy Director, Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Australia
| | - Wen K Lim
- University of Melbourne, Melbourne, Australia.,Northern Hospital, Epping, Australia
| | - Benny Katz
- Geriatric Medicine, St Vincent's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,La Trobe University, Melbourne, Australia
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Fastame MC, Hitchcott PK, Penna MP, Murino G. Does institutionalization influence perceived metamemory, psychological well-being, and working-memory efficiency in Italian elders? A preliminary study. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jcgg.2015.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Epidemiological Characteristics of Hypertension in the Elderly in Beijing, China. PLoS One 2015; 10:e0135480. [PMID: 26295836 PMCID: PMC4546586 DOI: 10.1371/journal.pone.0135480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/22/2015] [Indexed: 12/12/2022] Open
Abstract
Background/Objectives The prevalence rate of hypertension increases significantly with the aging society, and hypertension is obviously becoming a major health care concern in China. The aim of the study was to explore the epidemiological characteristics of hypertension in the elderly and to provide a basis for the prevention of hypertension. Design 3-cross sectional studies in 2000, 2004, and 2007, respectively. Setting Beijing, China. Participants A group of 2,832, 1,828, and 2,277 elderly residents aged ≥60 years were included this study in 2000, 2004, and 2007, respectively. Intervention None. Measurements Statistical sampling techniques included cluster, stratification, and random selection. Trained staff used a comprehensive geriatric assessment questionnaire and a standard survey instrument to complete the assessments. During the person-to-person interviews, the participants’ demographic characteristics, living conditions, and health status were collected, and their blood pressure was measured. Results The prevalence rates (69.2%, 61.9%, and 56.0%) of hypertension and the control rates (22.6%, 16.7%, and 21.5%) lowered annually, while the awareness rates (43.7%, 55.8%, and 57.6%) of the treatment elevated annually in 2000, 2004, and 2007, respectively. There was no increase in the control rates for males (26.2%, 16.7%, and 20.8%), younger participants (28.0%, 18.4%, and 21.0%), and rural residents (19.5%, 9.6%, and 13.4%) in 2000, 2004, and 2007, respectively. Conclusions Our study findings indicated that the prevalence of hypertension is high in rural elderly participants, while the rates of awareness, treatment, and control were low. This suggests that effective public measures need to be developed to improve the prevention and control of hypertension.
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Abstract
Aging occurs as a series of small steps, first causing cellular damage and then affecting tissues and organs. This is also true in the brain. Frailty, a state of increased risk due to accelerated deficit accumulation, is robustly a risk factor for cognitive impairment. Community-based autopsy studies show that frail individuals have brains that show multiple deficits without necessarily demonstrating cognitive impairment. These facts cast a new light on the growing number of risk factors for cognitive impairment, suggesting that, on a population basis, most health deficits can be associated with late-life cognitive impairment. The systems mechanism by which things that are bad for the body are likely to be bad for the brain can be understood like this: the burden of health deficits anywhere indicates impaired ability to withstand or repair endogenous and environmental damage. This in turn makes additional damage more likely. If true, this suggests that a life course approach to preventing cognitive impairment is desirable. Furthermore, conducting studies in highly selected, younger, healthier individuals to provide ‘proof of concept’ information is now common. This strategy might exclude the very circumstances that are required for disease expression in the people in whom dementia chiefly occurs (that is, older adults who are often in poor health).
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Affiliation(s)
- Samuel D Searle
- Department of Medicine, Dalhousie University, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada ; Capital District Health Authority, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada ; Centre for Health Care of Elderly, Division of Geriatric Medicine QEII Health Sciences Centre, Capital District Health Authority, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada
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Armstrong JJ, Mitnitski A, Andrew MK, Launer LJ, White LR, Rockwood K. Cumulative impact of health deficits, social vulnerabilities, and protective factors on cognitive dynamics in late life: a multistate modeling approach. ALZHEIMERS RESEARCH & THERAPY 2015; 7:38. [PMID: 26052349 PMCID: PMC4457088 DOI: 10.1186/s13195-015-0120-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/16/2015] [Indexed: 01/03/2023]
Abstract
Introduction Many factors influence late-life cognitive changes, and evaluating their joint impact is challenging. Typical approaches focus on average decline and a small number of factors. We used multistate transition models and index variables to look at changes in cognition in relation to frailty (accumulation of health deficits), social vulnerability, and protective factors in the Honolulu-Asia Aging Study (HAAS). Methods The HAAS is a prospective cohort study of 3,845 men of Japanese descent, aged 71 to 93 years at baseline. Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI). Baseline index variables were constructed of health deficits (frailty), social vulnerabilities, and protective factors. The chances of improvement/stability/decline in cognitive function and death were simultaneously estimated using multistate transition modeling for 3- and 6-year transitions from baseline. Results On average, CASI scores declined by 5.3 points (standard deviation (SD) = 10.0) over 3 years and 9.5 points (SD = 13.9) over 6 years. After adjusting for education and age, baseline frailty was associated with an increased risk of cognitive decline at 3 years (β = 0.18, 95% confidence interval (CI), 0.08 to 0.29) and 6 years (β = 0.40, 95% CI, 0.27 to 0.54). The social vulnerability index was associated with 3-year changes (β = 0.16, 95% CI, 0.09 to 0.23) and 6-year changes (β = 0.14, 95% CI, 0.05 to 0.24) in CASI scores. The protective index was associated with reductions in cognitive decline over the two intervals (3-year: β = −0.16, 95% CI, −0.24 to −0.09; 6-year: β = −0.21, 95% CI, −0.31 to –0.11,). Conclusions Research on cognition in late life needs to consider overall health, the accumulation of protective factors, and the dynamics of cognitive change. Index variables and multistate transition models can enhance understanding of the multifactorial nature of late-life changes in cognition. Electronic supplementary material The online version of this article (doi:10.1186/s13195-015-0120-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joshua J Armstrong
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Arnold Mitnitski
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Melissa K Andrew
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University, Halifax, NS Canada ; Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, NS Canada
| | - Lenore J Launer
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD USA
| | - Lon R White
- Pacific Health Research & Education Institute, Honolulu, HI USA
| | - Kenneth Rockwood
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University, Halifax, NS Canada ; Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, NS Canada
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