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Fei Y, Niu S, Xi X, Tang W, Zhao Y, Zhang G, Yu X, Li C, Li X, Liu Y, Li Y, Yin Y, Cui Y, Li X. Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults especially for females: a cross-sectional study. BMC Geriatr 2024; 24:468. [PMID: 38811863 PMCID: PMC11134949 DOI: 10.1186/s12877-024-05056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Oral frailty is reported to increase the risk of new onset of mild cognitive impairment. Whereas, the association of oral frailty with cognition among older adults in both physical frail and non-physical frail status has not been sufficiently explored, and whether there are sex differences in the association is unclear. This study investigated the association of oral frailty and physical frailty with global cognitive function and executive function among older adults, as well as the sex differences in such association. METHODS This cross-sectional study included 307 participants aged ≥ 60 years old from communities between June 2023 and August 2023, in Nanjing, China. Global cognitive function and executive function were assessed by using the Montreal Cognitive Assessment (MoCA) and Trail Making Tests A (TMT-A), respectively. Oral frailty was identified by the combination of natural tooth, Oral Frailty Index-8 (OFI-8), and oral diadochokinesis. Physical frailty was measured by using Fried phenotype model which contained 5 criteria: unintentional weight loss, weakness, exhaustion, slowness, and low physical activity. Multiple linear regression analyses for overall participants and stratified by sex and presence or absence of physical frailty were performed, respectively, to examine the association between oral frailty and cognitive functions. RESULTS The median age of participants was 70 years old. The study included 158 (51.5%) females, 53 (17.3%) individuals with physical frailty, and 65 (21.2%) participants with oral frailty. After adjustment, the association between oral frailty and global cognitive function was observed in the physical frailty group (B = -2.67, 95% Confidence Interval [CI]: -5.27 to -0.07, p = 0.045) and the females with physical frailty (B = -4, 95% CI: -7.41 to -0.58, p = 0.024). Oral frailty was associated with executive function in overall participants (B = 0.12, 95% CI: 0.01 to 0.22, p = 0.037), physical frailty group (B = 23.68, 95% CI: 1.37 to 45.99, p = 0.038). In the adjusted models, oral frailty was significantly associated with executive function in all females (B = 0.21, 95% CI: 0.05 to 0.36, p = 0.009), in females without physical frailty (B = 0.19, 95% CI: 0.02 to 0.36, p = 0.027), and in females with physical frailty (B = 48.69, 95% CI: 7.17 to 90.21, p = 0.024). CONCLUSIONS Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults, particularly among females. It is ponderable to consider sex differences and facilitate the management of physical frailty when it comes to promoting cognitive health based on the perspective of oral health among older adults.
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Affiliation(s)
- Yang Fei
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Shuzhen Niu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Xueru Xi
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Wenping Tang
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yue Zhao
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Ge Zhang
- Department of Geriatrics (Geriatric Neurology), the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, China
| | - Xiaohong Yu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Cheng Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Xinru Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Ying Liu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yaxin Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yueheng Yin
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China.
| | - Yan Cui
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China.
| | - Xianwen Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
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Lenoir KM, Paul R, Wright E, Palakshappa D, Pajewski NM, Hanchate A, Hughes JM, Gabbard J, Wells BJ, Dulin M, Houlihan J, Callahan KE. The Association of Frailty and Neighborhood Disadvantage with Emergency Department Visits and Hospitalizations in Older Adults. J Gen Intern Med 2024; 39:643-651. [PMID: 37932543 PMCID: PMC10973290 DOI: 10.1007/s11606-023-08503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Risk stratification and population management strategies are critical for providing effective and equitable care for the growing population of older adults in the USA. Both frailty and neighborhood disadvantage are constructs that independently identify populations with higher healthcare utilization and risk of adverse outcomes. OBJECTIVE To examine the joint association of these factors on acute healthcare utilization using two pragmatic measures based on structured data available in the electronic health record (EHR). DESIGN In this retrospective observational study, we used EHR data to identify patients aged ≥ 65 years at Atrium Health Wake Forest Baptist on January 1, 2019, who were attributed to affiliated Accountable Care Organizations. Frailty was categorized through an EHR-derived electronic Frailty Index (eFI), while neighborhood disadvantage was quantified through linkage to the area deprivation index (ADI). We used a recurrent time-to-event model within a Cox proportional hazards framework to examine the joint association of eFI and ADI categories with healthcare utilization comprising emergency visits, observation stays, and inpatient hospitalizations over one year of follow-up. KEY RESULTS We identified a cohort of 47,566 older adults (median age = 73, 60% female, 12% Black). There was an interaction between frailty and area disadvantage (P = 0.023). Each factor was associated with utilization across categories of the other. The magnitude of frailty's association was larger than living in a disadvantaged area. The highest-risk group comprised frail adults living in areas of high disadvantage (HR 3.23, 95% CI 2.99-3.49; P < 0.001). We observed additive effects between frailty and living in areas of mid- (RERI 0.29; 95% CI 0.13-0.45; P < 0.001) and high (RERI 0.62, 95% CI 0.41-0.83; P < 0.001) neighborhood disadvantage. CONCLUSIONS Considering both frailty and neighborhood disadvantage may assist healthcare organizations in effectively risk-stratifying vulnerable older adults and informing population management strategies. These constructs can be readily assessed at-scale using routinely collected structured EHR data.
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Affiliation(s)
- Kristin M Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Elena Wright
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Deepak Palakshappa
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of General Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Amresh Hanchate
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jaime M Hughes
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Gabbard
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Brian J Wells
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Michael Dulin
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jennifer Houlihan
- Value Based Care and Population Health, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Kathryn E Callahan
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Gonzalez A, Soto J, Babiker N, Wroblewski K, Sawicki S, Schoeller D, Luke A, Huisingh-Scheetz M. Higher baseline resting metabolic rate is associated with 1-year frailty decline among older adults residing in an urban area. BMC Geriatr 2023; 23:815. [PMID: 38062368 PMCID: PMC10704798 DOI: 10.1186/s12877-023-04534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Dysregulated energy metabolism is one hypothesized mechanism underlying frailty. Resting energy expenditure, as reflected by resting metabolic rate (RMR), makes up the largest component of total energy expenditure. Prior work relating RMR to frailty has largely been done in cross section with mixed results. We investigated whether and how RMR related to 1-year frailty change while adjusting for body composition. METHODS N = 116 urban, predominantly African-American older adults were recruited between 2011 and 2019. One-year frailty phenotype (0-5) was regressed on baseline RMR, frailty phenotype, demographics and body composition (DEXA) in an ordinal logistic regression model. Multimorbidity (Charlson comorbidity scale, polypharmacy) and cognitive function (Montreal Cognitive Assessment) were separately added to the model to assess for change to the RMR-frailty relationship. The model was then stratified by baseline frailty status (non-frail, pre-frail) to explore differential RMR effects across frailty. RESULTS Higher baseline RMR was associated with worse 1-year frailty (odds ratio = 1.006 for each kcal/day, p = 0.001) independent of baseline frailty, demographics, and body composition. Lower fat-free mass (odds ratio = 0.88 per kg mass, p = 0.008) was independently associated with worse 1-year frailty scores. Neither multimorbidity nor cognitive function altered these relationships. The associations between worse 1-year frailty and higher baseline RMR (odds ratio = 1.009, p < 0.001) and lower baseline fat-free mass (odds ratio = 0.81, p = 0.006) were strongest among those who were pre-frail at baseline. DISCUSSION We are among the first to relate RMR to 1-year change in frailty scores. Those with higher baseline RMR and lower fat-free mass had worse 1-year frailty scores, but these relationships were strongest among adults who were pre-frail at baseline. These relationships were not explained by chronic disease or impaired cognition. These results provide new evidence suggesting higher resting energy expenditure is associated with accelerate frailty decline.
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Affiliation(s)
| | - J Soto
- Illinois Institute of Technology, Chicago, USA
| | | | - K Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, USA
| | - S Sawicki
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, USA
| | - D Schoeller
- University of Wisconsin in Madison, Madison, USA
| | - A Luke
- Department of Public Health Sciences, Loyola University, Chicago, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, USA.
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Zhang H, Wei X, Pan J, Chen X, Sun X. Anemia and frailty in the aging population: implications of dietary fiber intake (findings of the US NHANES from 2007-2018). BMC Geriatr 2023; 23:634. [PMID: 37805459 PMCID: PMC10560428 DOI: 10.1186/s12877-023-04352-9] [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: 11/25/2022] [Accepted: 09/25/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Frailty has long been seen as an indicator of reduced physical functions in the elderly, which may be caused by a variety of chronic illnesses or cancerous tumors. Dietary fiber was connected with anemia and frailty, whereas it was uncertain if dietary fiber consumption modifies the impact of anemia on frailty in elderly adults. METHODS We performed a secondary analysis using older adults aged 60 years and over from the National Health and Nutrition Examination Survey (NHANES) 2007-2018 cycles. Dietary fiber intake was estimated using two 24-h dietary recalls. Participants were dichotomized as frail or non-frail based on a modified Fried physical frailty phenotype from previous NHANES studies. The weighted logistic regression was used to estimate the odds ratio (OR) and confidence interval (CI) for the associations between hemoglobin levels and frailty at high- and low-dietary fiber intake levels. RESULTS A total of 9644 older adults were included in this study, and the weighted sample was 56,403,031, of whom 3,569,186 (6.3%) were deemed to be frail, and the remainder were deemed to be non-frail. Among the low dietary fiber intake group, higher hemoglobin was significantly associated with a lower risk of frailty (OR = 0.79, 95% CI: 0.71-0.87), and anemia was associated with an almost threefold elevated risk of frailty (OR = 3.24, 95% CI:1.98-5.29) in the fully adjusted model. However, this phenomenon was not observed in groups with high dietary fiber intake. In addition, L-shaped dose response relationship was found in the high dietary fiber intake group (P overall association < 0.001; P non-linear association = 0.076). Whereas the dose response relationship was not significant in the high dietary fiber intake group (P overall association 0.752; P non-linear association = 0.734). CONCLUSIONS Frailty was positively associated with the severity of anemia in older adults with low, but not high, dietary fiber intake. Adequate fiber intake may be an innovative dietary strategy to reduce frailty in older adults.
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Affiliation(s)
- HuanRui Zhang
- Department of Geriatric, The First Hospital of China Medical University, NO.155 Nanjing North Street, Heping Ward, Shenyang, 110001, China
| | - Xuejiao Wei
- Department of Health Services and Policy Research, Queen's University, Kingston, ON, Canada
| | - Jiani Pan
- Department of Geriatric, The First Hospital of China Medical University, NO.155 Nanjing North Street, Heping Ward, Shenyang, 110001, China
| | - XiTao Chen
- Department of Thoracic Surgery, The First Hospital of China Medical University, NO.155 Nanjing North Street, Heping Ward, Shenyang, 110001, China.
| | - XiaoDi Sun
- Department of Geriatric, The First Hospital of China Medical University, NO.155 Nanjing North Street, Heping Ward, Shenyang, 110001, China.
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Han CY, Sharma Y, Yaxley A, Baldwin C, Woodman R, Miller M. Individualized Hospital to Home, Exercise-Nutrition Self-Managed Intervention for Pre-Frail and Frail Hospitalized Older Adults: The INDEPENDENCE Randomized Controlled Pilot Trial. Clin Interv Aging 2023; 18:809-825. [PMID: 37220521 PMCID: PMC10200110 DOI: 10.2147/cia.s405144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose Pre-frailty and frailty in older adults are associated with poor health outcomes and increase health-care costs, and further worsening during hospitalization. This study aimed to examine the effect of an individualized hospital to home, exercise-nutrition self-managed intervention for pre-frail and frail hospitalized older adults. Patients and Methods Older adults admitted to an acute medical unit of a tertiary hospital in South Australia who were pre-frail or frail were recruited from September 2020 to June 2021, randomized to either control or intervention group and followed up at 3 and 6 months. The outcome variables were program adherence, frailty status by the Edmonton Frail Scale (EFS) score, lower extremity physical function, handgrip strength, nutritional status, cognition, mood, health-related quality of life, risk of functional decline, unplanned readmissions. Results Participants were 79.2 ±6.6 years old, 63% female, mostly frail (67%), with EFS of 8.6±1.9. Adherence to the inpatient and home visits/telehealth intervention were high (91±13% and 92±21%, respectively). Intention-to-treat analysis using linear regression models showed that participants in the intervention group had significantly greater reduction in EFS at 3 (-3.0; 95% CI: -4.8 to -3.0) and 6 months (-2.5; 95% CI: -3.8 to -1.0, P<0.001 for both) compared to the control group; particularly the functional performance component. There were also improvements in overall Short Physical Performance Battery score at 3 (4.0; 95% CI: 1.3 to 6.6) and 6 months (3.9; 95% CI: 1.0 to 6.9, P<0.05 for both), mini-mental state examination (2.6; 95% 0.3-4.8, P=0.029) at 3 months and handgrip strength (3.7; 95% CI: 0.2-7.1, P=0.039) and Geriatric Depression Scale, at 6 months (-2.2; 95% CI: -4.1 to -0.30, P=0.026) in the intervention group as compared to control. Conclusion This study provided evidence of acceptability to a patient self-managed exercise-nutrition program that may benefit and alleviate pre-frailty and frailty in hospitalised older adults.
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Affiliation(s)
- Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of General Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Alison Yaxley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Claire Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Richard Woodman
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Michelle Miller
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Li L, Wang Y, Yang C, Huang C, Duan L, Zhou J, Lu Y, Zhao G. Frailty in hypertensive population and its association with all-cause mortality: data from the National Health and Nutrition Examination Survey. Front Cardiovasc Med 2023; 10:945468. [PMID: 37180794 PMCID: PMC10167047 DOI: 10.3389/fcvm.2023.945468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives This study aimed to investigate the relationship between frailty and all-cause mortality in hypertensive population. Methods We used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 and mortality data from the National Death Index. Frailty was assessed using the revised version of the Fried frailty criteria (weakness, exhaustion, low physical activity, shrinking, and slowness). This study aimed to evaluate the association between frailty and all-cause mortality. Cox proportional hazard models were used to evaluate the association between frailty category and all-cause mortality, adjusted for age, sex, race, education, poverty-income ratio, smoking, alcohol, diabetes, arthritis, congestive heart failure, coronary heart disease, stroke, overweight, cancer or malignancy, chronic obstructive pulmonary disease, chronic kidney disease, and taking medicine for hypertension. Results We gathered data of 2,117 participants with hypertension; 17.81%, 28.77%, and 53.42% were classified as frail, pre-frail, and robust, respectively. We found that frail [hazard ratio (HR) = 2.76, 95% confidence interval (CI) = 2.33-3.27] and pre-frail (HR = 1.38, 95% CI = 1.19-1.59] were significantly associated with all-cause mortality after controlling for variables. We found that frail (HR = 3.02, 95% CI = 2.50-3.65) and pre-frail (HR = 1.35, 95% CI = 1.15-1.58) were associated with all-cause mortality in the age group ≥65 years. For the frailty components, weakness (HR = 1.77, 95% CI = 1.55-2.03), exhaustion (HR = 2.25, 95% CI = 1.92-2.65), low physical activity (HR = 2.25, 95% CI = 1.95-2.61), shrinking (HR = 1.48, 95% CI = 1.13-1.92), and slowness (HR = 1.44, 95% CI = 1.22-1.69) were associated with all-cause mortality. Conclusion This study demonstrated that frailty and pre-frailty were associated with an increased risk of all-cause mortality in patients with hypertension. More attention should be paid to frailty in hypertensive patients, and interventions to reduce the burden of frailty may improve outcomes in these patients.
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Affiliation(s)
- Li Li
- Department of Cardiovascular Surgery, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuge Wang
- Department of Medicine, Jinggangshan University, Ji'an, China
| | - Chunlei Yang
- Department of Cardiology, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenhui Huang
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Lanzhi Duan
- Department of Medicine, Jinggangshan University, Ji'an, China
| | - Jianghua Zhou
- Department of Cardiology, The First Affliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yanyu Lu
- Department of Cardiology, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guojun Zhao
- Department of Cardiology, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
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Keizer HG, Brands R, Seinen W. An AMP Kinase-pathway dependent integrated stress response regulates ageing and longevity. Biogerontology 2023:10.1007/s10522-023-10024-3. [PMID: 36877293 DOI: 10.1007/s10522-023-10024-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/18/2023] [Indexed: 03/07/2023]
Abstract
The purpose of this article is to investigate the role of the AMP-kinase pathway (AMPK pathway) in the induction of a concomitant set of health benefits by exercise, numerous drugs, and health ingredients, all of which are adversely affected by ageing. Despite the AMPK pathway being frequently mentioned in relation to both these health effects and ageing, it appears challenging to understand how the activation of a single biochemical pathway by various treatments can produce such a diverse range of concurrent health benefits, involving so many organs. We discovered that the AMPK pathway functions as an integrated stress response system because of the presence of a feedback loop in it. This evolutionary conserved stress response system detects changes in AMP/ATP and NAD/NADH ratios, as well as the presence of potential toxins, and responds by activating a common protective transcriptional response that protects against aging and promotes longevity. The inactivation of the AMPK pathway with age most likely explains why ageing has a negative impact on the above-mentioned set of health benefits. We conclude that the presence of a feedback loop in the AMP-kinase pathway positions this pathway as an AMPK-ISR (AMP Kinase-dependent integrated stress response) system that responds to almost any type of (moderate) environmental stress by inducing various age-related health benefits and longevity.
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Affiliation(s)
- H G Keizer
- AMRIF Biotechnology, Agrobusiness Park 10, 6708 PW, Wageningen, The Netherlands.
| | - R Brands
- AMRIF Biotechnology, Agrobusiness Park 10, 6708 PW, Wageningen, The Netherlands.,Institute for Risk Assessment Sciences (IRAS), Yalelaan 1, 3584 CL, Utrecht, The Netherlands
| | - W Seinen
- AMRIF Biotechnology, Agrobusiness Park 10, 6708 PW, Wageningen, The Netherlands.,Institute for Risk Assessment Sciences (IRAS), Yalelaan 1, 3584 CL, Utrecht, The Netherlands
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Guan Z, Ma L, Wu C. Association Between Serum Klotho and Physical Frailty in Middle-Aged and Older Adults: Finding From the National Health and Nutrition Examination Survey. J Am Med Dir Assoc 2023:S1525-8610(23)00226-8. [PMID: 37001558 DOI: 10.1016/j.jamda.2023.02.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/10/2023] [Accepted: 02/18/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES To date, no consensus has been reached regarding the role of klotho in the development of frailty. This study aimed to examine the relationship between serum klotho and physical frailty and to explore potential age, sex, and racial/ethnic differences, using a large, nationally representative sample of middle-aged and older adults in the United States. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Participants were 7107 adults aged 45 years or older from the 2007-2008, 2009-2010, 2011-2012, 2013-2014, and 2015-2016 cycles of the National Health and Nutrition Examination Survey (NHANES), a large data set including a series of cross-sectional nationally representative samples in the United States. METHODS We assessed the frailty status using the Physical Frailty Phenotype (PFP) and the Frailty Index (FI). Five criteria were used in the PFP, and 34 health items were included to construct the FI as a proportion of accumulated deficits. We used multinomial and binary logistic regression models to examine the association between serum klotho and frailty, adjusted for several covariates. RESULTS Participants with a higher serum klotho level (>785.5 pg/mL) had a lower prevalence of frailty, defined by either the PFP or the FI, than those with a lower level (≤785.5 pg/mL). After adjustment for all covariates, the higher serum klotho level was associated with a 26% (95% CI 2%-45%) and 17% (95% CI 1%-30%) lower odds of frailty vs robustness when using the PFP and FI, respectively. In the PFP, the association was significantly stronger among participants aged <60 years than those aged ≥60 years (odds ratio: 0.60 vs 0.85; Pinteraction = .03). No effect modification by race/ethnicity on the association was found. CONCLUSIONS AND IMPLICATIONS Higher serum klotho level relates to lower odds of physical frailty among middle-aged and older adults. Our findings suggest that klotho might be a potential biomarker of frailty, specifically in the middle-aged population. Future research should further investigate the mechanisms underlying this association to determine if lower levels of klotho may serve as a novel risk factor for physical frailty.
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Affiliation(s)
- Zhongyang Guan
- Yancheng Municipal Center for Disease Control and Prevention, Yancheng, Jiangsu, China
| | - Lina Ma
- Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China.
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Hanlon P, Guo X, McGhee E, Lewsey J, McAllister D, Mair FS. Systematic review and meta-analysis of prevalence, trajectories, and clinical outcomes for frailty in COPD. NPJ Prim Care Respir Med 2023; 33:1. [PMID: 36604427 PMCID: PMC9816100 DOI: 10.1038/s41533-022-00324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
This systematic review synthesised measurement and prevalence of frailty in COPD and associations between frailty and adverse health outcomes. We searched Medline, Embase and Web of Science (1 January 2001-8 September 2021) for observational studies in adults with COPD assessing frailty prevalence, trajectories, or association with health-related outcomes. We performed narrative synthesis and random-effects meta-analyses. We found 53 eligible studies using 11 different frailty measures. Most common were frailty phenotype (n = 32), frailty index (n = 5) and Kihon checklist (n = 4). Prevalence estimates varied by frailty definitions, setting, and age (2.6-80.9%). Frailty was associated with mortality (5/7 studies), COPD exacerbation (7/11), hospitalisation (3/4), airflow obstruction (11/14), dyspnoea (15/16), COPD severity (10/12), poorer quality of life (3/4) and disability (1/1). In conclusion, frailty is a common among people with COPD and associated with increased risk of adverse outcomes. Proactive identification of frailty may aid risk stratification and identify candidates for targeted intervention.
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Affiliation(s)
- Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Xuetong Guo
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Eveline McGhee
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jim Lewsey
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - David McAllister
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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10
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Forssten MP, Mohammad Ismail A, Ioannidis I, Wretenberg P, Borg T, Cao Y, Ribeiro MAF, Mohseni S. The mortality burden of frailty in hip fracture patients: a nationwide retrospective study of cause-specific mortality. Eur J Trauma Emerg Surg 2022; 49:1467-1475. [PMID: 36571633 DOI: 10.1007/s00068-022-02204-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Frailty is a condition characterized by a reduced ability to adapt to external stressors because of a reduced physiologic reserve, which contributes to the high risk of postoperative mortality in hip fracture patients. This study aims to investigate how frailty is associated with the specific causes of mortality in hip fracture patients. METHODS All adult patients in Sweden who suffered a traumatic hip fracture and underwent surgery between 2008 and 2017 were eligible for inclusion. The Orthopedic Hip Frailty Score (OFS) was used to classify patients as non-frail (OFS 0), pre-frail (OFS 1), and frail (OFS ≥ 2). The association between the degree of frailty and both all-cause and cause-specific mortality was determined using Poisson regression models with robust standard errors and presented using incidence rate ratios (IRRs) with corresponding 95% confidence intervals (CIs), adjusted for potential sources of confounding. RESULTS After applying the inclusion and exclusion criteria, 127,305 patients remained for further analysis. 23.9% of patients were non-frail, 27.7% were pre-frail, and 48.3% were frail. Frail patients exhibited a 4 times as high risk of all-cause mortality 30 days [adj. IRR (95% CI): 3.80 (3.36-4.30), p < 0.001] and 90 days postoperatively [adj. IRR (95% CI): 3.88 (3.56-4.23), p < 0.001] as non-frail patients. Of the primary causes of 30-day mortality, frailty was associated with a tripling in the risk of cardiovascular [adj. IRR (95% CI): 3.24 (2.64-3.99), p < 0.001] and respiratory mortality [adj. IRR (95% CI): 2.60 (1.96-3.45), p < 0.001] as well as a five-fold increase in the risk of multiorgan failure [adj. IRR (95% CI): 4.99 (3.95-6.32), p < 0.001]. CONCLUSION Frailty is associated with a significantly increased risk of all-cause and cause-specific mortality at 30 and 90 days postoperatively. Across both timepoints, cardiovascular and respiratory events along with multiorgan failure were the most prevalent causes of mortality.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Ioannis Ioannidis
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Per Wretenberg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Tomas Borg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, 701 82, Orebro, Sweden
| | - Marcelo A F Ribeiro
- Pontifical Catholic University of São Paulo, São Paulo, Brazil.,Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City-Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Orebro, Sweden. .,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden.
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11
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Chen M, Lu C, Zha J. Long Sleep Duration Increases the Risk of All-Cause Mortality Among Community-Dwelling Older Adults With Frailty: Evidence From NHANES 2009-2014. J Appl Gerontol 2022; 42:1078-1088. [PMID: 36560922 DOI: 10.1177/07334648221147917] [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: 12/24/2022] Open
Abstract
Objectives: The aim of this study was to determine the effect of sleep duration on all-cause mortality among older adults with frailty. Methods: The prospective cohort study included 5705 community participants aged 60 or above in the National Health and Nutrition Examination Survey (NHANES). Health indicators were selected in the NHANES to obtain the frailty index and sleep duration. The risk of all-cause mortality was estimated by a Cox proportional hazard model. Results: During the follow-up, long sleep duration was associated with higher all-cause mortality (adjusted HR = 1.28, 95% CI 1.03-1.59). The hazard of all-cause mortality was the lowest from the beginning of sleep until sleep duration reached 5.8 hours among older adults with frailty. Discussion: Long sleep duration was associated with higher all-cause mortality among older adults with frailty. There was a U-shaped relationship between sleep duration and all-cause mortality.
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Affiliation(s)
- Mingzhuang Chen
- Divison of Medical Affairs, 117556The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chao Lu
- First Affiliated Hospital, 91594Anhui University of Science and Technology, Huainan, China
| | - Jingru Zha
- Office of Party, 117556The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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12
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Venturini C, Moreira BDS, Silva SLAD, Sampaio RF. Physical frailty, activity limitation and mortality in older Brazilians: longitudinal findings from FIBRA-BH study (2009-2019). CIENCIA & SAUDE COLETIVA 2022; 27:4015-4023. [PMID: 36134807 DOI: 10.1590/1413-812320222710.08492022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022] Open
Abstract
The aim was to investigate the longitudinal association between physical frailty and change in the profile of limitation to perform basic and instrumental activities of daily living (BADL and IADL) and mortality in a 10-year period in Brazilian community-dwelling older people. A longitudinal study was conducted with data from the Frailty in Brazilian Older People (FIBRA) study, 2009-2019. Physical frailty was categorized into vulnerability (pre-frail and frail) and robustness (non-frail). The generalized estimating equation and the Cox proportional hazards models were used in the data analysis. Out of 200 older people evaluated in 2009 (moment 1), 139 were located in 2019 (moment 2). Of these, 102 were interviewed and 37 deaths were recorded. The chance of vulnerable older people at moment 1 being dependent on performing BADL at moment 2 was 4.19-fold the chance of robust older people. For IADL, the chance of vulnerable older people at moment 1 being dependent at moment 2 was 3.12-fold the chance of robust older people. Cox's analysis showed that the risk of death among vulnerable older people was 2.50-fold that among robust older people. The results reinforce the importance of monitoring and early intervention to prevent frailty, and the limitation to performing activities of daily living and death among Brazilian older people.
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Affiliation(s)
- Claudia Venturini
- Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais. Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
| | - Bruno de Souza Moreira
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou (Fiocruz Minas). Belo Horizonte MG Brasil
| | | | - Rosana Ferreira Sampaio
- Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais. Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
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13
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Frailty and risks of all-cause and cause-specific death in community-dwelling adults: a systematic review and meta-analysis. BMC Geriatr 2022; 22:725. [PMID: 36056319 PMCID: PMC9437382 DOI: 10.1186/s12877-022-03404-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background The associations of frailty with all-cause and cause-specific mortality remain unclear. Therefore, we performed this meta-analysis to fill this gap. Methods We searched the PubMed and Embase databases through June 2022. Prospective cohort studies or clinical trials examining frailty were evaluated, and the multiple adjusted risk estimates of all-cause and cause-specific mortality, such as death from cardiovascular disease (CVD), cancer, respiratory illness, dementia, infection, and coronavirus disease 2019 (COVID-19), were included. A random effects model was used to calculate the summary hazard ratio (HR). Results Fifty-eight studies were included for the qualitative systematic review, of which fifty-six studies were eligible for the quantitative meta-analysis, and the studies included a total of 1,852,951 individuals and more than 145,276 deaths. Compared with healthy adults, frail adults had a significantly higher risk of mortality from all causes (HR 2.40; 95% CI 2.17–2.65), CVD (HR 2.64; 95% CI 2.20–3.17), respiratory illness (HR 4.91; 95% CI 2.97–8.12), and cancer (HR 1.97; 95% CI 1.50–2.57). Similar results were found for the association between prefrail adults and mortality risk. In addition, based on the studies that have reported the HRs of the mortality risk per 0.1 and per 0.01 increase in the frailty index, we obtained consistent results. Conclusions The present study demonstrated that frailty was not only significantly related to an increased risk of all-cause mortality but was also a strong predictor of cause-specific mortality from CVD, cancer, and respiratory illness in community-dwelling adults. More studies are warranted to clarify the relationship between frailty and cause-specific mortality from dementia, infection, and COVID-19. Trial registration PROSPERO (CRD42021276021). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03404-w.
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14
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Lohman MC, Mezuk B, Fairchild AJ, Resciniti NV, Merchant AT. The role of frailty in the association between depression and fall risk among older adults. Aging Ment Health 2022; 26:1805-1812. [PMID: 35993919 PMCID: PMC9395731 DOI: 10.1080/13607863.2021.1950616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Although there is a recognized association between depression and greater fall risk among older adults, the mechanisms explaining this association are unclear. This study evaluated the role of frailty, a common geriatric syndrome, in determining greater risk of falls among older adults with depression. METHOD We used longitudinal data from three biennial waves of the Health and Retirement Study (HRS; 2010-2014). The sample included community-dwelling survey respondents age ≥ 65 who participated in objective physiological measures. Major Depression (MD) was measured using Composite International Diagnostic Interview for depression short form. Frailty was measured using criteria outlined in the frailty phenotype model. Causal mediation analysis was used to differentiate the direct effect of depression and indirect effect mediated by frailty on falls, fall injuries, and multiple falls. RESULTS Major depression was associated with significantly greater odds of experiencing a fall (OR: 1.91; 95% CI: 1.31, 2.77), fall injury (OR: 1.86; 95% CI: 1.17, 2.95), and multiple falls (OR: 2.26; 95% CI: 1.52, 3.37) over a two-year period. Frailty was a significant mediator of the effects of depression on falls and multiple falls, accounting for approximately 18.9% and 21.3% of the total effects, respectively. We found no evidence of depression-frailty interaction. Sensitivity analyses showed that results were robust to unmeasured confounding and alternative operationalizations of depression. CONCLUSION Frailty explains a significant proportion of increased likelihood of falls among older adults with depression. Treatment and management of frailty symptoms may be an important components of fall prevention among older adults with depression.
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Affiliation(s)
- Matthew C. Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Briana Mezuk
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Nicholas V. Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Anwar T. Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
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15
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O'Donoghue P, O'Halloran A, Kenny RA, Romero-Ortuno R. Older adults identified as frail by Frailty Index and FRAIL scale who were intensively treated for hypertension were at increased risk of 2-year adverse health outcomes in The Irish Longitudinal Study on Ageing (TILDA). HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13522.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Frailty is associated with adverse health outcomes. In frail older adults, blood pressure (BP) treated intensively may result in adverse events. We hypothesised that frail older adults, with BP treated below the threshold of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guideline (<130/70 mmHg), could be associated with adverse health outcomes. Methods: Data was gathered from participants in Wave 1 (W1) of The Irish Longitudinal Study on Ageing (TILDA) who were aged ≥65 years and on treatment for hypertension. Frail classifications as per a 32-item Frailty Index (FI) and FRAIL (Fatigue, Resistance, Ambulation, Illnesses & Loss of Weight) scale were compared in their ability to predict W2 (2-year) adverse outcomes associated with intensive BP control (‘below threshold (BT)’: <130/70 mmHg vs. ‘above threshold (AT)’: ≥130/70 mmHg). We created eight participant groups based on frailty-BP status. W2 outcomes were analysed using adjusted binary logistic regression models. Results: In W1, 1,920 participants were included. Of these 1,274 had complete FI-BP and 1,276 FRAIL-BP data. The frail by FI treated BT and frail by FRAIL treated BT had increased risk of hospitalisation, heart failure and falls/fracture by W2. The frail by FRAIL treated BT also had increased risk of mortality by W2. The frail by FI treated AT had increased risk of syncope and falls/fractures. The non-frail by FI or FRAIL did not have any increased risk of the adverse outcomes studied. Conclusions: FI and FRAIL captured increased risk of adverse health outcomes when BP was treated below the current ESC/ESH threshold. FI and FRAIL could be more useful than other frailty identification tools to signal risks associated with tighter BP control in frail older adults. Future hypertension management guidelines should consider incorporating specific frailty identification tools to help guide clinicians in making personalised BP medication treatment decisions.
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16
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O'Donoghue P, O'Halloran A, Kenny RA, Romero-Ortuno R. Older adults identified as frail by Frailty Index and FRAIL scale who were intensively treated for hypertension were at increased risk of 2-year adverse health outcomes in The Irish Longitudinal Study on Ageing (TILDA). HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13522.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Frailty is associated with adverse health outcomes. In frail older adults, blood pressure (BP) treated intensively may result in side effects including orthostatic hypotension, falls or fractures. We hypothesised that frail older adults, with BP treated below the threshold of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guideline (<130/70 mmHg), could be associated with adverse health outcomes. Methods: Data was gathered from participants in Wave 1 (W1) of The Irish Longitudinal Study on Ageing (TILDA) who were aged ≥65 years and on treatment for hypertension. Frail classifications as per a 32-item Frailty Index (FI) and FRAIL (Fatigue, Resistance, Ambulation, Illnesses & Loss of Weight) scale were compared in their ability to predict W2 (2-year) adverse outcomes associated with intensive BP control (‘low’: <130/70 mmHg vs. ‘high’: ≥130/70 mmHg). We created eight participant groups based on frailty-BP status. W2 outcomes were analysed using adjusted binary logistic regression models. Results: In W1, 1,920 participants were included. Of these 1,274 had complete FI-BP and 1,276 FRAIL-BP data. The frail by FI treated low and frail by FRAIL treated low had increased risk of hospitalisation, heart failure and falls/fracture by W2. The frail by FRAIL treated low also had increased risk of mortality by W2. The frail by FI treated high had increased risk of syncope and falls/fractures. The non-frail by FI or FRAIL did not have increased risk of any of the adverse outcomes studied. Conclusions: FI and FRAIL captured increased risk of adverse health outcomes when BP was treated below the current ESC/ESH threshold. FI and FRAIL could be more useful than other frailty identification tools to signal risks associated with tighter BP control in frail older adults. Hypertension management guidelines should specify which frailty identification tools clinicians should use to help them make personalised treatment decisions.
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17
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Travers J, Romero-Ortuno R, Cooney MT. Testing the feasibility of a primary-care exercise intervention to prevent and reverse early frailty and build resilience in community-dwelling older adults. EClinicalMedicine 2022; 46:101355. [PMID: 35340628 PMCID: PMC8943408 DOI: 10.1016/j.eclinm.2022.101355] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/03/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Resistance exercises have been shown to prevent and reverse frailty but their application in clinical practice is low. We wished to test the feasibility of an optimised exercise intervention for mild or pre-frailty in a primary-care setting and inform the design of a definitive randomised control trial. METHODS The intervention was co-designed with eighteen older adults in two group workshops, informed by systematic review and meta-analysis. Eligible patients aged 65+, mildly frail or less, presenting to an Irish primary-care centre over 6 months from January 2020 were invited to participate. They were offered an exercise guide and educational discussion. Demographics, health indicators and frailty scores were recorded. Feasibility was assessed using the Bowen model for acceptability; participation; demand; implementation; practicality; adaptation; integration; expansion; and limited-efficacy. Half of the randomly selected participants were telephoned after one month, and all the participants were called after two to measure effects on adherence. FINDINGS 94 of 107 eligible people (88%) participated (average age 77, 59 women (63%)). Only 15% had previously considered resistance exercises. The intervention satisfied all Bowen feasibility criteria. At one month, 65% of participants were exercising. At two months, adherence amongst those previously called was higher: 78%. 87% described exercises as 'very easy' or 'somewhat easy'. 66% felt 'much better' or 'slightly better'. INTERPRETATION Frailty intervention uptake and adherence were high. A single telephone call appeared to help increase adherence. Participants reported meaningful physical and mental health benefits. FUNDING Roman Romero-Ortuno is funded by a grant from Science Foundation Ireland (SFI), grant number 18/FRL/6188.
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Affiliation(s)
- John Travers
- School of Medicine, University College Dublin, Dublin
- Trinity College Dublin HSE Specialist Training Programme in General Practice, Dublin
- Corresponding author at: School of Medicine, University College Dublin, Dublin.
| | - Roman Romero-Ortuno
- Global Brain Health Institute, Trinity College Dublin, Dublin
- Mercer's Institute for Successful Aging, St James's Hospital, Dublin
| | - Marie-Therese Cooney
- School of Medicine, University College Dublin, Dublin
- Department of Geriatric Medicine, St Vincent's University Hospital, Dublin
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18
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Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 Study. BMJ 2022; 376:e068208. [PMID: 35273014 PMCID: PMC9316948 DOI: 10.1136/bmj-2021-068208] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) to estimate mortality and disability trends for the population aged ≥70 and evaluate patterns in causes of death, disability, and risk factors. DESIGN Systematic analysis. SETTING Participants were aged ≥70 from 204 countries and territories, 1990-2019. MAIN OUTCOMES MEASURES Years of life lost, years lived with disability, disability adjusted life years, life expectancy at age 70 (LE-70), healthy life expectancy at age 70 (HALE-70), proportion of years in ill health at age 70 (PYIH-70), risk factors, and data coverage index were estimated based on standardised GBD methods. RESULTS Globally the population of older adults has increased since 1990 and all cause death rates have decreased for men and women. However, mortality rates due to falls increased between 1990 and 2019. The probability of death among people aged 70-90 decreased, mainly because of reductions in non-communicable diseases. Globally disability burden was largely driven by functional decline, vision and hearing loss, and symptoms of pain. LE-70 and HALE-70 showed continuous increases since 1990 globally, with certain regional disparities. Globally higher LE-70 resulted in higher HALE-70 and slightly increased PYIH-70. Sociodemographic and healthcare access and quality indices were positively correlated with HALE-70 and LE-70. For high exposure risk factors, data coverage was moderate, while limited data were available for various dietary, environmental or occupational, and metabolic risks. CONCLUSIONS Life expectancy at age 70 has continued to rise globally, mostly because of decreases in chronic diseases. Adults aged ≥70 living in high income countries and regions with better healthcare access and quality were found to experience the highest life expectancy and healthy life expectancy. Disability burden, however, remained constant, suggesting the need to enhance public health and intervention programmes to improve wellbeing among older adults.
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19
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Lynch DH, Petersen CL, Fanous MM, Spangler HB, Kahkoska AR, Jimenez D, Batsis JA. The relationship between multimorbidity, obesity and functional impairment in older adults. J Am Geriatr Soc 2022; 70:1442-1449. [PMID: 35113453 PMCID: PMC9106850 DOI: 10.1111/jgs.17683] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/15/2021] [Accepted: 01/07/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Declining mortality rates and an aging population have contributed to increasing rates of multimorbidity (MM) in the United States. MM is strongly associated with a decline in physical function. Obesity is an important risk factor for the development of MM, and its prevalence continues to rise. Our study aimed to evaluate the associations between obesity, MM, and rates of functional limitations in older adults. METHODS We analyzed body mass index (BMI) and self-reported comorbidity data from 7261 individuals aged ≥60 years from the National Health and Nutrition Examination Surveys 2005-2014. Weight status was defined based on standard BMI categories. MM was defined as 2 or more comorbidities, while functional limitations were self-reported. Adjusted logistic regression quantified the association between standard BMI categories and MM. We also examined the difference in the prevalence of limitations between those with and without MM. RESULTS The overall proportion of individuals with concomitant MM and obesity was 27.0%. Compared to a normal BMI, older adults with obesity had higher odds of MM (Prevalence odds ratio 1.79, 95% CI 1.49, 2.12). Overall, 67.5% of patients with MM also reported a functional limitation, with rates of functional limitation increasing with increasing BMI. When evaluating functional limitations in those with MM by BMI class, 90% of patients classified as severely obese (BMI ≥40 kg/m2 ) with MM also had a concomitant functional limitation. CONCLUSIONS Compared to normal weight status, obesity is associated with an increased burden of MM and functional limitation among older adults. Our results underscore the importance of identifying and addressing obesity, MM, and functional limitation patterns and the need for evidence-based interventions that address all three conditions in this population.
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Affiliation(s)
- David H Lynch
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Curtis L Petersen
- The Dartmouth Institute for Health Policy, Dartmouth College, Hanover, New Hampshire, USA.,Quantitative Biomedical Sciences Program, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Marco M Fanous
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hillary B Spangler
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anna R Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daniel Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - John A Batsis
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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20
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Kang YP, Chen LY, Zhu JJ, Liu WX, Ma CS. Association of frailty with in-hospital outcomes in elderly patients with heart failure. World J Clin Cases 2021; 9:11208-11219. [PMID: 35071551 PMCID: PMC8717519 DOI: 10.12998/wjcc.v9.i36.11208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/28/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Frailty is prevalent in elderly patients with cardiovascular diseases. However, the association between frailty and in-hospital outcomes for elderly patients with heart failure and reduced ejection (HFrEF) remains unknown.
AIM To evaluate the predictive efficacy of frailty, compared with pre-frailty, for adverse events in these patients.
METHODS Elderly patients (≥ 60 years) with HFrEF were assessed. Frailty was evaluated with the Fried phenotype criteria, and physical performance was evaluated based on handgrip strength and the short physical performance battery (SPPB). The composite incidence of adverse events, including all-cause death, multiple organ failure, cardiac shock, and malignant arrhythmia, during hospitalization was recorded.
RESULTS Overall, 252 elderly individuals with HFrEF [mean age: 69.4 ± 6.7 years, male: 169 (67.0%)] were included. One hundred and thirty-five (53.6%) patients were frail and 93 (36.9%) were pre-frail. Frail patients were older, more likely to be female, to have a lower blood pressure, and to present with left ventricular thrombosis (P all < 0.05). Frail patients with HFrEF had a higher incidence of in-hospital mortality (11.9% vs 4.3%, P = 0.048). Multivariate analyses showed that female gender (OR = 0.422), aging (OR = 1.090), poor cardiac functional class (OR = 2.167), frailty (OR = 2.379), and lower handgrip strength (OR = 1.106) were independent predictors of in-hospital adverse events (P all < 0.05).
CONCLUSION Frailty may be associated with poor in-hospital outcomes for elderly patients with HFrEF. The influence of frailty on long-term prognosis in these patients deserves further investigation.
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Affiliation(s)
- Yun-Peng Kang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
| | - Li-Ying Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
| | - Jia-Jia Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
| | - Wen-Xian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
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21
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Hladek MD, Zhu J, Buta BJ, Szanton SL, Bandeen-Roche K, Walston JD, Xue QL. Self-efficacy proxy predicts frailty incidence over time in non-institutionalized older adults. J Am Geriatr Soc 2021; 69:3507-3518. [PMID: 34418062 PMCID: PMC8648965 DOI: 10.1111/jgs.17417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Physical frailty is defined as a syndrome of decreased physiologic reserve conferring vulnerability to functional decline, mortality, and other adverse outcomes upon experiencing stressors. Self-efficacy, which is confidence in one's ability to perform well in a domain of life, is modifiable. Self-efficacy is associated with improved health behavior and decreased chronic disease burden. Its relationship to frailty is unknown. The purpose of this study was to evaluate whether a general self-efficacy proxy predicts incident frailty. METHODS A nationally representative sample of 4825 U.S. older adults aged 65 and older living in the community or non-nursing home care setting enrolled in the National Health and Aging Trends Study from 2011 to 2018 was used. Self-efficacy was dichotomized into low and high groups using the one-item self-efficacy proxy measure. The Physical Frailty Phenotype was used to categorize participants as frail and non-frail. A discrete time hazard model using data from eight rounds was used to obtain incident hazard ratios of frailty in two models. Model 1 was adjusted for age, race, sex, education, and income. Model 2 contained Model 1 covariates and added disability and comorbidities. RESULTS Among people without frailty at baseline, risk of developing frailty over 7 years was increased by 41% among those with low versus high self-efficacy after adjustment for sociodemographics (P = 0.002), and by 27% after further adjustment for disability and comorbidities (P = 0.032). CONCLUSION This study generates a rationale to further explore self-efficacy in frailty research. Self-efficacy may be a key modifiable element to incorporate into multimodal physical frailty interventions.
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Affiliation(s)
| | - Jiafeng Zhu
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Brian J. Buta
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | | | - Karen Bandeen-Roche
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jeremy D. Walston
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Qian-Li Xue
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
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22
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Kurnat-Thoma EL, Murray MT, Juneau P. Frailty and Determinants of Health Among Older Adults in the United States 2011-2016. J Aging Health 2021; 34:233-244. [PMID: 34470533 PMCID: PMC9100462 DOI: 10.1177/08982643211040706] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To characterize frailty phenotype in a representative cohort of older
Americans and examine determinants of health factors. Methods Retrospective analysis of data from 5,553 adults ≥60 years old in the
2011–2016 cross-sectional National Health and Nutrition Examination Survey
(NHANES). World Health Organization “Determinants of
Health” conceptual model was used to prioritize variables for
multinomial logistic regression for the outcome of modified Fried frailty
phenotype. Results 482 participants (9%) were frail and 2432 (44%) prefrail. Four factors were
highly associated with frailty: difficulty with ≥1 activity of daily living
(77%; OR 24.81 p < 0.01), ≥2 hospitalizations in the
previous year (17%, OR 3.94 p < 0.01), having >2
comorbidities (27%; OR 3.33 p < 0.01), and polypharmacy
(66%; OR 2.38 p < 0.01). Discussion A modified Fried frailty assessment incorporating five self-reported criteria
may be useful as a rapid nursing screen in low-resource settings. These
assessments can streamline nursing care coordination and case management
activities, thereby facilitating targeted frailty interventions to support
healthy aging in vulnerable populations.
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Affiliation(s)
- Emma L Kurnat-Thoma
- National Institute of Nursing Research, 35047National Institutes of Health, Bethesda, MD, USA.,Georgetown University School of Nursing & Health Studies, Department of Professional Nursing Practice, Washington, DC, USA
| | - Meghan T Murray
- National Institute of Nursing Research, 35047National Institutes of Health, Bethesda, MD, USA.,Columbia University, School of Nursing, New York, NY, USA
| | - Paul Juneau
- Division of Data Services, NIH Library, Office of Research Services, National Institutes of Health, 10952Bethesda, MD, USA
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23
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Guida JL, Alfini AJ, Gallicchio L, Spira AP, Caporaso NE, Green PA. Association of objectively measured sleep with frailty and 5-year mortality in community-dwelling older adults. Sleep 2021; 44:6066553. [PMID: 33406254 DOI: 10.1093/sleep/zsab003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY OBJECTIVES To determine whether actigraphy-measured sleep was independently associated with risk of frailty and mortality over a 5-year period among older adults. METHODS We used data from Waves 2 (W2) and 3 (W3) (2010-2015) of the National Social Life, Health and Aging Project, a prospective cohort of community-dwelling older adults born between 1920 and 1947. One-third of W2 respondents were randomly selected to participate in a sleep study, of whom N = 727 consented and N = 615 were included in the analytic sample. Participants were instructed to wear a wrist actigraph for 72 h (2.93 ± 0.01 nights). Actigraphic sleep parameters were averaged across nights and included total sleep time, percent sleep, sleep fragmentation index, and wake after sleep onset. Subjective sleep was collected via questionnaire. Frailty was assessed using modified Fried Frailty Index. Vital status was ascertained at the time of the W3 interview. W3 frailty/mortality status was analyzed jointly with a four-level variable: robust, pre-frail, frail, and deceased. Associations were modeled per 10-unit increase. RESULTS After controlling for baseline frailty (robust and pre-frail categories), age, sex, education, body mass index, and sleep time preference, a higher sleep fragmentation index was associated with frailty (OR = 1.70, 95% CI: 1.02-2.84) and mortality (OR = 2.12, 95% CI: 1.09-4.09). Greater wake after sleep onset (OR = 1.24, 95% CI: 1.02-1.50) and lower percent sleep (OR = 0.41, 95% CI: 0.17-0.97) were associated with mortality. CONCLUSIONS Among community-dwelling older adults, actigraphic sleep is associated with frailty and all-cause mortality over a 5-year period. Further investigation is warranted to elucidate the physiological mechanisms underlying these associations.
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Affiliation(s)
- Jennifer L Guida
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Alfonso J Alfini
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Gallicchio
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Paige A Green
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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24
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Hoffman V, Hallas J, Linder M, Margulis AV, Suehs BT, Arana A, Phiri K, Enger C, Horter L, Odsbu I, Olesen M, Perez-Gutthann S, Xu Y, Kristiansen NS, Appenteng K, de Vogel S, Seeger JD. Cardiovascular Risk in Users of Mirabegron Compared with Users of Antimuscarinic Treatments for Overactive Bladder: Findings from a Non-Interventional, Multinational, Cohort Study. Drug Saf 2021; 44:899-915. [PMID: 34236595 PMCID: PMC8280006 DOI: 10.1007/s40264-021-01095-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION During clinical trials, mirabegron, a β3-adrenoreceptor agonist, was associated with increased vital signs vs placebo in patients with overactive bladder. OBJECTIVE The purpose of this study was to compare incidence rates of adverse cardiovascular (CV) outcomes following mirabegron or antimuscarinic use. METHODS We conducted an observational post-marketing safety study utilising real-world data. The study population was identified within five sources: Danish and Swedish National Registers, Clinical Practice Research Datalink (UK), Optum (USA) and Humana (USA). Episodes of time when patients were new users of mirabegron or antimuscarinics (October 2012-December 2018) were sourced from prescriptions and matched on propensity scores. Occurrences of major adverse cardiovascular events (MACE), acute myocardial infarction (AMI), stroke, CV mortality and all-cause mortality were identified. Outcome incidence rates and hazard ratios from Cox models were estimated. RESULTS Overall, 152,026 mirabegron and 152,026 antimuscarinic episodes were matched. The population consisted of 63.1% women and 72.6% were ≥ 65 years old. There were no appreciable differences in the incidence rates of MACE, AMI or stroke between users of mirabegron and antimuscarinics. Incidence rates of CV mortality (hazard ratio 0.83, 95% confidence interval 0.73-0.95) and all-cause mortality (hazard ratio 0.80, 95% confidence interval 0.76-0.84) were no higher with mirabegron vs antimuscarinics. Results restricted to episodes at high risk for CV events or stratified by age (< 65 years, ≥ 65 years) or prior overactive bladder medication use were consistent with overall findings. CONCLUSIONS This large, multinational study found no higher risk of MACE, AMI, stroke, CV mortality or all-cause mortality among users of mirabegron relative to users of antimuscarinics.
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Affiliation(s)
| | | | - Marie Linder
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Cheryl Enger
- Optum, 1325 Boylston Street, Boston, MA, 02215, USA
| | | | - Ingvild Odsbu
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Yihua Xu
- Humana Healthcare Research, Louisville, KY, USA
| | | | | | | | - John D Seeger
- Optum, 1325 Boylston Street, Boston, MA, 02215, USA.
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25
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Jin X, Ren Y, Shao L, Guo Z, Wang C, He Y, Zhou L, Cong M, Ma H, Wang W, Zhou C, Feng Y, Ba Y, Gao J, Lu M, Zhang M, Gu XW, Song C, Xu H, Shi H. Prevalence of frailty and prediction of mortality in Chinese cancer patients using a frailty index-based clinical algorithm-A multicentre study. Cancer Med 2021; 10:6207-6217. [PMID: 34318626 PMCID: PMC8446570 DOI: 10.1002/cam4.4155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose To investigate the frailty status in Chinese cancer patients through establishing a novel prediction algorithm. Methods The percentage of frailty in various age groups, locations, and tumor types in Chinese cancer patients was investigated. The prediction capacity of frailty on mortality of Chinese cancer patients was analysed by the frailty index composing of routine laboratory data (FI‐LAB) accessible from a blood test and calculated as the ratio of abnormal factors to 22 total variables. The establishment of a novel algorithm, MCP (mortality of cancer patients), to predict the 5‐year mortality in Chinese cancer patients was accomplished and the algorithm's prediction capacity was tested in the training and validation sets using receiver operating characteristic (ROC) analysis. Results We found that the risk of death in cancer patients can be successfully identified through FI‐LAB. The univariable and multivariable Cox regression were used to evaluate the effect of frailty on death. In the 5‐year follow‐up, 20.6% of the 2959 participants (age = 55.8 ± 11.7 years; 43.5% female) died, while the mean FI‐LAB score in baseline was 0.23 (standard deviation = 0.13; range = 0–0.73). Frailty (after adjusting for gender, age, and other confounders) directly correlated with an increased risk of death, hazard ratio of 12.67 (95% confidence interval [CI]: 7.19, 22.31), compared to those without frailty. In addition, the MCP algorithm (MCP) = 3.678 × FI‐LAB + 1.575 × sex + 1.779 × first tumor node metastasis staging, presented an area under the ROC (AUC) of 0.691 (95% CI: 0.656–0.726) and 0.648 (95% CI: 0.613–0.684) in the training and validation sets, respectively. Conclusion Frailty as defined by FI‐LAB was common and indicated a significant death risk in cancer patients. Our novel developed algorithm MCP had a passable prediction capacity on 5‐year MCP.
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Affiliation(s)
- Xi Jin
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yue Ren
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Shao
- Institute of Translational Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Zengqing Guo
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Chang Wang
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Ying He
- Department of Clinical Nutrition, Chongqing General Hospital, Chongqing, China
| | - Lan Zhou
- Department of Nutrition, Third Affiliated Hospital of Kunming Medical College, Tumor Hospital of Yunnan Province, Kunming, China
| | - Minghua Cong
- Comprehensive Oncology Department, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hu Ma
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wei Wang
- Cancer Center, The First People's Hospital of Foshan, Foshan, China
| | - Chunling Zhou
- Department of Clinical Nutrition, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yongdong Feng
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Ba
- Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Jianguo Gao
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Miaomiao Lu
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengmeng Zhang
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xue-Wei Gu
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chunhua Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hongxia Xu
- Department of Nutrition, Department of Nutrition, Daping Hospital & Research Institute of Surgery, Third Military Medical University, Chongqing, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University/The 9th Clinical Medical College, Peking University, Beijing, China
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26
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Frailty as a mortality predictor in older adults with COVID-19: A systematic review and meta-analysis of cohort studies. Geriatr Nurs 2021; 42:983-992. [PMID: 34256158 PMCID: PMC8196304 DOI: 10.1016/j.gerinurse.2021.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/20/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused the coronavirus diseases 2019 (COVID-19) pandemic, continues to spread rapidly worldwide and is associated with high rates of mortality among older adults, those with comorbidities, and those in poor physiological states. This paper aimed to systematically identify the impact of frailty on overall mortality among older adults with COVID-19. We conducted a systematic review of the literature indexed in 4 databases. A random-effects model with inverse variance-weighted meta-analysis using the odds ratio was used to study the association of frailty levels with clinical outcomes among older adults with COVID-19. Heterogeneity was measured using the I2 statistic and Egger's test. We identified 22 studies that met our inclusion criteria, including 924,520 total patients. Overall, frailty among older adults was associated with high rates of COVID-19-related mortality compared with non-frail older adults (OR [odds ratio]:5.76; 95% confidence interval [95% CI]: 3.85-8.61, I2: 40.5%). Our results show that physical limitations, such as those associated with frailty among older adults, are associated with higher rates of COVID-19-related mortality.
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27
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Liperoti R, Vetrano DL, Palmer K, Targowski T, Cipriani MC, Lo Monaco MR, Giovannini S, Acampora N, Villani ER, Bernabei R, Onder G. Association between frailty and ischemic heart disease: a systematic review and meta-analysis. BMC Geriatr 2021; 21:357. [PMID: 34112104 PMCID: PMC8193864 DOI: 10.1186/s12877-021-02304-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Frailty is increasingly reported among older adults with cardiovascular diseases and it has been demonstrated to increase negative health outcomes and mortality. To date, no systematic review of the evidence is available regarding the association between frailty and ischemic heart disease (IHD). We performed a systematic review of literature and a meta-analysis to assess the association between frailty and IHD. Methods We selected all the studies that provided information on the association between frailty and IHD, regardless of the study setting, study design, or definition of IHD and frailty. PubMed, Web of Science and Embase were searched for relevant papers. Studies that adopted the Fried definition for frailty were included in the meta-analyses. For each measure of interest (proportions and estimates of associations), a meta-analysis was performed if at least three studies used the same definition of frailty. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Results Thirty-seven studies were included. Of these, 22 adopted the Fried criteria to define frailty and provided estimates of prevalence and therefore they were included in meta-analyses. The pooled prevalence of IHD in frail individuals was 17% (95% Confidence Interval [95%CI] 11–23%) and the pooled prevalence of frailty in individuals with IHD was 19% (95% CI 15–24%). The prevalence of frailty among IHD patients ranged from 4 to 61%. Insufficient data were found to assess longitudinal association between frailty and IHD. Conclusions Frailty is quite common in older persons with IHD. The identification of frailty among older adults with IHD should be considered relevant to provide individualized strategies of cardiovascular prevention and care. Further research should specifically explore the association between frailty and IHD and investigate the potential common biological ground. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02304-9.
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Affiliation(s)
- Rosa Liperoti
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Katie Palmer
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy
| | - Tomasz Targowski
- Department of Geriatrics, National Institute of Geriatrics, Rheumatology, and Rehabilitation, Warsaw, Poland
| | - Maria C Cipriani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Nicola Acampora
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emanuele Rocco Villani
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.
| | - Roberto Bernabei
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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28
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Crow RS, Haudenschild C, Lohman MC, Roth RM, Roderka M, Masterson T, Brand J, Gooding T, Mackenzie TA, Batsis JA. Modified STEADI Fall Risk Categories Predict Incident Cognitive Impairment. J Am Geriatr Soc 2021; 69:1257-1264. [PMID: 33565618 PMCID: PMC8232824 DOI: 10.1111/jgs.17034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES It is unknown whether older adults at high risk of falls but without cognitive impairment have higher rates of subsequent cognitive impairment. DESIGN This was an analysis of cross-sectional and longitudinal data from National Health and Aging Trends Study (NHATS). SETTING NHATS, secondary analysis of data from 2011 to 2019. PARTICIPANTS Community dwelling adults aged 65 and older without cognitive impairment. MEASUREMENTS Participants were classified at baseline in three categories of fall risk (low, moderate, severe) using a modified algorithm from the Center for Disease Control's STEADI (Stop Elderly Accidents, Deaths, and Injuries) and fall risk from data from the longitudinal NHATS. Impaired global cognition was defined as NHATS-derived impairment in either the Alzheimer's Disease-8 score, immediate/delayed recall, orientation, clock-drawing test, or date/person recall. The primary outcome was the first incident of cognitive impairment in an 8 year follow-up period. Cox-proportional hazard models ascertained time to onset of cognitive impairment (referent = low modified STEADI incidence). RESULTS Of the 7,146 participants (57.8% female), the median age category was 75 to 80 years. Prevalence of baseline fall modified STEADI risk categories in participants was low (51.6%), medium (38.5%), and high (9.9%). In our fully adjusted model, the risk of developing cognitive impairment was hazard ratio (HR) 1.18 [95% CI = 1.08, 1.29] in the moderate risk category, and HR 1.74 [95% CI = 1.53, 1.98] in the high-risk category. CONCLUSION Older, cognitively intact adults at high fall risk at baseline had nearly twice the risk of cognitive decline at 8 year follow-up.
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Affiliation(s)
- Rebecca S. Crow
- Veterans Affairs Medical Center, White River Junction, Vermont USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Christian Haudenschild
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- The Dartmouth Institute for Health Policy, Lebanon, New Hampshire, USA
| | - Matthew C. Lohman
- University of South Carolina, Department of Epidemiology and Biostatics
| | - Robert M. Roth
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Meredith Roderka
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Travis Masterson
- Department of Nutritional Sciences at The Pennsylvania State University, State College, PA, USA
| | - John Brand
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Tyler Gooding
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Todd A. Mackenzie
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy, Lebanon, New Hampshire, USA
| | - John A. Batsis
- Division of Geriatric Medicine, School of Medicine, and the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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29
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Wang Y, Han HR, Yang W, Zhang H, Zhang J, Ruan H, Tang N, Ren J, Sun X, Li C, Han L. Associations between risk factors for cardiovascular diseases and frailty among community-dwelling older adults in Lanzhou, China. Int J Nurs Sci 2021; 8:168-174. [PMID: 33997130 PMCID: PMC8105554 DOI: 10.1016/j.ijnss.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/09/2021] [Accepted: 03/08/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives To examine the relationship between cardiovascular disease risk factors and frailty in a sample of older Chinese adults. Methods A total of 458 community-dwelling older adults (≥65 years) in Lanzhou, Gansu Province of China participated in a cross-sectional survey. Their status was evaluated in terms of frailty phenotype (unintentional weight loss, exhaustion, low activity levels, slowness and weakness). Participants were categorized as not frail, prefrail or frail. Cardiovascular disease risk factors that were assessed included: blood pressure, body mass index, waist circumference, blood glucose, total cholesterol, triglycerides, low-density lipoproteins and high-density lipoproteins. Results Individuals with obesity had an increased risk of prefrailty (OR: 2.26; 95% CI: 1.05, 4.84). Hypertension was inversely associated with frailty among the participants (OR: 0.31; 95% CI: 0.11, 0.87) after adjusting for covariates. Conclusions The findings suggest that much more attention should be paid to weight control of the elderly in the community for preventing them from transition to prefrailty or frailty. Active prevention and control of cardiovascular diseases among the community-dwelling elder are still of great importance.
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Affiliation(s)
- Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Maryland, USA
| | - Wei Yang
- Gastroenterology Department, The First Hospital of Lanzhou University, Lanzhou, China
| | | | - Jing Zhang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Haihui Ruan
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Nan Tang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Jingjing Ren
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Xia Sun
- Community Health Services Center of Tuanjiexincun, Lanzhou, China
| | - Chunrong Li
- Community Health Services Center of Jiaojiawan, Lanzhou, China
| | - Lin Han
- School of Nursing, Lanzhou University, Lanzhou, China
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30
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Lohman MC, Sonnega AJ, Resciniti NV, Leggett AN. Frailty Phenotype and Cause-Specific Mortality in the United States. J Gerontol A Biol Sci Med Sci 2021; 75:1935-1942. [PMID: 31956891 DOI: 10.1093/gerona/glaa025] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Frailty is a common condition among older adults increasing risk of adverse outcomes including mortality; however, little is known about the incidence or risk of specific causes of death among frail individuals. METHODS Data came from the Health and Retirement Study (HRS; 2004-2012), linked to underlying cause-of-death information from the National Death Index (NDI). Community-dwelling HRS participants aged 65 and older who completed a general health interview and physical measurements (n = 10,490) were included in analysis. Frailty was measured using phenotypic model criteria-exhaustion, low weight, low energy expenditure, slow gait, and weakness. Underlying causes of death were determined using International Classification of Diseases, Version 10 codes. We used Cox proportional hazards and competing risks regression models to calculate and compare incidence of cause-specific mortality by frailty status. RESULTS During follow-up, prefrail and frail older adults had significantly greater hazard of all-cause mortality compared to individuals without symptoms (adjusted hazard ratio [HR] prefrail: 1.85, 95% CI: 1.51, 2.25; HR frail: 2.75, 95% CI: 2.14, 3.53). Frailty was associated with 2.96 (95% CI: 2.17, 4.03), 2.82 (95% CI: 2.02, 3.94), 3.48 (95% CI: 2.17, 5.59), and 2.87 (95% CI: 1.47, 5.59) times greater hazard of death from heart disease, cancer, respiratory illness, and dementia, respectively. CONCLUSIONS Significantly greater risk of mortality from several different causes should be considered alongside the potential costs of screening and intervention for frailty in subspecialty and general geriatric clinical practice. Findings may help investigators estimate the potential impact of frailty reduction approaches on mortality.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia
| | - Amanda J Sonnega
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Nicholas V Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia
| | - Amanda N Leggett
- Department of Psychiatry, University of Michigan, Ann Arbor.,Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
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Soh Y, Won CW. Sex differences in association between body composition and frailty or physical performance in community-dwelling older adults. Medicine (Baltimore) 2021; 100:e24400. [PMID: 33530237 PMCID: PMC7850682 DOI: 10.1097/md.0000000000024400] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/30/2020] [Indexed: 01/05/2023] Open
Abstract
Frailty is a common geriatric condition due to aging, defined as a decrease in the functional reserve to maintain the homeostasis. As part of the aging process, body composition changes occur. This study investigated the relationship between body composition and frailty in a community-dwelling elderly Korean population.This cross-sectional cohort study analyzed data of 2,385 elderly participants (aged 70-84 years, 1131 males and 1254 females) of the Korean Frailty and Aging Cohort Study from 2016 to 2017. Body composition, including total and trunk fat masses and fat-free mass, were measured with dual-energy X-ray absorptiometry. Fat mass index (FMI), trunk fat mass index, and fat-free mass index (FFMI) represented total fat mass, trunk fat mass, and fat-free mass according to height. Based on the frailty index developed by Fried, we compared the frail and non-frail groups. Poor physical performance assessed with the short physical performance battery score of < 9 is considered frailty. To evaluate the relationship between the variables, simple and fully adjusted multivariable logistic regression analyses were performed according to sex.Among the participants, 462 (19.3%) were defined as the frail group, with a significantly high mean age of 77.9 ± 4.0 years. In the logistic regression analysis of frailty based on body mass index (BMI) categories, underweight (BMI < 18 kg/m2) participants showed a high incidence of frailty in both sexes. BMI showed an association with frailty only in males. Lower FFMI was associated with a higher incidence of frailty in both sexes, which was statistically significant in the fully adjusted models. In the female, fat-related indexes including body fat percentage, FMI, and trunk fat mass index showed a significant association with poor physical performance. In contrast, males with low FFMI only showed a significant association with poor physical performance.Frailty was closely correlated with lower FFMI in both sexes. The poor physical performance associated with frailty correlated with fat-related body composition in females and fat-free mass in males, owing to the difference in body composition between the sexes. In the assessment of frailty, body composition and sex-related differences should be analyzed.
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Affiliation(s)
- Yunsoo Soh
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Medical Center
| | - Chang Won Won
- Department of Family Medicine, College of medicine, Kyung Hee University, Seoul, Republic of Korea
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Chi J, Chen F, Zhang J, Niu X, Tao H, Ruan H, Wang Y, Hu J. Impacts of frailty on health care costs among community-dwelling older adults: A meta-analysis of cohort studies. Arch Gerontol Geriatr 2021; 94:104344. [PMID: 33516075 DOI: 10.1016/j.archger.2021.104344] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The demands for health care services from the frail elderly individuals in the community continue to increase, which will exert a tremendous burden on health care costs. However, little is known regarding the magnitude of these impacts. In this study, we performed a systematic review and meta-analysis of the evidence to explore the impact of frailty on health care costs among community-dwelling older adults. MATERIALS AND METHODS Relevant published articles were searched from PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Full-text Database (VIP), Wanfang Database, Chinese Biomedical Literature Database (CBM), and the reference lists of articles. Published cohort or cross-sectional studies assessing the impacts of frailty on health care costs among community-dwelling older adults were identified (to June 2020). The outcomes on health care costs before and after baseline were stratified by frailty status. RESULTS A total of 7 cohort studies comprised of a total of 3,750,611 participants were included in our study. Our analyses showed that: (1) compared with the robust group, health care costs increased by $79-13,423.83 (standardized mean difference, SMD = 0.22, 95% Confidence interval, 95% CI, 0.22-0.22; P < 0.00001) in the pre-frail elderly and by $616-32,549.96 (SMD = 0.55, 95% CI, 0.44-0.67; P < 0.00001) in the frail elderly in the community. A significantly higher in the increase of health care costs was observed in the frail group compared with the pre-frail group(SMD = 0.35, 95% CI, 0.19-0.51; P < 0.0001); (2) the frailty phenotype components increased the health care costs of the elderly in community (weight loss: $1,630-6,209, SMD = 0.43, 95% CI, 0.17-0.69; P = 0.001; weakness: $275-7,586, SMD = 0.24, 95% CI, 0.08-0.40; P = 0.001; exhaustion: $1,545-10,559, SMD = 0.31, 95% CI, 0.13-0.49; P = 0.0006; slowness: $352-1,1891, SMD = 0.40, 95% CI = 0.14-0.65; P = 0.003; low physical activity: $512-3,459, SMD = 0.26, 95% CI, 0.16-0.36; P < 0.00001); (3) the increase in the frailty index was parallel with the increase in health care costs by $12,363-21,066 (SMD = 0.41, 95% CI, 0.29-0.53; P < 0.00001). CONCLUSIONS AND IMPLICATIONS This study revealed the adverse economic impacts of frailty status, frailty phenotype components, and frailty index on health care costs in community-dwelling older adults. Future research is warranted to investigate costs incurred by interventions to improve frailty, which will provide further insights into additional health care costs due to frailty.
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Affiliation(s)
- Junting Chi
- School of nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Fei Chen
- School of nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China; Evidence-based Nursing Center, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Jing Zhang
- School of nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Xiaodan Niu
- School of nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Hongxia Tao
- School of nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Haihui Ruan
- School of nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Yanhong Wang
- School of nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China.
| | - Junping Hu
- Reproductive Medicine Department of the First Affiliated Hospital of Lanzhou University, NO.1 Donggang West Road, Lanzhou, Gansu 730000, PR China; Key laboratory of reproductive medicine and embryology gansu province, NO.1 Donggang West Road, Lanzhou, Gansu 730000, PR China.
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Domergue H, Regueme SC, Zafra OL, Manaz-Rodriguez L, Sinclair A, Bourdel-Marchasson I. Gait Speed and Evolution of Verbal Fluencies in Frail or Prefrail Older People with Type 2 Diabetes. A Pilot Study. J Nutr Health Aging 2021; 25:802-807. [PMID: 34179937 DOI: 10.1007/s12603-021-1636-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Type 2 diabetes (T2D) is a risk factor of frailty and cognitive impairment. Impaired gait in older people is associated with incident vascular dementia. We aimed to assess whether in frail or prefrail older subjects with T2D, lower gait speed can be associated with faster cognitive decline. DESIGN Case-control study nested in a large randomized control trial (RCT, MID-frail); post hoc analysis. SETTING AND PARTICIPANTS Older frail and prefrail subjects (>70y) with T2D and with no history of cognitive problems were enrolled in a single recruiting center. Participants were divided into two groups depending on their walking speed - above (fast walkers) or below (slow walkers) using a cut off of 1 m/sec. MEASURE Cognitive function was assessed at baseline and during follow-up with the MMSE, category and letter fluencies at 15 sec (initiation) and 15-60 sec (late). RESULTS 48 subjects were included, 22 were fast walkers, 26 were slow walkers. The mean follow-up was 60.9 (SD 17.5) weeks. The baseline 0-15 sec letter fluency was higher in fast walkers (p=0.008). There was no difference at baseline with MMSE scores and category fluency. The MID-Frail intervention did not change the evolution of any cognitive changes. Comparisons were adjusted for age, sex and baseline performance, and showed a steeper decline of category fluency score in slow walkers (fast walkers +0.04 (-1.49 to1.56) compared with -0.89 (-2.15 to 0.38), p=0.049) with a moderate effect size. CONCLUSION In frail or prefrail older adults with diabetes, we observed a decline in category fluency in those with low gait speed.
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Affiliation(s)
- H Domergue
- Professor Isabelle Bourdel-Marchasson, Centre Henri Choussat, Hôpital Xavier Arnozan, 33604 Pessac cedex, France, tel: 33 (0)5 57 65 65 71, fax 33 (0)5 57 65 62 26,
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Fan J, Yu C, Guo Y, Bian Z, Sun Z, Yang L, Chen Y, Du H, Li Z, Lei Y, Sun D, Clarke R, Chen J, Chen Z, Lv J, Li L. Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study. Lancet Public Health 2020; 5:e650-e660. [PMID: 33271078 PMCID: PMC7708389 DOI: 10.1016/s2468-2667(20)30113-4] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The fraily index is a useful proxy measure of accelerated biological ageing and in estimating all-cause and cause-specific mortality in older individuals in European and US populations. However, the predictive value of the frailty index in other populations outside of Europe and the USA and in adults younger than 50 years is unknown. We aimed to examine the association between the frailty index and mortality in a population of Chinese adults. METHODS In this prospective cohort study, we used data from the China Kadoorie Biobank. We included adults aged 30-79 years from ten areas (five urban areas and five rural areas) of China who had no missing values for the items that made up the frailty index. We did not exclude participants on the basis of baseline morbidity status. We calculated the follow-up person-years from the baseline date to either the date of death, loss to follow-up, or Dec 31, 2017, whichever came first, through linkage with the registries of China's Disease Surveillance Points system and local residential records. Active follow-up visits to local communities were done annually for participants who were not linked to any established registries. Causes of death from official death certificates were supplemented, if necessary, by reviewing medical records or doing standard verbal autopsy procedures. The frailty index was calculated using 28 baseline variables, all of which were health status deficits measured by use of questionnaires and physical examination. We defined three categories of frailty status: robust (frailty index ≤0·10), prefrail (frailty index >0·10 to <0·25), and frail (frailty index ≥0·25). The primary outcomes were all-cause mortality and cause-specific mortality in Chinese adults aged 30-79 years. We used a Cox proportional hazards model to estimate the associations between the frailty index and all-cause and cause-specific mortality, adjusting for chronological age, education, and lifestyle factors. FINDINGS 512 723 participants, recruited between June 25, 2004, and July 15, 2008, were followed up for a median of 10·8 years (IQR 10·2-13·1; total follow-up 5 551 974 person-years). 291 954 (56·9%) people were categorised as robust, 205 075 (40·0%) people were categorised as prefrail, and 15 694 (3·1%) people were categorised as frail. Women aged between 45 years and 79 years had a higher mean frailty index and a higher prevalence of frailty than did men. During follow-up, 49 371 deaths were recorded. After adjustment for established and potential risk factors for death, each 0·1 increment in the frailty index was associated with a higher risk of all-cause mortality (hazard ratio [HR] 1·68, 95% CI 1·66-1·71). Such associations were stronger among younger adults than among older adults (pinteraction<0·0001), with HRs per 0·1 increment of the frailty index of 1·95 (95% CI 1·87-2·03) for those younger than 50 years, 1·80 (1·76-1·83) for those aged 50-64 years, and 1·56 (1·53-1·59) for those 65 years and older. After adjustments, there was no difference between the sexes in the association between the frailty index and all-cause mortality (pinteraction=0·75). For each 0·1 increment of the frailty index, the corresponding HRs for risk of death were 1·89 (95% CI 1·83-1·94) from ischaemic heart disease, 1·84 (1·79-1·89) from cerebrovascular disease, 1·19 (1·16-1·22) from cancer, 2·54 (2·45-2·63) from respiratory disease, 1·78 (1·59-2·00) from infection, and 1·78 (1·73-1·83) from all other causes. INTERPRETATION The frailty index is associated with all-cause and cause-specific mortality independent of chronological age in younger and older Chinese adults. The identification of younger adults with accelerated ageing by use of surrogate measures could be useful for the prevention of premature death and the extension of healthy active life expectancy. FUNDING The National Natural Science Foundation of China, the National Key R&D Program of China, the Chinese Ministry of Science and Technology, the Kadoorie Charitable Foundation, and the Wellcome Trust.
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Affiliation(s)
- Junning Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yu Guo
- Peking University Health Science Center, and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zhijia Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhongxiao Li
- Noncommunicable Diseases Prevention and Control Department, Maiji Centre for Disease Control and Prevention, Tianshui, China
| | - Yulong Lei
- Noncommunicable Diseases Prevention and Control Department, Maiji Centre for Disease Control and Prevention, Tianshui, China
| | - Dianjianyi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Peking University Institute of Environmental Medicine, Peking University, Beijing, China; Peking University Health Science Center, and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University, Beijing, China.
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Abstract
Frailty is a syndrome characterized by the decline in the physiologic reserve and function of several systems, leading to increased vulnerability and adverse health outcomes. While common in the elderly, recent studies have underlined the higher prevalence of frailty in chronic diseases, independent of age. The pathophysiological mechanisms that contribute to frailty have not been completely understood, although significant progresses have recently been made. In this context, chronic inflammation is likely to play a pivotal role, both directly and indirectly through other systems, such as the musculoskeletal, endocrine, and neurological systems. Rheumatic diseases are characterized by chronic inflammation and accumulation of deficits during time. Therefore, studies have recently started to explore the link between frailty and rheumatic diseases, and in this review, we report what has been described so far. Frailty is dynamic and potentially reversible with 8.3%-17.9% of older adults spontaneously improving their frailty status over time. Muscle strength is likely the most significant influencing factor which could be improved with training thus pointing at the need to maintain physical activity. Not surprisingly, frailty is more prevalent in patients affected by rheumatic diseases than in healthy controls, regardless of age and is associated with high disease activity to affect the clinical outcomes, largely due to chronic inflammation. More importantly, the treatment of the underlying condition may prevent frailty. Scales to assess frailty in patients affected by rheumatic diseases have been proposed, but larger casuistries are needed to validate disease-specific indexes, which could allow more accurate prognostic estimates than demographic and disease-related variables alone. Frail patients can be more vulnerable and more difficult to treat, due to the risk of side effects, therefore frailty should be taken into account in clinical decisions. Clinical trials addressing frailty could identify patients who are less likely to tolerate potentially toxic medications and might benefit from more conservative regimens. In conclusion, the implementation of the concept of frailty in rheumatology will allow a better understanding of the patient global health, a finest risk stratification and a more individualized management strategy.
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Affiliation(s)
- Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center– IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Antonio Sica
- Humanitas Clinical and Research Center - IRCCS - Laboratory of Molecular Immunology, Milan, Italy
- Department of Pharmaceutical Sciences, University of Piemonte Orientale “A. Avogadro”, Novara, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center– IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
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Lewsey SC, Weiss K, Schär M, Zhang Y, Bottomley PA, Samuel TJ, Xue QL, Steinberg A, Walston JD, Gerstenblith G, Weiss RG. Exercise intolerance and rapid skeletal muscle energetic decline in human age-associated frailty. JCI Insight 2020; 5:141246. [PMID: 32941181 PMCID: PMC7605538 DOI: 10.1172/jci.insight.141246] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Physical frailty in older individuals is characterized by subjective symptoms of fatigue and exercise intolerance (EI). Objective abnormalities in skeletal muscle (SM) mitochondrial high-energy phosphate (HEP) metabolism contribute to EI in inherited myopathies; however, their presence or link to EI in the frail older adult is unknown. METHODS Here, we studied 3 groups of ambulatory, community-dwelling adults with no history of significant coronary disease: frail older (FO) individuals (81 ± 2.7 years, mean ± SEM), nonfrail older (NFO) individuals (79 ± 2.0 years), and healthy middle-aged individuals, who served as controls (CONT, 51 ± 2.1 years). Lower extremity SM HEP levels and mitochondrial function were measured with 31P magnetic resonance (MR) techniques during graded multistage plantar flexion exercise (PFE). EI was quantified by a 6-minute walk (6MW) and peak oxygen consumption during cardiopulmonary testing (peak VO2). RESULTS During graded exercise, FO, NFO, and CONT individuals all fatigued at similar SM HEP levels, as measured by 31P-MR. However, FO individuals fatigued fastest, with several-fold higher rates of PFE-induced HEP decline that correlated closely with shorter exercise duration in the MR scanner and with 6MW distance and lower peak oxygen consumption on cardiopulmonary testing (P < 0.001 for all). SM mitochondrial oxidative capacity was lower in older individuals and correlated with rapid HEP decline but less closely with EI. CONCLUSION Several-fold faster SM energetic decline during exercise occurs in FO individuals and correlates closely with multiple measures of EI. Rapid energetic decline represents an objective, functional measure of SM metabolic changes and a potential new target for mitigating frailty-associated physical limitations. FUNDING This work was supported by NIH R21 AG045634, R01 AG063661, R01 HL61912, the Johns Hopkins University Claude D. Pepper Older Americans Independence Center P30AG021334, and the Clarence Doodeman Endowment in Cardiology at Johns Hopkins. Rapid exercise-induced skeletal muscle high-energy phosphate decline occurs in frail, older individuals and is closely linked to exercise intolerance and fatigue.
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Affiliation(s)
| | - Kilian Weiss
- Division of Cardiology, Department of Medicine, and.,Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Philips Healthcare Germany, Hamburg, Germany
| | - Michael Schär
- Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yi Zhang
- Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Paul A Bottomley
- Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Qian-Li Xue
- Divison of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Jeremy D Walston
- Divison of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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The joint effects of frailty and telomere length for predicting mortality in older adults: the National Health and Nutrition Examination Survey 1999-2002. Aging Clin Exp Res 2020; 32:1839-1847. [PMID: 31646458 DOI: 10.1007/s40520-019-01376-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/04/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Frailty and short telomere length, which address different aspects of biological aging, are separately associated with mortality in older adults. AIMS To evaluate whether the combination of these two biomarkers would be a better predictor of mortality than either alone. METHODS This present study included participants 60 years of age or older from the National Health and Nutrition Examination Survey in the 1999-2002 phase. The frailty phenotype was identified based on the Fried definition. Telomere length relative to standard reference DNA (T/S ratio) was assessed using quantitative polymerase chain reaction (PCR). Cox proportional hazards regression models were used to estimate the individual and combined effects of frailty phenotype and telomere length on all-cause and cardiovascular mortality. RESULTS Compared with participants with neither impairment, the mortality risks increased slightly among participants with short telomere length only (hazard ratio [HR] 1.19, 95% confidence interval [CI]: 1.00-1.42) or pre-frailty only (HR 2.16, 95% CI 1.80-2.60) and gradually elevated approximately 3 folds with both short telomere length and pre-frailty (HR 2.23, 95% CI 1.81-2.74) or frailty (HR 3.57, 95% CI 2.56-4.98). Moreover, participants with both short telomere length and frailty had the highest increased all-cause mortality (HR 5.16, 95% CI 3.38-7.85) and cardiovascular mortality (HR 4.67, 95% CI 2.02-10.82). DISCUSSION AND CONCLUSIONS The combined predictor had more capability of predicting mortality, which suggested that integrating both molecular biomarkers and physiological functional parameters would be a more informative measure of biological aging.
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Leading changes in perioperative medicine: beyond length of stay. Int Anesthesiol Clin 2020; 58:2-6. [PMID: 32852313 DOI: 10.1097/aia.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guida JL, Ahles TA, Belsky D, Campisi J, Cohen HJ, DeGregori J, Fuldner R, Ferrucci L, Gallicchio L, Gavrilov L, Gavrilova N, Green PA, Jhappan C, Kohanski R, Krull K, Mandelblatt J, Ness KK, O'Mara A, Price N, Schrack J, Studenski S, Theou O, Tracy RP, Hurria A. Measuring Aging and Identifying Aging Phenotypes in Cancer Survivors. J Natl Cancer Inst 2020; 111:1245-1254. [PMID: 31321426 DOI: 10.1093/jnci/djz136] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/17/2019] [Accepted: 07/03/2019] [Indexed: 02/07/2023] Open
Abstract
Observational data have shown that some cancer survivors develop chronic conditions like frailty, sarcopenia, cardiac dysfunction, and mild cognitive impairment earlier and/or at a greater burden than similarly aged individuals never diagnosed with cancer or exposed to systemic or targeted cancer therapies. In aggregate, cancer- and treatment-related physical, cognitive, and psychosocial late- and long-term morbidities experienced by cancer survivors are hypothesized to represent accelerated or accentuated aging trajectories. However, conceptual, measurement, and methodological challenges have constrained efforts to identify, predict, and mitigate aging-related consequences of cancer and cancer treatment. In July 2018, the National Cancer Institute convened basic, clinical, and translational science experts for a think tank titled "Measuring Aging and Identifying Aging Phenotypes in Cancer Survivors." Through the resulting deliberations, several research and resource needs were identified, including longitudinal studies to examine aging trajectories that include detailed data from before, during, and after cancer treatment; mechanistic studies to elucidate the pathways that lead to the emergence of aging phenotypes in cancer survivors; long-term clinical surveillance to monitor survivors for late-emerging effects; and tools to integrate multiple data sources to inform understanding of how cancer and its therapies contribute to the aging process. Addressing these needs will help expand the evidence base and inform strategies to optimize healthy aging of cancer survivors.
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Lee JY, Kim KJ, Kim CO, Lee KH. Relationship of the pre-operative comprehensive geriatric assessment to length of stay in Korean older adults undergoing spinal surgery. Aging Clin Exp Res 2020; 32:1137-1143. [PMID: 31429002 DOI: 10.1007/s40520-019-01300-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/29/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although pre-operative, Comprehensive Geriatric Assessment has been used widely, its impact on the health status of older adults has not been fully examined. AIMS This study aimed to investigate the relationships between subcomponents of a Comprehensive Geriatric Assessment and length of hospital stay in older adults undergoing spinal surgery. METHODS Participants were 133 older adults in neurosurgical department. The Comprehensive Geriatric Assessment included nutrition, physical activity, functional status, cognition, depression, the Timed Up and Go test, self-rated health, and frailty. Length of stay was replaced by excessive number of days, because expected length of stay varied depending on the type of surgery. RESULTS Excessive lengths of stay were associated with pre-frailty (p = 0.02), frailty (p = 0.02), risk of depression (p < 0.01), and post-operative complications (p < 0.01). More specifically, frailty and risk of depression played as moderators as interacting post-operative complications. The effect of interaction was greatest in the older adults who were frail and depressed (p < 0.001). DISCUSSION Among the subcomponent of Comprehensive Geriatric Assessment, frailty and depression were significant predictors of excessive length of stay. The interrelationship between frailty and depression better explained excessive length of stay rather than considered as individual variable. CONCLUSIONS Clinicians are encouraged to pay attention to depression and frailty, and its interaction to improve the health status of surgical elderly patients.
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Crow RS, Petersen CL, Cook SB, Stevens CJ, Titus AJ, Mackenzie TA, Batsis JA. Reported Weight Change in Older Adults and Presence of Frailty. J Frailty Aging 2020; 9:74-81. [PMID: 32259180 DOI: 10.14283/jfa.2019.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE A 5% change in weight is a significant predictor for frailty and obesity. We ascertained how self-reported weight change over the lifespan impacts rates of frailty in older adults. METHODS We identified 4,984 subjects ≥60 years with body composition measures from the National Health and Nutrition Examination Survey. An adapted version of Fried's frailty criteria was used as the primary outcome. Self-reported weight was assessed at time current,1 and 10 years earlier and at age 25. Weight changes between each time point were categorized as ≥ 5%, ≤5% or neutral. Logistic regression assessed the impact of weight change on the outcome of frailty. RESULTS Among 4,984 participants, 56.5% were female, mean age was 71.1 years, and mean BMI was 28.2kg/m2. A weight loss of ≥ 5% had a higher association with frailty compared to current weight, age 25 (OR 2.94 [1.72,5.02]), 10 years ago (OR 1.68 [1.05,2.69]), and 1 year ago (OR 1.55 [1.02,2.36]). Weight gain in the last year was associated with increased rate of frailty (1.59 [1.09,2.32]). CONCLUSION There is an association between frailty and reported weight loss over time while only weight gain in the last year has an association with frailty.
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Affiliation(s)
- R S Crow
- Rebecca Crow DO, Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, Telephone: (603) 653-9500, Facsimile: (603) 650-0915, E-mail:
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Frilling B. Geriatrisches Assessment – Evidenz und Anwendungsmöglichkeiten in der HNO-Heilkunde. HNO 2020; 68:150-154. [DOI: 10.1007/s00106-020-00815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sayyed Kassem L, Aron DC. The assessment and management of quality of life of older adults with diabetes mellitus. Expert Rev Endocrinol Metab 2020; 15:71-81. [PMID: 32176560 DOI: 10.1080/17446651.2020.1737520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
Introduction: As the population ages, the number of older adults with diabetes mellitus will continue to rise. The burden of diabetes on older adults is significant due to the disease itself, its complications, and its treatments. This is compounded by geriatric syndromes such as frailty and cognitive dysfunction. Consequently, health and diabetes-related quality of life (QoL) are diminished.Areas covered: This article reviews the value of assessing QoL in providing patient-centered care and the associations between QoL measures and health outcomes. The determinants of QoL particular to diabetes and the older population are reviewed, including psychosocial, physical, and cognitive burdens of diabetes and aging and the impact of hypoglycemia on QoL. Strategies are described to alleviate these burdens and improve QoL, and barriers to multidisciplinary patient-centered care are discussed. QoL measurement instruments are reviewed.Expert opinion: The goals of treating diabetes and its complications should be considered carefully along with each patient's capacity to withstand the burdens of treatment. This capacity is reduced by socioeconomic, psychological, cognitive, and physical factors reduces this capacity. Incorporating measurement of HRQoL into clinical practices is possible, but deficiencies in the systems of health-care delivery need to be addressed to facilitate their use.
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Affiliation(s)
- Laure Sayyed Kassem
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C Aron
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Nutrition and frailty: Current knowledge. Prog Neuropsychopharmacol Biol Psychiatry 2019; 95:109703. [PMID: 31325470 DOI: 10.1016/j.pnpbp.2019.109703] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/29/2019] [Accepted: 07/16/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE OF THE REVIEW Nutrition, as part of lifestyle and modifiable environmental factors, constitutes an interesting approach for the prevention of geriatric syndromes. The objective of this review was to examine the most recent evidence on the association between nutrition, from dietary patterns to specific nutrients, and frailty, before the onset of disability, among elderly individuals. RECENT FINDINGS Based on available epidemiological studies, three meta-analyses published in 2018 have outlined a protective effect of greater adherence to a Mediterranean-type diet (MeDi) on the risk for frailty, with up to a 60% reduction in risk. Several studies focusing on particular food groups, macronutrients and micronutrients have also been published and have highlighted that a protein intake of 1 g/kg in body weight per day should be fulfilled (except for patients suffering from kidney or hepatic dysfunction) and that vitamin deficiencies should be avoided. Available interventional studies of nutritional supplements and/or physical activity programs have mainly been limited to disabled participants to date. SUMMARY Research efforts should target both developing a better understanding of the mechanisms underlying frailty and improving detection tools and the effectiveness of intervention studies, alongside efforts to address the specific needs of older people. For instance, ensuring an adequate nutritional status, by fighting the age-related increased prevalence of undernutrition or sarcopenic obesity, should be privileged.
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Advani S, Braithwaite D. Optimizing selection of candidates for lung cancer screening: role of comorbidity, frailty and life expectancy. Transl Lung Cancer Res 2019; 8:S454-S459. [PMID: 32038937 PMCID: PMC6987350 DOI: 10.21037/tlcr.2019.10.03] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/23/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Shailesh Advani
- Cancer Prevention and Control Program, Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA
- Social Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dejana Braithwaite
- Cancer Prevention and Control Program, Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA
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Amini S, Crowley S, Hizel L, Arias F, Libon DJ, Tighe P, Giordano C, Garvan CW, Enneking FK, Price CC. Feasibility and Rationale for Incorporating Frailty and Cognitive Screening Protocols in a Preoperative Anesthesia Clinic. Anesth Analg 2019; 129:830-838. [PMID: 31425227 PMCID: PMC6927245 DOI: 10.1213/ane.0000000000004190] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Advanced age, frailty, low education level, and impaired cognition are generally reported to be associated with postoperative cognitive complications. To translate research findings into hospital-wide preoperative assessment clinical practice, we examined the feasibility of implementing a preoperative frailty and cognitive assessment for all older adults electing surgical procedures in a tertiary medical center. We examined associations among age, education, frailty, and comorbidity with the clock and 3-word memory scores, estimated the prevalence of mild to major cognitive impairment in the presurgical sample, and examined factors related to hospital length of stay. METHODS Medical staff screened adults ≥65 years of age for frailty, general cognition (via the clock-drawing test command and copy, 3-word memory test), and obtained years of education. Feasibility was studied in 2 phases: (1) a pilot phase involving 4 advanced nurse practitioners and (2) a 2-month implementation phase involving all preoperative staff. We tracked sources of missing data, investigated associations of study variables with measures of cognition, and used 2 approaches to estimate the likelihood of dementia in our sample (ie, using extant data and logistic regression modeling and using Mini-Cog cut scores). We explored which protocol variables related to hospital length of stay. RESULTS The final implementation phase sample included 678 patients. Clock and 3-word memory scores were significantly associated with age, frailty, and education. Education, clock scores, and 3-word scores were not significantly different by surgery type. Likelihood of preoperative cognitive impairment was approximately 20%, with no difference by surgery type. Length of stay was significantly associated with preoperative comorbidity and performance on the clock copy condition. CONCLUSIONS Frailty and cognitive screening protocols are feasible and provide information for perioperative care planning. Challenges to clinical adaptation include staff training, missing data, and additional administration time. These challenges appear minimal relative to the benefits of identifying frailty and cognitive impairment in a group at risk for negative postoperative cognitive outcome.
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Affiliation(s)
- Shawna Amini
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Samuel Crowley
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | - Loren Hizel
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - David J. Libon
- Department of Geriatrics, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
- Department of Gerontology, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
- Department of Psychology, Rowan University, School of Osteopathic Medicine, New Jersey Institute for Successful Aging, Stratford, New Jersey
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Chris Giordano
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Cynthia W. Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - F. Kayser Enneking
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
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Li X, Ploner A, Karlsson IK, Liu X, Magnusson PKE, Pedersen NL, Hägg S, Jylhävä J. The frailty index is a predictor of cause-specific mortality independent of familial effects from midlife onwards: a large cohort study. BMC Med 2019; 17:94. [PMID: 31088449 PMCID: PMC6518710 DOI: 10.1186/s12916-019-1331-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/29/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Frailty index (FI) is a well-established predictor of all-cause mortality, but less is known for cause-specific mortality and whether familial effects influence the associations. Middle-aged individuals are also understudied for the association between FI and mortality. Furthermore, the population mortality impact of frailty remains understudied. METHODS We estimated the predictive value of FI for all-cause and cause-specific mortality, taking into account familial factors, and tested whether the associations are time-dependent. We also assessed the proportion of all-cause and cause-specific deaths that are attributable to increased levels of frailty. We analyzed 42,953 participants from the Screening Across the Lifespan Twin Study (aged 41-95 years at baseline) with up to 20 years' mortality follow-up. The FI was constructed using 44 health-related items. Deaths due to cardiovascular disease (CVD), respiratory-related causes, and cancer were considered in the cause-specific analysis. Generalized survival models were used in the analysis. RESULTS Increased FI was associated with higher risks of all-cause, CVD, and respiratory-related mortality, with the corresponding hazard ratios of 1.28 (1.24, 1.32), 1.31 (1.23, 1.40), and 1.23 (1.11, 1.38) associated with a 10% increase in FI in male single responders, and 1.21 (1.18, 1.25), 1.27 (1.15, 1.34), and 1.26 (1.15, 1.39) in female single responders. No significant associations were observed for cancer mortality. No attenuation of the mortality associations in unrelated individuals was observed when adjusting for familial effects in twin pairs. The associations were time-dependent with relatively greater effects observed in younger ages. Before the age of 80, the proportions of deaths attributable to FI levels > 0.21 were 18.4% of all-cause deaths, 25.4% of CVD deaths, and 20.4% of respiratory-related deaths in men and 19.2% of all-cause deaths, 27.8% of CVD deaths, and 28.5% of respiratory-related deaths in women. After the age of 80, the attributable proportions decreased, most notably for all-cause and CVD mortality. CONCLUSIONS Increased FI predicts higher risks of all-cause, CVD, and respiratory-related mortality independent of familial effects. Increased FI presents a relatively greater risk factor at midlife than in old age. Increased FI has a significant population mortality impact that is greatest through midlife until the age of 80.
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Affiliation(s)
- Xia Li
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Alexander Ploner
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Ida K Karlsson
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden.,Institute of Gerontology and Aging Research Network - Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Xingrong Liu
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Patrik K E Magnusson
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Nancy L Pedersen
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Sara Hägg
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Juulia Jylhävä
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden.
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Magkas N, Tsioufis C, Thomopoulos C, Dilaveris P, Georgiopoulos G, Sanidas E, Papademetriou V, Tousoulis D. Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations. J Clin Hypertens (Greenwich) 2019; 21:546-554. [DOI: 10.1111/jch.13521] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/14/2019] [Accepted: 02/20/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Nikolaos Magkas
- First Department of Cardiology “Hippokration” Hospital, University of Athens, Medical School Athens Greece
| | - Costas Tsioufis
- First Department of Cardiology “Hippokration” Hospital, University of Athens, Medical School Athens Greece
| | | | - Polychronis Dilaveris
- First Department of Cardiology “Hippokration” Hospital, University of Athens, Medical School Athens Greece
| | - Georgios Georgiopoulos
- First Department of Cardiology “Hippokration” Hospital, University of Athens, Medical School Athens Greece
| | - Elias Sanidas
- Hypertension Excellence Centre‐ESH, Department of Cardiology LAIKO General Hospital Athens Greece
| | - Vasilios Papademetriou
- Cardiology Department Georgetown University and Veterans Affairs Medical Center Washington District of Columbia
| | - Dimitrios Tousoulis
- First Department of Cardiology “Hippokration” Hospital, University of Athens, Medical School Athens Greece
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Lowery CL, Woulfe D, Kilic F. Responses of Plasma Catecholamine, Serotonin, and the Platelet Serotonin Transporter to Cigarette Smoking. Front Neurosci 2019; 13:32. [PMID: 30886568 PMCID: PMC6409334 DOI: 10.3389/fnins.2019.00032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022] Open
Abstract
Cigarette smoking is one of the major causes of coronary heart disease with a thirty percent mortality rate in the United States. Cigarette smoking acting on the central nervous system (CNS) to stimulate the sympathetic nervous system (SNS) through, which facilitates the secretion of serotonin (5-HT) and catecholamines to supraphysiological levels in blood. The enhanced levels of 5-HT and catecholamines in smokers’ blood are associated with increases in G protein-coupled receptor signaling and serotonylation of small GTPases, which in turn lead to remodeling of cytoskeletal elements to enhance granule secretion and promote unique expression of sialylated N-glycan structures on smokers’ platelets. These mechanisms enhance aggregation and adhesion of smokers’ platelets relative to those of non-smokers. This review focuses on the known mechanisms by which 5-HT and SERT, in coordinated signaling with catecholamines, impacts cigarette smokers’ platelet biology.
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Affiliation(s)
- Curtis Lee Lowery
- Departments of Biochemistry and Molecular Biology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Donna Woulfe
- Department of Biological Sciences, University of Delaware, Newark, DE, United States
| | - Fusun Kilic
- Departments of Biochemistry and Molecular Biology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Lohman MC, Resciniti NV, Wirth MD, Shivappa N, Hébert JR. Obesity, Dietary inflammation, and Frailty among Older Adults: Evidence from the National Health and Nutrition Examination Survey. J Nutr Gerontol Geriatr 2019; 38:18-32. [PMID: 30849025 DOI: 10.1080/21551197.2018.1552226] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Knowledge related to the relationship between obesity and frailty is limited. This study aimed to investigate associations between obesity, dietary inflammation, and frailty among older adults. Study data came from National Health and Nutrition Examination Survey (2007-2014) examinations of adults age ≥60 years (n = 7182). Dietary inflammatory potential was determined using the Dietary Inflammatory Index (DII®) derived from 24-h dietary recall. We analyzed independent and joint associations of obesity and DII with frailty to evaluate interaction. Multivariable logistic regression revealed that both obesity (Odds Ratio [OR] = 2.24, 95% CI: 1.68, 2.99) and moderately pro-inflammatory DII (OR = 1.68, 95% CI: 1.10, 2.58) were independently associated with greater frailty prevalence. A negative multiplicative interaction between obesity and highest pro-inflammatory diet also was found (adjusted odds in non-obese and obese were 2.07 and 2.37, respectively; p = 0.046). Results indicate the importance of considering obesity and dietary inflammatory potential when screening for frailty or developing treatments.
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Affiliation(s)
- Matthew C Lohman
- a Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA
| | - Nicholas V Resciniti
- a Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA
| | - Michael D Wirth
- a Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.,b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,c College of Nursing , University of South Carolina , Columbia , SC , USA.,d Connecting Health Innovations, LLC , Columbia , SC , USA
| | - Nitin Shivappa
- a Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.,b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,d Connecting Health Innovations, LLC , Columbia , SC , USA
| | - James R Hébert
- a Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.,b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,d Connecting Health Innovations, LLC , Columbia , SC , USA
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