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Wang Y, Shen S, Han P, Zheng K, Chen C, Wu Y, Huang C, Guo J, Qi Y, Chen X, Zheng Y, Xia X, Peng S, Guo Q. The association between visceral fat obesity and prefrailty in Chinese older adults: a cross-sectional study. BMC Endocr Disord 2024; 24:136. [PMID: 39090692 PMCID: PMC11295587 DOI: 10.1186/s12902-024-01625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/14/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The prevalence of obesity is escalating. Previous research has concentrated on the link between frailty and obesity; however, the association between prefrailty and obesity has been less studied. Prefrailty screening and intervention may prevent or postpone frailty in older persons. OBJECTIVE The study was to investigate into the relationship between prefrailty and several obesity indicators in Chinese community-dwelling older individuals. METHODS This research employed the Frailty Screening Index to investigate the frailty phenotype of people living in Shanghai. Bioelectrical impedance analysis was used for evaluating body composition. RESULTS There were 510 participants (39.0%) with high visceral adipose areas. Participants with a high visceral adipose area showed a higher risk of prefrailty (adjusted OR, 1.53; 95% CI, 1.19-1.96), according to multivariate models. When body mass index (BMI) and visceral fat area (VFA) were combined, it was discovered that having an overweight BMI with normal VFA was a protective factor for prefrailty (corrected OR, 0.62; 95% CI, 0.43-0.90), but having a normal weight but excess VFA increased the risk of prefrailty (corrected OR, 1.87; 95% CI, 1.15-3.03). CONCLUSION Visceral fat obesity is an independent risk factor for prefrailty in Chinese older adults. Implementing targeted interventions, such as dietary modifications, increased physical activity, and other lifestyle changes, could play a crucial role in reducing the risk of prefrailty and improving overall health outcomes in this population.
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Affiliation(s)
- Yue Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200135, China
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Suxing Shen
- Rehabilitation Medicine Department, Tianjin Fifth Central Hospital, Tianjin, 300457, China
| | - Peipei Han
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Kai Zheng
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200135, China
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Cheng Chen
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
- School of Health, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Yahui Wu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200135, China
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Chuanjun Huang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200135, China
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Jiangling Guo
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yiqiong Qi
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, 200438, China
| | - Xiaoyu Chen
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Yuxuan Zheng
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Xinwei Xia
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Siyan Peng
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Qi Guo
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China.
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, 200438, China.
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences affiliated Zhoupu Hospital, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China.
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Yen HK, Lin WH, Groot OQ, Chen CW, Yang JJ, Bongers MER, Karhade A, Shah A, Yang TC, Bindels BJ, Dai SH, Verlaan JJ, Schwab J, Yang SH, Hornicek FJ, Hu MH. Comparison of Classically and Machine Learning Generated Survival Prediction Models for Patients With Spinal Metastasis - A meta-Analysis of Two Recently Developed Algorithms. Global Spine J 2024:21925682231162817. [PMID: 39069660 DOI: 10.1177/21925682231162817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
STUDY DESIGN A systemic review and a meta-analysis. We also provided a retrospective cohort for validation in this study. OBJECTIVE (1) Using a meta-analysis to determine the pooled discriminatory ability of The Skeletal Oncology Research Group (SORG) classical algorithm (CA) and machine learning algorithms (MLA); and (2) test the hypothesis that SORG-CA has less variability in performance than SORG-MLA in non-American validation cohorts as SORG-CA does not incorporates regional-specific variables such as body mass index as input. METHODS After data extraction from the included studies, logit-transformation was applied for extracted AUCs for further analysis. The discriminatory abilities of both algorithms were directly compared by their logit (AUC)s. Further subgroup analysis by region (America vs non-America) was also conducted by comparing the corresponding logit (AUC). RESULTS The pooled logit (AUC)s of 90-day SORG-CA was .82 (95% confidence interval [CI], .53-.11), 1-year SORG-CA was 1.11 (95% CI, .74-1.48), 90-day SORG-MLA was 1.36 (95% CI, 1.09-1.63), and 1-year SORG-MLA was 1.57 (95% CI, 1.17-1.98). All the algorithms performed better in United States than in Taiwan (P < .001). The performance of SORG-CA was less influenced by a non-American cohort than SORG-MLA. CONCLUSION These observations might highlight the importance of incorporating region-specific variables into existing models to make them generalizable to racially or geographically distinct regions.
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Affiliation(s)
- Hung-Kuan Yen
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Education, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- Department of Orthopedic Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Wei-Hsin Lin
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Chih-Wei Chen
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiun-Jen Yang
- School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Aditya Karhade
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Akash Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, Albany, NY, USA
| | - Bas Jj Bindels
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Shih-Hsiang Dai
- Department of International Business, National Taiwan University Hospital, Taipei, Taiwan
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Joseph Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Shu-Hua Yang
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ming-Hsiao Hu
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Har BJ. Defining Success of Transcatheter Device Closure for Mitral Paravalvular Leak: Why It's Important. Can J Cardiol 2024; 40:1223-1225. [PMID: 38579963 DOI: 10.1016/j.cjca.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024] Open
Affiliation(s)
- Bryan J Har
- Libin Cardiovascular Institute and Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Williams-Farrelly MM, Ferraro KF. Early Origins of Frailty: Do Later-Life Social Relationships Alter Trajectories of Decline? J Aging Health 2024; 36:275-285. [PMID: 37358912 PMCID: PMC10749989 DOI: 10.1177/08982643231185426] [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] [Indexed: 06/27/2023]
Abstract
Objectives: Social relationships are widely regarded as salubrious, but do they mediate the influence of childhood experiences on frailty in later life? Drawing from cumulative inequality theory, we assess the influence of childhood experiences and adult relationships on frailty trajectories. Methods: We analyzed data from the Health and Retirement Study to examine the influence of six domains of childhood experiences and social relationships on frailty trajectories over 8 years. Mediation analyses were completed with structural equation models. Results: Risky adolescent behavior, chronic disease, and impairments during childhood are associated directly with higher risk of initial frailty, but not over time. More social roles and higher social support mediate the relationship between childhood experiences and frailty, and the effect of more social roles continues over time. Discussion: This study provides compelling evidence that supportive social relationships mediate the risk and severity of frailty in later life associated with noxious childhood experiences.
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Affiliation(s)
- Monica M. Williams-Farrelly
- Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Kenneth F. Ferraro
- Department of Sociology, Purdue University, West Lafayette, IN, USA
- Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
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Owodunni OP, Courville EN, Peter-Okaka U, Ricks CB, Schmidt MH, Bowers CA. Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic. Int J Obes (Lond) 2024; 48:360-369. [PMID: 38110501 DOI: 10.1038/s41366-023-01423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND/OBJECTIVES Obesity is a global health challenge that affects a large proportion of adults worldwide. Obesity and frailty pose considerable health risks due to their potential to interact and amplify one another's negative effects. Therefore, we sought to compare the discriminatory thresholds of the risk analysis index (RAI), 5-factor modified frailty index (m-FI-5) and patient age for the primary endpoint of postoperative mortality. SUBJECTS/METHODS We included spine surgery patients ≥18 years old, from the American College of Surgeons National Quality Improvement program database from 2012-2020, that were classified as obese. We performed receiver operating characteristic curve analysis to compare the discrimination threshold of RAI, mFI-5, and patient age for postoperative mortality. Proportional hazards risk-adjusted regressions were performed, and Hazard ratios and corresponding 95% Confidence intervals (CI) are reported. RESULTS Overall, there were 149 163 patients evaluated, and in the ROC analysis for postoperative mortality, RAI showed superior discrimination C-statistic 0.793 (95%CI: 0.773-0.813), compared to mFI-5 C-statistic 0.671 (95%CI 0.650-0.691), and patient age C-statistic 0.686 (95%CI 0.666-0.707). Risk-adjusted analyses were performed, and the RAI had a stepwise increasing effect size across frailty strata: typical patients HR 2.55 (95%CI 2.03-3.19), frail patients HR 3.48 (95%CI 2.49-4.86), and very frail patients HR 4.90 (95%CI 2.87-8.37). We found increasing postoperative mortality effect sizes within Clavein-Dindo complication strata, consistent across obesity categories, exponentially increasing with frailty, and multiplicatively enhanced within CD, frailty and obesity strata. CONCLUSION In this study of 149 163 patients classified as obese and undergoing spine procedures in an international prospective surgical database, the RAI demonstrated superior discrimination compared to the mFI-5 and patient age in predicting postoperative mortality risk. The deleterious effects of frailty and obesity were synergistic as their combined effect predicted worse outcomes.
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Affiliation(s)
- Oluwafemi P Owodunni
- Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, NM, USA.
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA.
| | - Evan N Courville
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Uchenna Peter-Okaka
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Christian B Ricks
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
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Wu JJ, Ou WF, Yu YY, Wu CL, Yang TY, Chan MC. Lower body mass index is an independent predictor of mortality in older patients with acute respiratory distress syndrome. Heliyon 2024; 10:e25749. [PMID: 38390194 PMCID: PMC10881338 DOI: 10.1016/j.heliyon.2024.e25749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
Background Acute respiratory distress syndrome (ARDS) is associated with high mortality. The impacts of body mass index (BMI) on the morality of older patients with ARDS remain unclear. Methods This is a single-center cohort study which was conducted at Taichung Veterans General Hospital, Taiwan. Adult patients admitted to the ICU needing mechanical ventilation with ARDS were included for analysis. We compared the data of older patients (age ≥65 years) with those of younger patients (Age <65 years). The factors associated with in-hospital mortality of older patients were investigated. Results This study included a total of 728 (mean age: 66 years; men: 63%) patients, and 425 (58.4%) of them aged ≥65 years. Older patients exhibited lower body mass index (BMI) (23.8 vs 25.2), higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (28.9 vs 26.3), higher Charlson Comorbidity Index (CCI) (4.0 vs 3.4), and lower Sequential Organ Failure Assessment (SOFA) scores (10.0 vs 11.1) than younger patients. Furthermore, older patients had mortality rates similar to younger patients (40.5% vs 42.9%, P = 0.542), but had longer length of stay in the ICU (17.6 vs 15.6 days, P = 0.047). For older patients, BMI <18.5 (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.45-5.34), high SOFA score (OR, 1.20; 95% CI, 1.12-1.28), and moderate (OR, 1.95; 95% CI 1.20-3.14) or severe ARDS (OR, 2.30; 95% CI 1.26-4.22) were independent risk factors for mortality. Conclusions In this cohort, critical ill older patients with ARDS had lower BMI, more comorbidities, and higher APACHE II scores than younger patients. Mortality rate was similar between older and younger patients. Low BMI, high SOFA score, and moderate or severe ARDS were independently associated with mortality in older patients with ARDS.
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Affiliation(s)
- Jia-Jun Wu
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan No.110, Sect. 1, Jianguo N. Road, Taichung, 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan No.110, Sect. 1, Jianguo N. Road, Taichung, 402, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan No.110, Sect. 1, Jianguo N. Road, Taichung, 402, Taiwan
| | - Wei-Fan Ou
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
| | - Yu-Yi Yu
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan No.155, Sect.2, Linong Street, Taipei, 112, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
| | - Chieh-Liang Wu
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
| | - Tsung-Ying Yang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
- Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
- Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan No.250, Kuo Kuang Road, Taichung, 402, Taiwan
| | - Ming-Cheng Chan
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
- School of Medicine, National Chung Hsing University No.250, Kuo Kuang Road, Taichung, 402, Taiwan
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Kravchenko G, Korycka-Bloch R, Stephenson SS, Kostka T, Sołtysik BK. Cardiometabolic Disorders Are Important Correlates of Vulnerability in Hospitalized Older Adults. Nutrients 2023; 15:3716. [PMID: 37686746 PMCID: PMC10490417 DOI: 10.3390/nu15173716] [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: 07/30/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
With an increasingly aging population worldwide, the concept of multimorbidity has attracted growing interest over recent years, especially in terms of frailty, which leads to progressive multisystem decline and increased adverse clinical outcomes. The relative contribution of multiple disorders to overall frailty index in older populations has not been established so far. This study aimed to assess the association between the vulnerable elders survey-13 (VES-13) score, which is acknowledged to be one of the most widely used measures of frailty, and the most common accompanying diseases amongst hospitalized adults aged 60 years old and more. A total of 2860 participants with an average age of 83 years were included in this study. Multiple logistic regression with adjustment for age and nutritional status was used to assess the independent impact of every particular disease on vulnerability. Diabetes mellitus type 2, coronary artery disease, atrial fibrillation, heart failure, chronic kidney disease, osteoarthritis, fractures, eyes disorders, depression, dementia, pressure ulcers, and urinary incontinence were associated with higher scores of VES-13. Hospital admission of older subjects with those conditions should primarily draw attention to the risk of functional decline, especially while qualifying older patients for further treatment in surgery and oncology. At the same time, lipid disorders, gastrointestinal diseases, higher body mass index, and albumins level were related to a lower risk of being vulnerable, which may be attributed to a younger age and better nutritional status of those patients.
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Affiliation(s)
| | | | | | - Tomasz Kostka
- Department of Geriatrics, Healthy Aging Research Centre (HARC), Medical University of Lodz, Haller Sqr. No. 1, 90-647 Lodz, Poland; (G.K.); (R.K.-B.); (S.S.S.); (B.K.S.)
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Thiamwong L, Xie R, Conner NE, Renziehausen JM, Ojo EO, Stout JR. Body composition, fear of falling and balance performance in community-dwelling older adults. TRANSLATIONAL MEDICINE OF AGING 2023; 7:80-86. [PMID: 38516177 PMCID: PMC10957135 DOI: 10.1016/j.tma.2023.06.002] [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] [Indexed: 03/23/2024] Open
Abstract
Objectives We aimed to 1) assess body composition using a portable technology, bioelectrical impedance analysis, (BIA) and 2) examine the associations between body composition and the discrepancy of fear of falling (FOF) and balance performance. Methods A cross-sectional study included 121 older adults 60 years and older, 78% were female, 41% lived alone, and 71% had no history of falls. The discrepancy between fear of falling and balance performance was categorized into four groups. We found 47% rational (low FOF and normal balance), 19% incongruent (low FOF despite poor balance), 18% irrational (high FOF despite normal balance), and 16% congruent (high FOF and poor balance). Results Body Fat Mass (BFM), Percent Body Fat (PBF), and Body Mass Index (BMI) were correlated with fear of falling and balance performance. BMI was significantly different in the rational group (p = 0.004) and incongruent group (p = 0.02) compared to the congruent group. PBF was significantly different between the incongruent (p = 0.002), irrational (p = 0.014), and rational (p < 0.001) groups, compared to the congruent group. Conclusions The study found that body BFM, PBF, and BMI were correlated with fear of falling and balance impairment. High Body Mass Index and Body Fat Mass were associated with a discrepancy between FOF and balance. Body composition analysis devices, such as BIA and other portable technologies, could be taken to underserved communities and may help identify community-dwelling older adults who are frail and may be at high risk of falling.
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Affiliation(s)
- Ladda Thiamwong
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Rui Xie
- Department of Statistics and Data Science, College of Science, University of Central Florida, Orlando, FL, USA
| | - Norma E. Conner
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Justine M. Renziehausen
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | | | - Jeffrey R. Stout
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
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Dramé M, Godaert L. The Obesity Paradox and Mortality in Older Adults: A Systematic Review. Nutrients 2023; 15:nu15071780. [PMID: 37049633 PMCID: PMC10096985 DOI: 10.3390/nu15071780] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
“Obesity paradox” describes the counterintuitive finding that aged overweight and obese people with a particular disease may have better outcomes than their normal weight or underweight counterparts. This systematic review was performed to summarize the publications related to the obesity paradox in older adults, to gain an in-depth understanding of this phenomenon. PubMed©, Embase©, and Scopus© were used to perform literature search for all publications up to 20 March 2022. Studies were included if they reported data from older adults on the relation between BMI and mortality. The following article types were excluded from the study: reviews, editorials, correspondence, and case reports and case series. Publication year, study setting, medical condition, study design, sample size, age, and outcome(s) were extracted. This review has been registered with PROSPERO (no. CRD42021289015). Overall, 2226 studies were identified, of which 58 were included in this systematic review. In all, 20 of the 58 studies included in this review did not find any evidence of an obesity paradox. Of these 20 studies, 16 involved patients with no specific medical condition, 1 involved patients with chronic diseases, and 2 involved patients with type 2 diabetes mellitus. Seven out of the nine studies that looked at short-term mortality found evidence of the obesity paradox. Of the 28 studies that examined longer-term mortality, 15 found evidence of the obesity paradox. In the studies that were conducted in people with a particular medical condition (n = 24), the obesity paradox appeared in 18 cases. Our work supports the existence of an obesity paradox, especially when comorbidities or acute medical problems are present. These findings should help guide strategies for nutritional counselling in older populations.
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Affiliation(s)
- Moustapha Dramé
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
- Department of Clinical Research and Innovation, University Hospitals of Martinique, 97261 Fort-de-France, France
| | - Lidvine Godaert
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
- Department of Geriatrics, General Hospital of Valenciennes, 59300 Valenciennes, France
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To TL, Kuo CP, Yeh CJ, Liao WC, Lee MC. Transitions of self-management behaviors and frailty status among community-dwelling older adults: a national longitudinal population-based cohort study. BMC Geriatr 2022; 22:874. [DOI: 10.1186/s12877-022-03578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 10/17/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Frailty in older adults is a common geriatric syndrome that could be prevented; thus, coping strategies for the aging population are essential. Self-management behaviors may represent cost-effective strategies to prevent physical frailty in community-dwelling older adults. This study aimed to describe the changes in frailty status among community-dwelling older adults in Taiwan and investigate the association between transitions of self-management behaviors and frailty status over 4 years of follow-up (2007 to 2011).
Methods
Data were retrieved from the Taiwan Longitudinal Study of Aging (TLSA), years 2007 and 2011. In this prospective cohort study, 1283 community-dwelling older adults aged 65 years and older without cognitive impairment were recruited. Frailty was defined based on Fried’s frailty phenotype. Self-management behaviors (maintaining body weight, quitting smoking or no smoking, drinking less or no drinking, exercising, keeping diet control, and maintaining a regular lifestyle) were assessed using a questionnaire. Multinomial logistic regression analyses were used to investigate the associations between changes in self-management behaviors and in frailty status. The age group was further stratified to examine the moderation effect in the relationship between changes in self-management behaviors and in frailty status among older adults.
Results
The prevalence of frailty was 8.7% at baseline and 14.9% after 4 years of follow-up, with 196 (15.3%) deaths. Overall, 514 (40.1%) participants maintained their frailty status, 424 (33.0%) worsened, and only 149 (11.6%) improved. Being aged ≥75 years old, having chronic diseases, and an absence of self-management behaviors were associated with frailty at baseline and after follow-up. Among individuals aged 65–74, compared to those who maintained no self-management behaviors, those who decreased the exercise behaviors (yes-to-no) had a higher risk of worsening (RRR = 2.518), while increasing (no-to-yes) and maintaining (yes-to-yes) frequent physical exercise were associated with a lower risk of worsening (RRR = 0.466 and 0.572, respectively) than stable frailty; those who maintained body weight (yes-to-yes) were associated with a lower risk of worsening (RRR = 0.327) than stable frailty after controlling for individual covariates and chronic diseases. Among individuals over 75 years old, compared to no exerciser, older old who decreased their physical exercise had a higher risk of frailty worsening (RRR = 3.255), and increasing frequent physical exercise (no-to-yes) was associated with an improvement in frailty status (RRR = 3.684). Age was a moderator between the effects of maintaining body weight on frailty worsening. There were no associations between the behavioral transitions of smoking, drinking, diet control, or regular lifestyle on the frailty status changes.
Conclusions
Maintaining body weight and frequent physical exercise increased the ratio of frailty stability among individuals 65–74 years old. Increasing exercise behavior is the only factor to improve their frailty status among older adults aged 75 years and over. Older adults should be encouraged to perform adequate physical exercise and maintain a healthy body weight to maintain the frailty status in younger old aged 65–74 years, and especially perform more frequent exercise to improve frailty status in older old over 75 years.
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11
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Inoue M, Takeuchi J, Sakuma M, Nakamura T, Morimoto T. Low Serum Total Protein at Admission Predicts in-Hospital Mortality Among General Inpatients: Historical Cohort Study. Int J Gen Med 2022; 15:7941-7949. [PMID: 36317096 PMCID: PMC9617561 DOI: 10.2147/ijgm.s385798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Low total protein (TP) is associated with mortality among patients with specific diseases, but its association was uncertain among general patients. We evaluated the effects of low TP on in-hospital mortality among general inpatients. Patients and Methods We used data from the Japan Adverse Drug Events study series. We enrolled adult inpatients (≥ 16 years) admitted to a tertiary care hospital between September 1 and November 30, 2013. We excluded patients with multiple myeloma, pregnant women, and bone marrow graft donors. Patient data were extracted from electronic medical records. All patients were stratified into those with and without malignancy and divided into the low and normal TP groups. Low TP was defined as < 6.5 g/dL. We compared the in-hospital mortality of the low and normal TP groups stratified by the presence of malignancy. Results Among the 2235 enrolled patients (mean age, 67.8 years), the TP value was lower in 516 patients with malignancy than in 1719 patients without malignancy (6.6 g/dL vs 6.8 g/dL, P = 0.0002). Among patients without or with malignancy, 27% (462/1719) and 35% (183/516) were in the low TP group, respectively. Mortality was higher in the low TP group among patients without malignancy (23.2% vs 10.2%, P < 0.0001). Likewise, among patients with malignancy, mortality was higher in the low TP group (34.7% vs 11.3%, P = 0.0029). The adjusted hazard ratio of the low TP group was 1.75 (95% confidence interval, 1.04–2.96) in patients without malignancy and 2.45 (95% confidence interval, 1.12–5.37) in patients with malignancy, but the interaction was not significant (P = 0.23). Conclusion Low TP values were associated with higher in-hospital mortality among general inpatients, and this association was observed among patients with and those without malignancy. Routinely measured TP should be utilized to risk stratification on admission.
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Affiliation(s)
- Miharu Inoue
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Jiro Takeuchi
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Mio Sakuma
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Tsukasa Nakamura
- Department of Infectious Diseases, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan,Correspondence: Takeshi Morimoto, Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan, Tel +81-798-45-6879, Fax +81-798-45-6920, Email
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12
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Li B, Li Y, Zhang Y, Liu P, Song Y, Zhou Y, Ma L. Visceral Fat Obesity Correlates with Frailty in Middle-Aged and Older Adults. Diabetes Metab Syndr Obes 2022; 15:2877-2884. [PMID: 36164455 PMCID: PMC9508679 DOI: 10.2147/dmso.s383597] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Frailty and obesity are associated with poor outcomes in older adults. Previous studies have shown that excessive visceral fat leads to frailty by promoting inflammation. However, the association between visceral fat obesity (VFO) and frailty has not been elucidated. We aimed to investigate the correlation between VFO and frailty in middle-aged and older adults. Methods A total of 483 adults aged ≥45 years were recruited. Estimated visceral fat area (eVFA) and total fat (TF) were determined by bioimpedance analysis. Waist circumference, body mass index (BMI), and waist-to-hip ratio (WHR) were recorded. Frailty was assessed using the Fried frailty phenotype. Logistic regression analysis was used to analyze the association between frailty and other variables. Spearman correlation coefficients were calculated to assess the correlations between the frailty phenotype score, eVFA/TF, and other factors. Results Frail adults were older and had higher waist circumference, eVFA metabolic indicators, and coronary artery disease incidence. Participants with frailty had a higher prevalence of VFO than those without. After adjusting for age, sex, and chronic diseases, frailty was associated with eVFA but not waist circumference, WHR, or BMI. Spearman correlation analysis showed that the frailty phenotype score was positively associated with eVFA and BMI in women but not men. After adjusting for age, frailty was not associated with BMI or WHR. The eVFA/TF ratio was negatively correlated with grip strength and walking speed and positively correlated with the clinical frailty scale score in middle-aged and older adults. Conclusion Middle-aged and older adults with VFO had a higher risk of frailty. Frailty was associated with a higher eVFA but not with BMI or WHR. The frailty score was positively associated with eVFA and BMI in women, but not in men. A higher eVFA was correlated with worse physical function, even after adjusting for TF.
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Affiliation(s)
- Bixi Li
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Yun Li
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Yaxin Zhang
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Pan Liu
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Yu Song
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Yaru Zhou
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
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13
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Watanabe D, Kurotani K, Yoshida T, Nanri H, Watanabe Y, Date H, Itoi A, Goto C, Ishikawa-Takata K, Kimura M, Miyachi M, Yamada Y. Diet quality and physical or comprehensive frailty among older adults. Eur J Nutr 2022; 61:2451-2462. [PMID: 35152337 PMCID: PMC8852878 DOI: 10.1007/s00394-022-02819-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/25/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE While the association between diet quality and mortality has been previously demonstrated, the association between frailty and diet quality has not been evaluated well. This study aimed to investigate the association between diet quality and prevalence of both physical and comprehensive frailty, using two validated tools, in a community-based cohort of older adults. METHODS We conducted cross-sectional analyses using baseline data of 7022 participants aged ≥ 65 years in the Kyoto-Kameoka study. Diet quality was assessed by calculating the adherence scores to the Japanese Food Guide Spinning Top using a validated questionnaire; the participants were stratified into quartile groups based on these scores. Physical and comprehensive frailty was assessed using the Fried phenotype model-based Frailty Screening Index and the Kihon Checklist, respectively. Multivariable logistic regression and the restricted cubic spline model were used to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for associations between adherence scores and frailty prevalence. RESULTS Higher adherence scores signified a higher intake of vitamin C, vegetables, dairy products, and fruits. Physical and comprehensive frailty prevalence was 14.2 and 35.8%, respectively. In a multivariable adjusted model, compared with the bottom adherence score quartile, the top quartile was associated with lower ORs of physical (OR 0.64; 95% CI 0.52-0.80) and comprehensive frailty (OR 0.60; 95% CI 0.51-0.71). These relationships were similar to results in the spline model. CONCLUSIONS This study shows an inverse dose-response relationship between diet quality and prevalence of both physical and comprehensive frailty in older adults.
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Affiliation(s)
- Daiki Watanabe
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Institute for Active Health, Institute of Interdisciplinary Research, Kyoto University of Advanced Science, Kyoto, 621-8555 Japan
| | - Kayo Kurotani
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Faculty of Food and Health Sciences, Showa Women’s University, Tokyo, 154-8533 Japan
| | - Tsukasa Yoshida
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Institute for Active Health, Institute of Interdisciplinary Research, Kyoto University of Advanced Science, Kyoto, 621-8555 Japan
| | - Hinako Nanri
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
| | - Yuya Watanabe
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Institute for Active Health, Institute of Interdisciplinary Research, Kyoto University of Advanced Science, Kyoto, 621-8555 Japan
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Tokyo, 192-0001 Japan
| | - Heiwa Date
- Department of Data Science, Shiga University, Shiga, 522-8522 Japan
| | - Aya Itoi
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Department of Health, Sports and Nutrition, Faculty of Health and Welfare, Kobe Women’s University, Hyogo, 650-0046 Japan
| | - Chiho Goto
- Department of Health and Nutrition, Faculty of Health and Human Life, Nagoya Bunri University, Aichi, 492-8520 Japan
| | - Kazuko Ishikawa-Takata
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Faculty of Applied Biosciences, Tokyo University of Agriculture, Tokyo, 156-8502 Japan
| | - Misaka Kimura
- Institute for Active Health, Institute of Interdisciplinary Research, Kyoto University of Advanced Science, Kyoto, 621-8555 Japan
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto, 602-8566 Japan
- Department of Nursing, Doshisha Women’s College of Liberal Arts, Kyoto, 610-0394 Japan
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Faculty of Sport Sciences, Waseda University, Saitama, 359-1192 Japan
| | - Yosuke Yamada
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Institute for Active Health, Institute of Interdisciplinary Research, Kyoto University of Advanced Science, Kyoto, 621-8555 Japan
| | - Kyoto-Kameoka Study Group
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
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14
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Liou JW, Wang PS, Wu YT, Lee SK, Chang SD, Liou M. ECG Approximate Entropy in the Elderly during Cycling Exercise. SENSORS (BASEL, SWITZERLAND) 2022; 22:5255. [PMID: 35890935 PMCID: PMC9324578 DOI: 10.3390/s22145255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Approximate entropy (ApEn) is used as a nonlinear measure of heart-rate variability (HRV) in the analysis of ECG time-series recordings. Previous studies have reported that HRV can differentiate between frail and pre-frail people. In this study, EEGs and ECGs were recorded from 38 elderly adults while performing a three-stage cycling routine. Before and after cycling stages, 5-min resting-state EEGs (rs-EEGs) and ECGs were also recorded under the eyes-open condition. Applying the K-mean classifier to pre-exercise rs-ECG ApEn values and body weights revealed nine females with EEG power which was far higher than that of the other subjects in all cycling stages. The breathing of those females was more rapid than that of other subjects and their average heart rate was faster. Those females also presented higher degrees of asymmetry in the alpha and theta bands (stronger power levels in the right frontal electrode), indicating stressful responses during the experiment. It appears that EEG delta activity could be used in conjunction with a very low ECG frequency power as a predictor of bursts in the heart rate to facilitate the monitoring of elderly adults at risk of heart failure. A resting ECG ApEn index in conjunction with the subject's weight or BMI is recommended for screening high-risk candidates prior to exercise interventions.
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Affiliation(s)
- Jiun-Wei Liou
- Department of Electrical Engineering, Ming Chi University of Technology, New Taipei City 243, Taiwan;
| | - Po-Shan Wang
- Department of Neurology, Municipal Gandau Hospital, Taipei 112, Taiwan;
| | - Yu-Te Wu
- Institute of Biophotonics, National Yang-Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Sheng-Kai Lee
- Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Cheng-Kung University & Academia Sinica, Taipei 701, Taiwan;
| | - Shen-Da Chang
- Institute of Statistical Science, Academia Sinica, Taipei 115, Taiwan;
| | - Michelle Liou
- Institute of Statistical Science, Academia Sinica, Taipei 115, Taiwan;
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15
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Cong T, Hall AJ, Jia Z, Christiano A, Elsevier HCK, Cheung ZB, Wellman D, Forsh D, Lane JM. Conceptualizing Biological Aging and Frailty in Orthopaedics: A Framework for Clinical Practice. J Bone Joint Surg Am 2022; 104:1212-1222. [PMID: 35275895 DOI: 10.2106/jbjs.21.01053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Biological aging can best be conceptualized clinically as a combination of 3 components: frailty, comorbidity, and disability. ➤ Despite advancements in the understanding of senescence, chronological age remains the best estimate of biological age. However, a useful exercise for practitioners is to look beyond chronological age in clinical and surgical decision-making. ➤ A chronologically aging person does not age biologically at the same rate. ➤ The best way to understand frailty is to consider it as a physical phenotype. ➤ Physical optimization should parallel medical optimization before elective surgery. ➤ The poorer the host (both in terms of bone quality and propensity for healing), the more robust the implant construct must be to minimize reliance on host biology.
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Affiliation(s)
- Ting Cong
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY
| | - Arielle J Hall
- Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Zhimeng Jia
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anthony Christiano
- Department of Orthopaedic Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Hannah C K Elsevier
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Zoe B Cheung
- Department of Orthopaedic Surgery, University of California Davis, Davis, California
| | - David Wellman
- Department of Orthopaedic Surgery, Westchester Medical Center, Westchester, New York
| | - David Forsh
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY
| | - Joseph M Lane
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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16
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Lin YC, Yan HT, Lin CH, Chang HH. Predicting frailty in older adults using vocal biomarkers: a cross-sectional study. BMC Geriatr 2022; 22:549. [PMID: 35778699 PMCID: PMC9248103 DOI: 10.1186/s12877-022-03237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Frailty is a common issue in the aging population. Given that frailty syndrome is little discussed in the literature on the aging voice, the current study aims to examine the relationship between frailty and vocal biomarkers in older people. METHODS Participants aged ≥ 60 years visiting geriatric outpatient clinics were recruited. They underwent frailty assessment (Cardiovascular Health Study [CHS] index; Study of Osteoporotic Fractures [SOF] index; and Fatigue, Resistance, Ambulation, Illness, and Loss of weight [FRAIL] index) and were asked to pronounce a sustained vowel /a/ for approximately 1 s. Four voice parameters were assessed: average number of zero crossings (A1), variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4). RESULTS Among 277 older adults, increased A1 was associated with a lower likelihood of frailty as defined by SOF (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.74-0.96). Participants with larger A2 values were more likely to be frail, as defined by FRAIL and CHS (FRAIL: OR 1.41, 95% CI 1.12-1.79; CHS: OR 1.38, 95% CI 1.10-1.75). Sex differences were observed across the three frailty indices. In male participants, an increase in A3 by 10 points increased the odds of frailty by almost 7% (SOF: OR 1.07, 95% CI 1.02-1.12), 6% (FRAIL: OR 1.06, 95% CI 1.02-1.11), or 6% (CHS: OR 1.06, 95% CI 1.01-1.11). In female participants, an increase in A4 by 0.1 conferred a significant 2.8-fold (SOF: OR 2.81, 95% CI 1.71-4.62), 2.3-fold (FRAIL: OR 2.31, 95% CI 1.45-3.68), or 2.8-fold (CHS: OR 2.82, 95% CI 1.76-4.51, CHS) increased odds of frailty. CONCLUSIONS Vocal biomarkers, especially spectral-domain voice parameters, might have potential for estimating frailty, as a non-invasive, instantaneous, objective, and cost-effective estimation tool, and demonstrating sex differences for individualised treatment of frailty.
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Affiliation(s)
- Yu-Chun Lin
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, 40447, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, No.91, Hsueh-Shih Road, North District, Taichung, 40402, Taiwan
| | - Huang-Ting Yan
- Institute of Political Science, Academia Sinica, 128 Academia Rd., Sec.2, Nankang, Taipei, 115, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, No.91, Hsueh-Shih Road, North District, Taichung, 40402, Taiwan
- Department of Family Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung, 40447, Taiwan
| | - Hen-Hong Chang
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, 40447, Taichung, Taiwan.
- Graduate Institute of Integrated Medicine, China Medical University, No.91, Hsueh-Shih Road, North District, Taichung, 40402, Taiwan.
- Chinese Medicine Research Centre, China Medical University, No.91, Hsueh-Shih RoadNorth District, Taichung, 40402, Taiwan.
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17
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Horikoshi T, Nakamura T, Yoshizaki T, Nakamura J, Watanabe Y, Uematsu M, Makino A, Kobayashi T, Saito Y, Obata JE, Sawanobori T, Takano H, Umetani K, Watanabe A, Asakawa T, Sato A. A Stratified Analysis of the Risk Associated With Low Body Mass Index for Patients After Percutaneous Coronary Intervention. J Atheroscler Thromb 2022; 30:502-514. [PMID: 35753778 PMCID: PMC10164593 DOI: 10.5551/jat.63650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS The relationship between low body mass index (BMI) and prognostic factors for patients with coronary artery disease, commonly observed in elderly individuals in Japan, is important. Few studies have evaluated the prognosis for patients with low BMI after percutaneous coronary intervention (PCI). Using a multivariable-adjusted model and data from a prospective cohort registry, we analyzed the risk associated with low BMI for patients after PCI. METHODS This prospective, multicenter registry included 5965 consecutive patients with coronary artery disease who underwent successful PCI. The patients were followed-up clinically for up to 3 years or until the occurrence of major adverse cardiac events. The primary endpoint was all-cause death and nonfatal myocardial infarction composite. RESULTS Primary events occurred in 639 (10.7%) patients during the follow-up period. A risk analysis of the primary endpoint adjusted for the multivariable model showed a significant increase in risk for elderly individuals, underweight individuals [HR 1.43 (95% confidence interval (CI), 1.10-1.85), P<0.001], those with diabetes mellitus (DM), peripheral artery disease, low left ventricular ejection fraction or acute coronary syndrome (ACS), and smokers. A stratified adjusted risk analysis based on BMI levels showed that the risk associated with underweight status was significantly pronounced for male patients, those aged 60-74 years, and those with DM or ACS. CONCLUSION Underweight patients with several risk factors significantly increased risk after PCI. Furthermore, the risk associated with low BMI was significantly more pronounced for men, individuals aged 60-74 years, and patients with DM or ACS.
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Affiliation(s)
- Takeo Horikoshi
- Department of Cardiology, University of Yamanashi, Faculty of Medicine
| | | | - Toru Yoshizaki
- Department of Cardiology, University of Yamanashi, Faculty of Medicine
| | - Jun Nakamura
- Department of Cardiology, Fujieda Municipal General Hospital
| | - Yosuke Watanabe
- Department of Cardiology, University of Yamanashi, Faculty of Medicine
| | - Manabu Uematsu
- Department of Cardiology, University of Yamanashi, Faculty of Medicine
| | - Aritaka Makino
- Department of Internal Medicine, Yamanashi Prefectural Central Hospital
| | | | - Yukio Saito
- Department of Cardiology, Kofu Municipal Hospital
| | - Jun-Ei Obata
- Department of Cardiology, Fujieda Municipal General Hospital
| | | | | | - Ken Umetani
- Department of Internal Medicine, Yamanashi Prefectural Central Hospital
| | | | | | - Akira Sato
- Department of Cardiology, University of Yamanashi, Faculty of Medicine
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18
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Prognostic impact of obesity in newly-diagnosed glioblastoma: a secondary analysis of CeTeG/NOA-09 and GLARIUS. J Neurooncol 2022; 159:95-101. [PMID: 35704157 PMCID: PMC9325931 DOI: 10.1007/s11060-022-04046-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
Purpose The role of obesity in glioblastoma remains unclear, as previous analyses have reported contradicting results. Here, we evaluate the prognostic impact of obesity in two trial populations; CeTeG/NOA-09 (n = 129) for MGMT methylated glioblastoma patients comparing temozolomide (TMZ) to lomustine/TMZ, and GLARIUS (n = 170) for MGMT unmethylated glioblastoma patients comparing TMZ to bevacizumab/irinotecan, both in addition to surgery and radiotherapy. Methods The impact of obesity (BMI ≥ 30 kg/m2) on overall survival (OS) and progression-free survival (PFS) was investigated with Kaplan–Meier analysis and log-rank tests. A multivariable Cox regression analysis was performed including known prognostic factors as covariables. Results Overall, 22.6% of patients (67 of 297) were obese. Obesity was associated with shorter survival in patients with MGMT methylated glioblastoma (median OS 22.9 (95% CI 17.7–30.8) vs. 43.2 (32.5–54.4) months for obese and non-obese patients respectively, p = 0.001), but not in MGMT unmethylated glioblastoma (median OS 17.1 (15.8–18.9) vs 17.6 (14.7–20.8) months, p = 0.26). The prognostic impact of obesity in MGMT methylated glioblastoma was confirmed in a multivariable Cox regression (adjusted odds ratio: 2.57 (95% CI 1.53–4.31), p < 0.001) adjusted for age, sex, extent of resection, baseline steroids, Karnofsky performance score, and treatment arm. Conclusion Obesity was associated with shorter survival in MGMT methylated, but not in MGMT unmethylated glioblastoma patients.
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19
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Characterization by Gender of Frailty Syndrome in Elderly People according to Frail Trait Scale and Fried Frailty Phenotype. J Pers Med 2022; 12:jpm12050712. [PMID: 35629135 PMCID: PMC9144746 DOI: 10.3390/jpm12050712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Frailty has emerged as one of the main geriatric syndromes to be prevented in order to improve quality of health and life in the elderly. In this sense, the characterization of this syndrome through reliable and feasible diagnostic tools for clinical use, such as the Frail Trait Scale 5 (FTS-5) and Frail Trait Scale 3 (FTS-3), represents the basis for this objective. Objectives: To characterize the frailty syndrome in a population of older adults using FTS-5, FTS-3, and Fried phenotype (FP) as frailty diagnostic tools. Design: Cross-sectional study. Participants: 300 adults ≥65 years recruited from different Family Health Centers and community groups of older people in Talca, Chile. Methods: The diagnosis of frailty was made according to FP, FTS-5, and FTS-3 tools. Data about sociodemographic characteristics and anthropometric measurements were collected by a clinical interview by a previously trained health professional. Results: A total prevalence of frailty according to the FP of 19.7% was observed; while in the group of women and men it was 21.4% and 15.0%, respectively. Concerning the FTS-5 tool, the total prevalence of frailty was 18%, while in the group of women and men was 18.0% and 17.5%, respectively. The FTS-3 tool shows a total prevalence of frailty of 23.3%, while in the group of women and men a prevalence of 22.7% and 25.0%, respectively. A significant difference is observed with respect to the presence of the Fried criteria of “weakness” (women: 21.4%, men: 38.8%) and “weight loss” (women: 16.8%, men: 7.5%; p < 0.05). A significant difference is observed concerning the average score of “Handgrip” criteria, “walking time”, and “Physical Activity Scale for the Elderly” (PASE) between the group of women and men. Frailty, diagnosed by FTS-3, is significantly associated with the risk factors of overweight (body mass index ≥ 25) (OR: 10.225, 95% CI: 1.297−80.617) and advanced age (age ≥ 75 years) (OR: 1.839, 95% CI: 1.040−3.250). Conclusion: The prevalence of frailty observed with the FTS-5 (18%) and FTS-3 (23.3%) tools are similar to the prevalence observed through the FP (19.7%) and those reported in other observational studies. Considering the similar prevalence of frailty diagnosed with the three tools, FTS-3 should be a valuable tool for the screening of frailty in the community.
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Jadhav R, Markides KS, Al Snih S. Body mass index and 12-year mortality among older Mexican Americans aged 75 years and older. BMC Geriatr 2022; 22:236. [PMID: 35313825 PMCID: PMC8939224 DOI: 10.1186/s12877-022-02945-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background The role of obesity in mortality in the very old and old-oldest Hispanic population has not been studied. The objective of this study was to examine the effect of body mass index (BMI) on 12-year mortality among older Mexican Americans aged 75 years and older. Methods Twelve year prospective cohort study consisting of a population-based sample of 1415 non-institutionalized Mexican American men and women aged 75 and older from 5 southwestern states: Arizona, California, Colorado, New Mexico, and Texas. Data was from Wave 5 of the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/2005–2016). Socio-demographics, body mass index (BMI), self-reported medical conditions, disability, depressive symptoms, falls, Mini-Mental-State-Examination (MMSE), and Short Physical Performance Battery (SPPB) were assessed at baseline during 2004–2005. BMI (Kg/m2) was classified as underweight (< 18.5), normal weight (18.5 to < 25), overweight (25 to < 30), obesity category I (30 to < 35), and obesity category II/morbid obesity (≥ 35). For assessment of mortality, deaths were ascertained through the National Death Index and report from relatives. Cox proportional hazards regression analysis was performed to estimate the hazard ratio (HR) of 12-year mortality as a function of BMI categories at baseline. Results The mean BMI was 27.5 ± 1.7 with participants classified as 1.8% underweight, 30.8% normal weight, 39.2% overweight, 20.7% obesity category I, and 7.6% obesity category II/morbid obesity. Mexican Americans aged ≥75 years with overweight or obesity category I had a reduced HR of death (0.82, 95% CI = 0.70–0.96 and 0.75, 95% CI = 0.62–0.91, respectively) over 12-years of follow-up. The HR of death for underweight and obesity category II/morbid obesity participants was 1.59 (95% CI = 1.03–2.45) and 1.12 (95% CI = 0.85–1.46), respectively. Female participants and those with high scores in the MMSE and SPPB had decreased risk of death. Conclusions This study showed the protective effect of overweight and obesity on mortality in Mexican Americans above 75 years of age, which might have implications when treating older adults with overweight and obesity.
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Affiliation(s)
- Reshma Jadhav
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kyriakos S Markides
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.,Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA
| | - Soham Al Snih
- Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA. .,Department of Nutrition, Metabolism, and Rehabilitation Sciences/School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA. .,Division of Geriatrics & Palliative Medicine /Department of Internal Medicine/School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
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21
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You HS, Kwon YJ, Kim S, Kim YH, Kim YS, Kim Y, Roh YK, Park B, Park YK, Park CH, Son JS, Shin J, Shin HY, Oh B, Lee JW, Shim JY, Won CW, Yoo JW, Lee SH, Kang HT, Lee DC. Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings. Korean J Fam Med 2021; 42:413-424. [PMID: 34871482 PMCID: PMC8648485 DOI: 10.4082/kjfm.21.0162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/08/2021] [Indexed: 01/06/2023] Open
Abstract
Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.
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Affiliation(s)
- Hyo-Sun You
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ye-Seul Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yonghwan Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yong-Kyun Roh
- Department of Family Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Byoungjin Park
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Young Kyu Park
- Department of Family Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang-Hae Park
- Department of Family Medicine, Haengbokhankajung Clinic, Seoul, Korea
| | - Joung Sik Son
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun-Young Shin
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Bumjo Oh
- Department of Family Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jae Yong Shim
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji Won Yoo
- School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Sang-Hyun Lee
- Department of Family Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Duk Chul Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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22
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Nguyen HT, Nguyen AH, Nguyen GTX. Prevalence and associated factors of frailty in patients attending rural and urban geriatric clinics. Australas J Ageing 2021; 41:e122-e130. [PMID: 34792256 DOI: 10.1111/ajag.13016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the prevalence and factors associated with frailty in rural and urban older outpatients in Vietnam. METHODS This cross-sectional study included 1084 outpatients (aged ≥60 years; mean age 71.7 ± 7.4 years; female 65%) from rural (n = 600) and urban (n = 484) geriatric clinics from December 2019 to July 2020. Frailty was assessed using Fried frailty phenotype. Factors associated with frailty were assessed using logistic regression. RESULTS Overall, frailty prevalence was 28% (rural, 26%; urban, 30%; p = 0.220). Factors associated with frailty were older age (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.13-1.20, p < 0.001), being underweight (OR 1.88, 95% CI 1.10-3.27, p = 0.025) and limitations in activities of daily living (ADLs) (OR 6.04, 95% CI 1.63-22.41, p = 0.007) and instrumental ADLs (OR 5.83, 95% CI 3.74-9.08, p < 0.001). Higher education (OR 0.47, 95% CI 0.29-0.76, p = 0.002) and productive work (OR 0.39, 95% CI 0.21-0.71, p = 0.002) were protective factors against frailty. CONCLUSIONS In Vietnam, the prevalence of frailty in older outpatients was 28%, though not significantly different between urban and rural areas. Older age, being underweight and limitations in functional status can increase the odds of frailty, but higher education and productive work can reduce the odds of frailty.
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Affiliation(s)
- Huan Thanh Nguyen
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Department of Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - An Huu Nguyen
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Giao Thi Xuan Nguyen
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Suissa K, Schneeweiss S, Douros A, Filion KB, Yin H, Patorno E, Azoulay L. The modifying effects of adiposity on the cardiovascular safety of sulphonylureas. Diabetes Obes Metab 2021; 23:2502-2512. [PMID: 34251086 DOI: 10.1111/dom.14494] [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: 04/22/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
AIMS To determine whether adiposity modified the effect on the cardiovascular safety of sulphonylureas as a first-line therapy compared with metformin among patients with type 2 diabetes. MATERIALS AND METHODS Using the UK Clinical Practice Research Datalink, we conducted a cohort study among 13 862 new sulphonylurea users matched on body mass index (BMI) and propensity score, in a 1:1 ratio, to new metformin users between April 1, 1998 and December 31, 2016. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of major adverse cardiovascular events (MACE), individual components of MACE (myocardial infarction [MI], ischaemic stroke, cardiovascular mortality), and all-cause mortality, comparing use of sulphonylureas with use of metformin, overall and within BMI categories (≤24.9 kg/m2 , 25.0-29.9 kg/m2 , ≥30 kg/m2 ). RESULTS Compared with metformin, sulphonylureas were not associated with an increased risk of MACE either overall (HR 1.08, 95% CI 0.94-1.23) or by BMI category. Similar findings were observed for MI and ischaemic stroke. By contrast, sulphonylureas were associated with an increased risk of cardiovascular mortality (HR 1.24, 95% CI 1.04-1.48), primarily among obese patients (HR 1.52, 95% CI 1.08-2.13), and not among normal-weight patients (HR 1.00, 95% CI 0.72-1.39; P-interaction 0.21). Similar results were observed for all-cause mortality (HR 1.47, 95% CI 1.32-1.62), where an increased risk was observed among obese patients (HR 1.83, 95% CI 1.49-2.25), but not normal-weight patients (HR 1.18, 95% CI 0.99-1.42; P-interaction: 0.006). CONCLUSION The findings of this study suggest that adiposity may have a modifying effect on the association between sulphonylureas and cardiovascular and all-cause mortality compared with metformin.
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Affiliation(s)
- Karine Suissa
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonios Douros
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kristian B Filion
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Hui Yin
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laurent Azoulay
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada
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Evans NR, Todd OM, Minhas JS, Fearon P, Harston GW, Mant J, Mead G, Hewitt J, Quinn TJ, Warburton EA. Frailty and cerebrovascular disease: Concepts and clinical implications for stroke medicine. Int J Stroke 2021; 17:251-259. [PMID: 34282986 PMCID: PMC8864332 DOI: 10.1177/17474930211034331] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Frailty is a distinctive health state in which the ability of older people to cope with
acute stressors is compromised by an increased vulnerability brought by age-associated
declines in physiological reserve and function across multiple organ systems. Although
closely associated with age, multimorbidity, and disability, frailty is a discrete
syndrome that is associated with poorer outcomes across a range of medical conditions.
However, its role in cerebrovascular disease and stroke has received limited attention.
The estimated rise in the prevalence of frailty associated with changing demographics over
the coming decades makes it an important issue for stroke practitioners, cerebrovascular
research, clinical service provision, and stroke survivors alike. This review will
consider the concept and models of frailty, how frailty is common in cerebrovascular
disease, the impact of frailty on stroke risk factors, acute treatments, and
rehabilitation, and considerations for future applications in both cerebrovascular
clinical and research settings.
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Affiliation(s)
| | - Oliver M Todd
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Jatinder S Minhas
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Patricia Fearon
- Department of Stroke Medicine, Royal Victoria Hospital, Belfast, UK
| | - George W Harston
- Acute Stroke Programme, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jonathan Mant
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jonathan Hewitt
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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An SJ, Yang YJ, Jeon NM, Hong YP, Kim YI, Kim DY. Significantly Reduced Alanine Aminotransferase Level Increases All-Cause Mortality Rate in the Elderly after Ischemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094915. [PMID: 34063029 PMCID: PMC8125228 DOI: 10.3390/ijerph18094915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/02/2021] [Accepted: 05/02/2021] [Indexed: 01/02/2023]
Abstract
(1) Background: A significantly reduced alanine aminotransferase (ALT) level is being recognized as a risk factor of increasing mortality in the elderly in relation to frailty. In the elderly, both frailty and ischemic stroke are not only common, but are also associated with mortality. The aim of this research was to investigate whether a significantly reduced ALT level increases the all-cause mortality rate in the elderly with ischemic stroke. (2) Methods: Between February 2014 and April 2019, a retrospective study of 901 patients with ischemic stroke admitted to a university-affiliated hospital was conducted. Cox proportional hazard regression was used to determine whether a significantly reduced ALT level is an independent risk factor for mortality in elderly patients after an ischemic stroke. (3) Results: This study enrolled 323 older adults (age ≥ 65 years) who were first diagnosed with ischemic stroke. The mean age of the participants was 76.5 ± 6.6 years, the mean survival time was 37.1 ± 20.4 months, and the number of deaths was 96 (29.7%). Our results showed that reduced ALT level (less than 10 U/L) increased the risk of all-cause mortality in the elderly after ischemic stroke (adjusted HR: 3.24, 95% CI: 1.95–5.41; p < 0.001). (4) Conclusions: A significantly reduced ALT level at the time of diagnosis (less than 10 U/L) is an independent risk factor that increases the mortality rate in the elderly after ischemic stroke.
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Affiliation(s)
- Sang Joon An
- Department of Neurology, Catholic Kwandong University International St Mary’s Hospital, Incheon 22711, Korea; (S.J.A.); (Y.I.K.)
| | - Yun-Jung Yang
- Institute of Biomedical Science, Catholic Kwandong University International St. Mary’s Hospital, Incheon 22711, Korea;
| | - Na-mo Jeon
- Department of Rehabilitation Medicine, Catholic Kwandong University International St Mary’s Hospital, Incheon 22711, Korea;
| | - Yeon-Pyo Hong
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Korea;
| | - Yeong In Kim
- Department of Neurology, Catholic Kwandong University International St Mary’s Hospital, Incheon 22711, Korea; (S.J.A.); (Y.I.K.)
| | - Doo-Young Kim
- Department of Rehabilitation Medicine, Catholic Kwandong University International St Mary’s Hospital, Incheon 22711, Korea;
- Correspondence: ; Tel.: +82-32-290-3112; Fax: +82-32-290-3879
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Bhardwaj PV, Rastegar V, Meka R, Sawalha K, Brennan M, Stefan MS. The Association Between Body Mass Index, Frailty and Long-Term Clinical Outcomes in Hospitalized Older Adults. Am J Med Sci 2021; 362:268-275. [PMID: 33894183 DOI: 10.1016/j.amjms.2021.04.004] [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: 06/30/2020] [Revised: 12/14/2020] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND While frailty is thought to be a wasting disorder, there is scarce data regarding the association between frailty and body mass index (BMI). The aim of this study was to determine the relationship between BMI, frailty, and mortality among hospitalized older adults. METHODS This is a secondary analysis of a prospective cohort study of patients aged ≥65 years admitted to a tertiary center between 2014 and 2016. Frailty was assessed by Reported Edmonton Frailty Scale (REFS) and categorized as: not frail, vulnerable/mild frail, and moderate/severe frail. BMI (kg/m2) was categorized as: underweight (<18.5), normal (18.5-24.9), overweight (25.0- 29.9), or obese (≥ 30.0). Primary outcome was all-cause one-year mortality. RESULTS Among 769 patients included in the study, 55.4% were frail. There was no statistically significant association between frailty categories and levels of BMI. Frail patients had a higher risk of death than non-frail after adjusting for confounders [HR: 1.98, 95% CI (1.46, 2.70) for mild frail and HR 2.03, 95% CI (1.43, 2.87) for moderate/severe frail]. Compared with normal weight patients, those who were overweight had a survival advantage if they were non-frail [HR 0.55, 95% CI (0.31, 0.96)] or vulnerable/mild frail [HR 0.65, 95% CI (0.43, 0.97)] but not if they were moderate/severe frail. There were no other statistically significant differences in survival by BMI and frailty categories. CONCLUSIONS We did not find a relationship between BMI and frailty among hospitalized older adults. Overweight patients had a survival advantage if they were non-frail or vulnerable. There is need for further longitudinal studies assessing the interaction between frailty and BMI in older adults.
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Affiliation(s)
- Prarthna V Bhardwaj
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
| | - Vida Rastegar
- Institute for Healthcare Delivery and Population Science, Springfield, MA, USA.
| | - Rohini Meka
- Department of Hospital Medicine, Baystate Medical Center, Springfield, MA, USA.
| | - Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
| | - Maura Brennan
- Division of Geriatrics, University of Massachusetts Medical School - Baystate, Springfield MA, USA.
| | - Mihaela S Stefan
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA; Institute for Healthcare Delivery and Population Science, Springfield, MA, USA.
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Kim DY, Cho KC. Extremely Low Serum Alanine Transaminase Level Is Associated with All-Cause Mortality in the Elderly after Intracranial Hemorrhage. J Korean Neurosurg Soc 2021; 64:460-468. [PMID: 33626855 PMCID: PMC8128522 DOI: 10.3340/jkns.2020.0212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Extremely low alanine transaminase (ALT) levels are associated with all-cause mortality in frail elderly individuals; the clinical significance of ALT as a reliable biomarker is now being considered. Predicting mortality with routine tests at the time of diagnosis is important for managing patients after intracranial hemorrhage. We aimed to investigate whether an extremely low ALT level is associated with mortality in the elderly after intracranial hemorrhage. METHODS A retrospective review was performed on 455 patients with intracranial hemorrhage admitted to a university-affiliated tertiary care hospital from February 2014 to May 2019. Multivariate Cox regression analysis was performed for all ages and for each age group to determine whether an extremely low ALT level is an independent predictor of mortality only in the elderly. RESULTS Overall, 294 patients were enrolled, and the mean age of the subjects was 59.1 years, with 99 (33.8%) aged ≥65 years. The variables associated with all-cause mortality in all subjects were age, C-reactive protein (CRP) levels, hemoglobin (Hb) levels (<11 g/dL), and initial Glasgow coma scale (GCS) scores. In young patients, CRP, low Hb levels, and initial GCS scores were significantly associated with all-cause mortality. However, in the elderly (≥65 years), the variables significantly associated with allcause mortality were extremely low levels of ALT (<10 U/L) (adjusted hazard ratio, 3.313; 95% confidence interval, 1.232-8.909; p=0.018) and initial GCS scores. CONCLUSION Extremely low ALT level (<10 U/L) at the time of diagnosis is a significant risk factor for all-cause mortality in the elderly after intracranial hemorrhage.
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Affiliation(s)
- Doo Young Kim
- Department of Rehabilitation Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
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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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Mei F, Gao Q, Chen F, Zhao L, Shang Y, Hu K, Zhang W, Zhao B, Ma B. Frailty as a Predictor of Negative Health Outcomes in Chronic Kidney Disease: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2020; 22:535-543.e7. [PMID: 33218914 DOI: 10.1016/j.jamda.2020.09.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/12/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To perform a comprehensive evidence synthesis to summarize the impact of frailty on health outcomes in patients with chronic kidney disease (CKD). DESIGN Systematic reviews and meta-analysis. SETTING Electronic searches in PubMed, Embase, Web of Science, CNKI, VIP, CBM, and Wanfang Database were performed. The methodological quality was evaluated using the Newcastle Ottawa Scale (NOS). PARTICIPANTS Patients with chronic kidney disease (CKD). MEASUREMENTS Potential clinical outcomes due to frailty. RESULTS Eighteen cohort studies incorporating a total of 22,788 participants were included. The overall risk of bias was low. The median reported prevalence of frail and prefrail individuals with CKD was 41.8% (range 2.8-81.5%) and 43.9% (range 19.1-62.7%), respectively. Prefrailty and frailty related to mortality indicated an increased hazard ratio (HR), with a pooled HR of 1.68 [95% confidence interval (CI) 1.46-1.94; P < .001] and 1.48 (95% CI 1.21-1.81; P < .001), respectively. Prefrailty and frailty related to hospitalization with the pooled HR/risk ratio (RR) of 1.56 (95% CI 1.37-1.76; P < .001) and 1.21 (95% CI 0.79-1.85; P = .38), respectively. Similarly, the pooled HR demonstrated a strong correlation between frailty and falls in patients with CKD with HR 1.83 (95% CI 1.40-2.37; P < .001) and no statistical correlation between prefrailty and falls in these patients with pooled HR 1.19 (95% CI 0.44-3.22; P = .73), respectively. CONCLUSIONS AND IMPLICATIONS Frailty is predictive of negative outcomes in patients with CKD, including all-cause mortality, all-cause hospitalization, and falls. Therefore, frailty should be routinely assessed among patients with CKD to prevent poor prognosis, reduce fatality rate, and provide evidence to support future targeted interventions. However, because of the limited amount of information currently in the literature, additional prospective studies are needed to explore the role of prefrailty in predicting adverse outcomes for patients with CKD.
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Affiliation(s)
- Fan Mei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Qianqian Gao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Fei Chen
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Li Zhao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yi Shang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Kaiyan Hu
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Weiyi Zhang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Bing Zhao
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Bin Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
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Afonso C, Sousa-Santos AR, Santos A, Borges N, Padrão P, Moreira P, Amaral TF. Frailty status is related to general and abdominal obesity in older adults. Nutr Res 2020; 85:21-30. [PMID: 33422742 DOI: 10.1016/j.nutres.2020.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 08/28/2020] [Accepted: 10/23/2020] [Indexed: 02/04/2023]
Abstract
The association between frailty and obesity may differ according to the heterogeneity of body mass index (BMI) and waist circumference (WC) phenotypes in older adults. We hypothesized that the use of simple indicators of general and abdominal obesity combined, may more accurately represent obesity and allow to further elucidate on how frailty status and its criteria are related to obesity. A sample of 1444 older adults, aged ≥65 years (Nutrition UP 65 study) was included in a cross-sectional analysis. General and abdominal obesity were defined according to World Health Organization BMI and WC cut-offs, and frailty by Fried et al. phenotype. A cluster analysis defined groups according to BMI and WC levels. Overweight (BMI between 25.0 and 29.9 kg/m2; 44.6%), general obesity (BMI ≥30.0 kg/m2; 39.0%), and abdominal obesity (WC >102 cm for men and >88 cm for women) were highly frequent (66.5%). Prefrailty (odds ratio [OR]: 2.33; 95% confidence interval [CI]: 1.52-3.57) and frailty (OR: 2.87; 95% CI: 1.58-5.22) were directly associated with the "general and abdominal obesity" cluster. Regarding frailty criteria, low handgrip strength (OR: 2.29; 95% CI: 1.55-3.38) and weight loss (OR: 0.27; 95% CI: 0.14-0.52) were also associated with this cluster. In this sample of older adults presenting a high frequency of overweight and obesity, prefrailty and frailty are linked to higher levels of adiposity, but only when both general and abdominal obesity are present. Present results emphasize the importance of the evaluation of both BMI and WC in the geriatric clinical practice and suggest that older adults presenting both general and abdominal obesity should be routinely screened for frailty.
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Affiliation(s)
- Cláudia Afonso
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Ana Rita Sousa-Santos
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.
| | - Alejandro Santos
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Nuno Borges
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; CINTESIS - Centro de Investigação em Tecnologia e Serviços de Saúde, Porto, Portugal
| | - Patrícia Padrão
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Pedro Moreira
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; CIAFEL - Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Teresa F Amaral
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; UISPA, LAETA-INEGI - Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
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Jung H, Kim M, Lee Y, Won CW. Prevalence of Physical Frailty and Its Multidimensional Risk Factors in Korean Community-Dwelling Older Adults: Findings from Korean Frailty and Aging Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217883. [PMID: 33121159 PMCID: PMC7662797 DOI: 10.3390/ijerph17217883] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 02/06/2023]
Abstract
Frailty is defined as a state of increased vulnerability to stressors, and it predicts disability and mortality in the older population. This study aimed to investigate the standardized prevalence and multidimensional risk factors associated with frailty among Korean community-dwelling older adults. We analyzed the baseline data of 2907 adults aged 70-84 years (mean age 75.8 ± 3.9 years, 57.8% women) in the Korean Frailty and Aging Cohort Study. The Fried frailty phenotype was used to define frailty. Analyzed data included sociodemographic, physical, physical function, biological, lifestyle, health condition, medical condition, psychological, and social domains. Data were standardized using the national standard population composition ratio based on the Korean Population and Housing Census. The standardized prevalence of frailty and prefrailty was 7.9% (95% confidence interval (CI) 6.8-8.9%) and 47.0% (95% CI, 45.1-48.8%), respectively. The following 14 risk factors were significantly associated with frailty: at risk of malnutrition, sarcopenia, severe mobility limitation, poor social capital, rural dwellers, depressive symptoms, poor self-perceived health, polypharmacy, elevated high-sensitivity C-reactive protein, elevated glycosylated hemoglobin, low 25-hydroxy vitamin D level, longer Timed Up and Go, and low Short Physical Performance Battery score (p < 0.05). Physiconutritional, psychological, sociodemographic, and medical factors are strongly associated with frailty.
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Affiliation(s)
- Heeeun Jung
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul 02447, Korea
- Correspondence: (M.K.); (C.W.W.); Tel.: +82-2-958-2840 (M.K.); +82-2-958-8700 (C.W.W.); Fax: +82-2-958-2836 (M.K.); +82-2-958-8699 (C.W.W.)
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon 16499, Korea;
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul 02447, Korea
- Correspondence: (M.K.); (C.W.W.); Tel.: +82-2-958-2840 (M.K.); +82-2-958-8700 (C.W.W.); Fax: +82-2-958-2836 (M.K.); +82-2-958-8699 (C.W.W.)
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Murayama H, Kobayashi E, Okamoto S, Fukaya T, Ishizaki T, Liang J, Shinkai S. National prevalence of frailty in the older Japanese population: Findings from a nationally representative survey. Arch Gerontol Geriatr 2020; 91:104220. [PMID: 32810734 DOI: 10.1016/j.archger.2020.104220] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Japan has the largest aging population in the world, thus, a focus on frailty is important in clinical geriatric practice. Using a nationally representative sample, this study provided national estimates of the prevalence of frailty among community-dwelling older Japanese people. We also examined variations in the prevalence by sociodemographic characteristics, health conditions, and geographical regions. METHODS Data came from the National Survey of the Japanese Elderly in 2012. The data were collected using a home visit and face-to-face interviews with trained interviewers. The sample consisted of 2206 adults aged ≥65 years. We used the widely accepted definition of physical frailty phenotype and calculated weighted estimates of the prevalence of frailty. RESULTS Overall estimated prevalence was 8.7 % (7.5 %-9.9 %) for frail, 40.8 % (38.7 %-42.9 %) for prefrail, and 50.5 % (48.4 %-52.6 %) for robust. Frailty was more prevalent in older groups, women, and those with lower socioeconomic status, which was measured by education and household income. Frail people tended to have worse health. We also observed a regional variation: frailty prevalence tended to be higher in eastern than western Japan. CONCLUSIONS This study provides important evidence on the prevalence of frailty in older Japanese people and found substantial disparities by sociodemographic characteristics, health conditions, and geographical regions.
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Affiliation(s)
- Hiroshi Murayama
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Erika Kobayashi
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shohei Okamoto
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan; Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan
| | - Taro Fukaya
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Tatsuro Ishizaki
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Jersey Liang
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Shoji Shinkai
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
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Javed AA, Aljied R, Allison DJ, Anderson LN, Ma J, Raina P. Body mass index and all-cause mortality in older adults: A scoping review of observational studies. Obes Rev 2020; 21:e13035. [PMID: 32319198 DOI: 10.1111/obr.13035] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
Abstract
In older age, body composition changes as fat mass increases and redistributes. Therefore, the current body mass index (BMI) classification may not accurately reflect risk in older adults (65+). This study aimed to review the evidence on the association between BMI and all-cause mortality in older adults and specifically, the findings regarding overweight and obese BMI. A systematic search of the OVID MEDLINE and Embase databases was conducted between 2013 and September 2018. Observational studies examining the association between BMI and all-cause mortality within a community-dwelling population aged 65+ were included. Seventy-one articles were included. Studies operationalized BMI categorically (n = 60), continuously (n = 8) or as a numerical change/group transition (n = 7). Reduced risk of mortality was observed for the overweight BMI class compared with the normal BMI class (hazard ratios [HR] ranged 0.41-0.96) and for class 1 or 2 obesity in some studies. Among studies examining BMI change, increases in BMI demonstrated lower mortality risks compared with decreases in BMI (HR: 0.83-0.95). Overweight BMI classification or a higher BMI value may be protective with regard to all-cause mortality, relative to normal BMI, in older adults. These findings demonstrate the potential need for age-specific BMI cut-points in older adults.
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Affiliation(s)
- Ayesha A Javed
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Rumaisa Aljied
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - David J Allison
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada.,Labarge Centre for Mobility in Aging, Hamilton, Canada
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Sousa-Santos AR, Afonso C, Borges N, Santos A, Padrão P, Moreira P, F Amaral T. Sarcopenia, physical frailty, undernutrition and obesity cooccurrence among Portuguese community-dwelling older adults: results from Nutrition UP 65 cross-sectional study. BMJ Open 2020; 10:e033661. [PMID: 32546486 PMCID: PMC7305469 DOI: 10.1136/bmjopen-2019-033661] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To investigate the coexistence of sarcopenia, frailty, undernutrition and obesity and to identify the factors associated with the cooccurrence of these conditions in an older population. DESIGN Cross-sectional. SETTING Portugal. PARTICIPANTS 1454 older adults with 65 years or older, from Nutrition UP 65 study. PRIMARY AND SECONDARY OUTCOME MEASURES Sarcopenia was identified using the European Working Group on Sarcopenia in Older People 2 guidelines and physical frailty using Fried phenotype. Mini-Nutritional Assessment-Short Form was used to ascertain undernutrition, and obesity was evaluated by body mass index. RESULTS 57.3% presented at least one condition, 38.0% were identified with one and 19.3% were identified with two or more conditions. When all preconditions were considered, 95.7% of the older adults presented at least one of these preconditions or conditions. Multinomial logistic regression multivariate analysis revealed that being male (OR 0.61; 95% CI 0.43 to 0.88), being married or in a common-law marriage (OR 0.58; 95% CI 0.40 to 0.84) and having a higher educational level (OR 0.23; 95% CI 0.07 to 0.73) were inversely associated with having two or more conditions, while age >75 years (OR 1.60; 95% CI 1.14 to 2.24), a poor self-perception of health status (OR 5.61; 95% CI 3.50 to 9.01), ≥5 medications (OR 3.11; 95% CI 1.77 to 5.46) and cognitive impairment (OR 1.84; 95% CI 1.37 to 2.48) were directly associated. CONCLUSIONS Almost three out of five older adults presented at least one of the conditions related to nutritional status, and about one in five had two or more of these occurrences. However, the low coexistence observed between all of these reinforces the need to assess them all individually during the geriatric assessment.
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Affiliation(s)
- Ana Rita Sousa-Santos
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Cláudia Afonso
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Nuno Borges
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- CINTESIS - Centro de Investigação em Tecnologia e Serviços de Saúde, Porto, Portugal
| | - Alejandro Santos
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Patrícia Padrão
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Pedro Moreira
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- CIAFEL - Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Teresa F Amaral
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- UISPA, LAETA-INEGI - Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
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Li Y, Lu D, Feng D, Cheng H, Huang Q, Zhao H, Chen P, Qin H, Cai Q. Management of incidental anterior skull base large and giant meningiomas in elderly patients. J Neurooncol 2020; 148:481-488. [PMID: 32529449 DOI: 10.1007/s11060-020-03484-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/03/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The incidence of meningiomas among the elderly is considered to be high, and are at increased risk of severe morbidity and mortality following surgery due to their aging physiology and unexpected comorbidities. This study aimed to evaluate the optimal management strategies of meningiomas in elderly patients. METHODS We retrospectively analyzed 150 patients with incidental large (≥ 3 cm) and giant (≥ 6 cm) anterior skull base meningiomas from 2009 to 2018. These patients were divided into elderly group (≥ 65 years, n = 70) and younger group (< 65 years, n = 80). Information of patients with regard to their medical records, operative details, relevant imaging, and follow-up data were obtained from their respective electronic medical records. RESULTS The elderly patients had significantly longer length of hospital stay (15.9 ± 3.5) compared to younger patients (13.6 ± 3.6, P < 0.001). Karnofsky Performance Scale (KPS) at discharge was significantly lower in elderly group when compared to younger group (P = 0.04). However, the KPS at 1-year after surgery was similar between the two groups. In addition, there was no significant difference in the incidence of surgical complications between the two groups. Multivariate regression analysis of postoperative complications revealed blood loss ≥ 800 mL (P = 0.007) and BMI (< 18.5 or ≥ 24, P < 0.001) as risk factors, rather than age. CONCLUSIONS Surgical resection in elderly patients with incidental anterior skull base large and giant meningiomas is considered to be a safe and effective therapeutic option owing to acceptable mortality, postoperative complications and postoperative clinical outcomes.
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Affiliation(s)
- Yuqian Li
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Dan Lu
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, 710100, Shaanxi, China
| | - Dayun Feng
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Hongyu Cheng
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, Shaanxi, China
| | - Qian Huang
- College of Basic Medicine, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Haikang Zhao
- Department of Neurosurgery, The Second Hospital Affiliated of Xi'an Medical University, Xi'an, 710038, Shaanxi, China
| | - Peng Chen
- Department of Neurosurgery, The Second Hospital Affiliated of Xi'an Medical University, Xi'an, 710038, Shaanxi, China
| | - Huaizhou Qin
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Qing Cai
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
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Watanabe D, Yoshida T, Watanabe Y, Yamada Y, Kimura M. A U-Shaped Relationship Between the Prevalence of Frailty and Body Mass Index in Community-Dwelling Japanese Older Adults: The Kyoto-Kameoka Study. J Clin Med 2020; 9:jcm9051367. [PMID: 32384756 PMCID: PMC7290950 DOI: 10.3390/jcm9051367] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/16/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022] Open
Abstract
The relationship between body mass index (BMI) and frailty remains unclear. Using two validated frailty assessment tools, this study aimed to investigate the relationship between the prevalence of frailty and BMI in Japanese older adults. This cross-sectional study used baseline data of 7191 individuals aged ≥65 years, living in Kameoka City, Kyoto, Japan. The BMI was calculated based on self-reported height and body weight, and classified into six categories. Frailty was defined using two validated assessment tools, the Fried phenotype (FP) model and Kihon Checklist (KCL). We evaluated the relationship between frailty and BMI using a multivariate restricted cubic spline logistic regression. The prevalence of frailty defined using the FP model was 25.3%, 19.6%, 14.3%, 12.4%, 12.6%, and 19.4% for each BMI category of <18.5, 18.5–19.9, 20.0–22.4, 22.5–24.9, 25.0–27.4, and ≥27.5 kg/m2, respectively. The spline model showed a significant U-shaped relationship between BMI and the prevalence of frailty defined using both, KCL and FP models. This study found that the BMI range corresponding to lowest prevalence of frailty defined using both tools was 21.4–25.7 kg/m2. Thus, a healthy BMI may reduce the prevalence of frailty, and the risk of frailty needs to be evaluated in individuals who are underweight or overweight.
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Affiliation(s)
- Daiki Watanabe
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Correspondence:
| | - Tsukasa Yoshida
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
- Senior Citizen’s Welfare Section, Kameoka City Government, Kyoto 621-8501, Japan
| | - Yuya Watanabe
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
- Faculty of Health and Sports Science, Doshisha University, Kyoto 610-0394, Japan
| | - Yosuke Yamada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Misaka Kimura
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
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O'Hoski S, Bean JF, Ma J, So HY, Kuspinar A, Richardson J, Wald J, Beauchamp MK. Physical Function and Frailty for Predicting Adverse Outcomes in Older Primary Care Patients. Arch Phys Med Rehabil 2019; 101:592-598. [PMID: 31891711 DOI: 10.1016/j.apmr.2019.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 11/14/2019] [Accepted: 11/17/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To explore the predictive ability of the Short Physical Performance Battery (SPPB), Late Life Function and Disability Instrument-Function component (LLFDI-function) and frailty phenotype, for falls, hospitalizations, emergency department (ED) visits, and low self-rated health (SRH) over 1 and 2 years in older adults. DESIGN Secondary analysis of data from a longitudinal study, the Boston Rehabilitative Impairment Study of the Elderly. SETTING Primary care. PARTICIPANTS Adults 65 years and older at risk for disability who completed ≥1 follow-up call (N=391). INTERVENTIONS None. MAIN OUTCOME MEASURES We computed separate logistic regression models using the SPPB, LLFDI-function, and frailty phenotype as independent variables and falls, hospitalizations, ED visits, and SRH over 1 and 2 years as dependent variables. Receiver operating characteristic curves were constructed and the areas under the curves calculated. RESULTS Participants had a mean age of 76.5±7.1 years. The SPPB, LLFDI-function, and frailty phenotype all predicted hospitalizations and low SRH over a 1- and 2-year timeframe (odds ratio [OR] min-max, 1.35-1.51 and 1.67-3.07, respectively). Over 2 years, the SPPB predicted ED visits (OR, 1.28), and the LLFDI-function predicted falls (OR, 1.31). The LLFDI-function predicted low SRH better than the frailty phenotype over 1 year. There were no differences between the measures for any of the other outcomes. CONCLUSIONS The SPPB, LLFDI-function, and frailty phenotype had similar accuracy for predicting falls, hospitalizations, ED visits, and low SRH over 1 and 2 years among older primary care patients at risk for disability. As a result, when considering the optimal screening tool for older adults, the choice between a measure of function and frailty may ultimately depend on clinical preference and context.
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Affiliation(s)
- Sachi O'Hoski
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Hon Yiu So
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Joshua Wald
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
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Chen CL, Chen CM, Wang CY, Ko PW, Chen CH, Hsieh CP, Chiu HC. Frailty is Associated with an Increased Risk of Major Adverse Outcomes in Elderly Patients Following Surgical Treatment of Hip Fracture. Sci Rep 2019; 9:19135. [PMID: 31836751 PMCID: PMC6910954 DOI: 10.1038/s41598-019-55459-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/23/2019] [Indexed: 02/08/2023] Open
Abstract
We intended to explore the effect of level of frailty on, and relationship with, 1-, 3-, and 6-month postoperative emergency department visits, readmissions, and mortality. This is a prospective multicenter observational cohort study design. Patients aged 50 years or older treated for hip fracture (n = 245) were taken from Orthopedic wards in one medical center (n = 131) and one district hospital (n = 114) in Changhua County, Taiwan. Frailty was defined as measured by the validated Clinical Frailty Scale and categorized as robust, pre-frail, and frail. We used Kaplan-Meier analysis to estimate survival rates and Cox regression to estimate the risk of frailty associated with adverse outcomes. To examine the longitudinal associations between frailty and adverse outcome, the cross-lagged models were explored. Of the 245 patients, 55 (22.4%) were classified as frail, 113 (46.1%) as pre-frail, and 77 (31.4%) as robust. More cumulative events occurred for frail than for robust patients for each adverse outcome. Frailty has long-term effect on each adverse outcome after discharge, rather than the effect simultaneously. Targeting pre-frailty and frailty is essential for prevent adverse outcomes and improving the overall health of older adults after discharge for hip fracture.
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Affiliation(s)
- Chiu-Liang Chen
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chun-Min Chen
- Research Education and Epidemiology Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chun-Yi Wang
- Department of Orthopedic Surgery, Yuanlin Christian Hospital, Changhua, Taiwan
| | - Po-Wei Ko
- Department of Orthopedic Surgery, Yuanlin Christian Hospital, Changhua, Taiwan
| | - Chung-Hwan Chen
- Orthopedic Research Centre, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Pu Hsieh
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Herng-Chia Chiu
- Institute of Hospital Management, Tsinghua University, Beijing, China. .,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Health Policy and Management, Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland, United States of America.
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Kolakshyapati M, Ikawa F, Abiko M, Mitsuhara T, Kinoshita Y, Takeda M, Kurisu K. Multivariate risk factor analysis and literature review of postoperative deterioration in Karnofsky Performance Scale score in elderly patients with skull base meningioma. Neurosurg Focus 2019; 44:E14. [PMID: 29606047 DOI: 10.3171/2018.1.focus17730] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Elderly patients are particularly at risk for severe morbidity following surgery. Among the various risk factors, age and skull base location of meningioma are known to be poor prognostic factors in meningioma surgery. The authors conducted this study to analyze significant preoperative risk factors in elderly patients with skull base meningioma. METHODS A total of 265 elderly patients (≥ 65 years old) with meningioma were surgically treated at the authors' institute and affiliated hospitals between 2000 and 2016, and these cases were reviewed. Among them, 57 patients with skull base meningioma were evaluated. Among the various risk factors, the authors analyzed age, sex, Karnofsky Performance Scale (KPS) score, American Society of Anesthesiologists score, and tumor size, location, and pathology. Body mass index (BMI) and serum albumin were investigated as the frailty factors. The authors also reviewed 11 surgical studies of elderly patients ≥ 60 years old with meningioma. RESULTS The mean age was 72.4 ± 5.7 years, and 42 patients were female (73.6%). The mean size of meningioma was 36.6 ± 14.8 mm at the maximum diameter, and the mean follow-up period was 31.1 ± 31.5 months. (The continuous variables are expressed as the mean ± SD.) Histopathological investigation revealed a higher incidence (71.9%) of WHO Grade I. The rates of deterioration after surgery, at 3 months, and at 1 year were 33.3%, 37.3%, and 39.1%, respectively. Univariate analysis revealed location, preoperative KPS score, BMI level 2, and serum albumin level (p = 0.010, 0.017, 0.0012, and 0.0019, respectively) to be poor prognostic factors. Multivariate analysis revealed that location (p = 0.038) and BMI (p = 0.035) were risk factors for KPS score deterioration immediately after surgery. According to the 11 papers reviewed, the median rate (25th-75th percentile) of skull base-related location was 43.5% (39.6-47.75); for asymptomatic status the mean was 24%; and for mortality at 3 months and 1 year the medians were 6.3% (0.7-7.1) and 8% (4.8-9.4), respectively. CONCLUSION Careful preoperative assessment based on the frailty concept was essential for better outcome in elderly patients with skull base meningioma. The BMI is appropriate as a quantitative factor for measure of frailty, particularly in elderly individuals with skull base meningioma. Further prospective randomized controlled trials are necessary to validate frailty as a preoperative risk factor. Not only patient selection but also surgical timing was an important factor.
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Cohen-Inbar O. Geriatric brain tumor management part II: Glioblastoma multiforme. J Clin Neurosci 2019; 67:1-4. [DOI: 10.1016/j.jocn.2019.05.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
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Cohen-Inbar O. Geriatric brain tumor management part I: Meningioma. J Clin Neurosci 2019; 67:5-9. [DOI: 10.1016/j.jocn.2019.05.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/27/2019] [Indexed: 12/26/2022]
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Mediating effect of waist:height ratio on the association between BMI and frailty: the Korean Frailty and Aging Cohort Study. Br J Nutr 2019; 124:513-520. [PMID: 31452484 DOI: 10.1017/s0007114519002058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Body weight is a major risk determinant of frailty, but the effect of obesity on frailty is controversial. The present study aimed to confirm the hypothesis that the risk of frailty is positively associated with obesity (BMI ≥ 30 kg/m2), but the association is mediated by the waist:height ratio (WHtR) in older women and men. A total of 2862 community-dwelling older individuals aged 70-84 years were assessed for frailty using the Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight index. Obesity (BMI ≥ 30 kg/m2) was associated with a higher risk of frailty compared with BMI 18·5-<23 kg/m2 in all the older individuals (OR 1·88; 95 % CI 1·11, 3·17; P = 0·018) and in older women (OR 1·86; 95 % CI 1·01, 3·42; P = 0·047) before adjusting for WHtR but was not associated with BMI after adjusting for WHtR. Additionally, obesity was not significantly associated with the risk of frailty before and after adjusting for WHtR in older men. Mediation analysis revealed that the association between BMI and frailty score was mediated by WHtR. Moreover, the mediating effect of WHtR on frailty score was positive in both women and men, but the frailty score was associated with BMI positively in women and negatively in men. The present study suggests that the risk of frailty is higher in obese women, which is mediated by WHtR, but not in obese men.
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Moraes DC, Lenardt MH, Seima MD, Mello BHD, Setoguchi LS, Setlik CM. Postural instability and the condition of physical frailty in the elderly. Rev Lat Am Enfermagem 2019; 27:e3146. [PMID: 31038639 PMCID: PMC6528635 DOI: 10.1590/1518-8345.2655-3146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 02/03/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the relationship between postural instability and the condition and markers of physical frailty of the elderly people in outpatient geriatric and gerontology care. METHOD a cross-sectional study with a sample of 381 elderly subjects. Physical frailty was evaluated by the frailty phenotype and postural instability through the Berg Balance Scale. Univariate analyses consisted in Chi-square tests, and multivariate analyses used the Forward Stepwise method, which resulted in a model of physical frailty associated with postural instability. RESULTS among the participants, 56 (14.7%) were frail, 217 (57%) pre-frail, and 68 (28.3%) non-frail. Pre-frailty (p < 0.001), frailty (p = 0.000), and the markers hand grip strength (p = 0.0008), unintentional weight loss (p = 0.0094), level of physical activity (p = 0.0001), fatigue/exhaustion (p = 0.0001), and gait speed (p = 0.0001) were associated with postural instability. CONCLUSION the presence of postural instability determines a greater chance of the elderly being frail or pre-frail. This result favors the planning of gerontological nursing care and strengthens the treatment plan under a specific approach.
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Affiliation(s)
- Dayana Cristina Moraes
- Hospital Nossa Senhora do Pilar, Unidade de Terapia Intensiva, Curitiba, PR, Brasil.,Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil
| | - Maria Helena Lenardt
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil
| | - Marcia Daniele Seima
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil.,Prefeitura de São José dos Pinhais, Departamento de Atenção à Saúde, São José dos Pinhais, PR, Brasil
| | - Bruno Henrique de Mello
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil.,Hospital Nossa Senhora das Graças, Unidade de Terapia Intensiva, Curitiba, PR, Brasil
| | - Larissa Sayuri Setoguchi
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Clarice Maria Setlik
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil.,Hospital Nossa Senhora das Graças, Unidade de Internação, Curitiba, PR, Brasil
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Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Segev DL, Parekh RS, McAdams-DeMarco MA. Frailty, body composition and the risk of mortality in incident hemodialysis patients: the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease study. Nephrol Dial Transplant 2019; 34:346-354. [PMID: 29868775 PMCID: PMC6365769 DOI: 10.1093/ndt/gfy124] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/28/2018] [Indexed: 01/05/2023] Open
Abstract
Background Frail obese community-dwelling older adults are at increased mortality risk. Among hemodialysis (HD) patients, frailty is common and associated with increased mortality risk; however, in dialysis, obesity is associated with decreased mortality risk. Whether the frail-obese phenotype is associated with increased mortality risk among HD patients remains unclear. Methods This study included 370 incident HD patients enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study. We measured frailty using the Fried phenotype, general obesity [body mass index (BMI) ≥30 kg/m2] and abdominal obesity [waist:hip ratio (WHR) ≥median WHR] and estimated their associations with mortality. Results The mean age was 55 years, with 42% female, 73% African American, 57% diabetic and 52% frail. Frail HD patients had higher mean BMI (frail = 30.3 kg/m2, non-frail = 28.3 kg/m2; P = 0.02) and similar WHR (P = 0.8). Twenty-two percent were frail with general obesity and 27% were frail with abdominal obesity. Frailty was associated with 1.66-fold increased mortality risk [95% confidence interval (CI) 1.03-2.67]. BMI was associated with a decreased mortality risk [25.0-29.9 kg/m2 hazard ratio (HR) 0.53 (95% CI 0.31-0.93); ≥30 kg/m2 HR 0.34 (95% CI 0.19-0.62)]. Frailty was associated with elevated mortality risk among HD patients with general [HR 3.77 (95% CI 1.10-12.92)] and abdominal obesity [HR 2.38 (95% CI 1.17-4.82)]. Frailty was not associated with mortality among HD patients without general or abdominal obesity. Conclusions In adults initiating HD, frailty was associated with elevated mortality risk, even among the obese. Frail-obese HD patients may be a high-risk, often-overlooked population, as obesity is assumed to be protective. Measurement of frailty and obesity may facilitate risk stratification.
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Affiliation(s)
- Jessica Fitzpatrick
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Nephrology Center of Maryland, Baltimore, MD, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco and Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Dorry L Segev
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Division of Nephrology, Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Mara A McAdams-DeMarco
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
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Wang MC, Li TC, Li CI, Liu CS, Lin WY, Lin CH, Yang CW, Yang SY, Lin CC. Frailty, transition in frailty status and all-cause mortality in older adults of a Taichung community-based population. BMC Geriatr 2019; 19:26. [PMID: 30691410 PMCID: PMC6348637 DOI: 10.1186/s12877-019-1039-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/17/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Previous studies have reported the associations of frailty phenotype or its components with mortality. However, studies that explored the effects of transition in frailty status on mortality were far less in Asian or Chinese. The aim of this study was to evaluate baseline frailty status and one-year change of frailty status in relation to all-cause mortality in Taiwanese community-dwelling older adults who participated in the Taichung Community Health Study for Elders. METHODS We conducted a community-based prospective cohort study. A total of 921 community-dwelling elderly men and women aged 65-99 years in Taichung City were enrolled in 2009-2010 and were followed up through 2016. We adopted the definition of frailty proposed by Fried et al., including five components: shrinking, weakness, poor endurance and energy, slowness, and low physical activity. Cox proportional hazards models were used to determine adjusted hazard ratios (HRs) of mortality with 95% confidence intervals (CIs) for frailty at baseline and one-year change in frailty status. RESULTS There were 160 deaths during the follow-up period. The mortality rates in groups of robust and frail were 20.26 and 84.66 per 1000 person-years respectively. After multivariate adjustment, the HR (CIs) for baseline frailty was 2.67 (1.73-4.12). Poor endurance and energy [1.88 (1.03-3.42)], slowness [2.60 (1.76-3.83)] and weakness [1.65 (1.16-2.33)] were found to be predictors of mortality. Increased risks in mortality for subgroups of robust-to-frail [2.76 (1.22-6.27)], frail-to-robust [3.87 (1.63, 9.19)], and frail-to-frail [4.08 (1.92-8.66)] over one-year period were observed compared with those remaining robust. CONCLUSION Baseline frailty status and one-year change in frailty status are associated with 6-year all-cause mortality among Taiwanese elderly adults. Frailty may be useful for identifying older adults at high risks for mortality prevention.
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Affiliation(s)
- Mu-Cyun Wang
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chia-Ing Li
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Hsueh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chuan-Wei Yang
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. .,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. .,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. .,China Medical University, 91 Hsueh-Shih Road, Taichung, 40421, Taiwan.
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Han SV, Park M, Kwon YM, Yoon HJ, Chang Y, Kim H, Lim YH, Kim SG, Ko A. Mild Anemia and Risk for All-Cause, Cardiovascular and Cancer Deaths in Apparently Healthy Elderly Koreans. Korean J Fam Med 2019; 40:151-158. [PMID: 30650952 PMCID: PMC6536909 DOI: 10.4082/kjfm.17.0089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/17/2017] [Indexed: 02/05/2023] Open
Abstract
Background Being common, mild anemia is sometimes considered a mere consequence of aging; however, aging alone is unlikely to lead to anemia. Therefore, this study aimed to investigate the association between mild anemia and total mortality and cause-specific mortality in apparently healthy elderly subjects. Methods A retrospective cohort study was conducted on 10,114 apparently healthy elderly individuals who underwent cancer screening and routine medical check-ups at one Health Promotion Center between May 1995 and December 2007. We defined mild anemia as a hemoglobin concentration between 10.0 g/dL and 11.9 g/dL in women and between 10.0 g/dL and 12.9 g/dL in men. We assessed the relationship between the overall, cardiovascular (CV), and cancer mortality and mild anemia using Cox proportional hazard models. Results Mild anemia was present in 143 men (3.1%) and 246 women (6.1%). During an average follow-up of 7.6 years, 495 deaths occurred, including 121 CV and 225 cancer deaths. After adjustments, mild anemia was associated with a 128% increase in the risk of all-cause mortality hazard ratio (HR, 2.28; 95% confidence interval [CI], 1.54– 3.37) in men and cancer-related mortality (HR, 2.25; 95% CI, 1.22–4.13), particularly lung cancer (HR, 2.70; 95% CI, 1.03–7.08) in men, but not in women. In the subgroup analyses based on smoking status, obesity, and age, the associations were more prominent in never or former smoker groups and the older group. Conclusion The present study shows that overall and cancer-related mortality was associated with mild anemia in elderly men. Future prospective studies are needed to consolidate our findings.
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Affiliation(s)
- Sil Vi Han
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Minseon Park
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Min Kwon
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Hyung-Jin Yoon
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Yoosoo Chang
- Health Screening Center, Center for Cohort Study, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Kim
- Department of Biostatistics and Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Youn-Hee Lim
- Institute of Health and Environment, Seoul National University School of Public Health, Seoul, Korea
| | - Su Gyeong Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ahryoung Ko
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Crow RS, Lohman MC, Titus AJ, Cook SB, Bruce ML, Mackenzie TA, Bartels SJ, Batsis JA. Association of Obesity and Frailty in Older Adults: NHANES 1999-2004. J Nutr Health Aging 2019; 23:138-144. [PMID: 30697622 PMCID: PMC6371801 DOI: 10.1007/s12603-018-1138-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Body composition changes with aging can increase rates of obesity, frailty and impact function. Measuring adiposity using body fat (%BF) or central adiposity using waist circumference (WC) have greater diagnostic accuracy than traditional measures such as body mass index (BMI). DESIGN This is an observational study. SETTING This study focused on older community-dwelling participants. PARTICIPANTS We identified individuals age ≥ 60 years old using the 1999-2004 cross-sectional National Health and Nutrition Survey (NHANES). INTERVENTION The primary analysis evaluated the association between frailty and %BF or WC. Frailty was the primary predictor (robust=referent) and %BF and WC were considered continuous outcomes. Multiple imputation analyses accounted for missing characteristics. MEASUREMENT Dual energy x-ray absorptiometry was used to assess %BF and WC was objectively measured. Frailty was defined using an adapted version of Fried's criteria that was self-reported: (low BMI<18.5kg/m2; slow walking speed [<0.8m/s]; weakness [unable to lift 10lbs]; exhaustion [difficulty walking between rooms on same floor] and low physical activity [compared to others]). Robust, pre-frail and frail persons met zero, 1 or 2, and ≥3 criteria, respectively. RESULTS Of the 4,984 participants, the mean age was 71.1±0.2 (SE) years and 56.5% were females. We classified 2,246 (50.4%), 2,195 (40.3%), and 541 (9.2%) individuals as robust, pre-frail and frail, respectively. Percent BF was 35.9±0.13, 38.3±0.20 and 40.0±0.46 in the robust, pre-frail and frail individuals, respectively. WC was 99.5±0.32 in the robust, 100.1±0.43 in pre-frail, 104.7±1.17 in frail individuals. Compared to robust individuals, only frail individuals had greater %BF on average (β=0.97±0.43,p=0.03); however, pre-frail and frail individuals had 2.18 and 4.80 greater WC, respectively (β=2.18±0.64,p=0.002, and β=4.80±1.1,p<0.001). CONCLUSION Our results demonstrate that in older adults, frailty and pre-frailty are associated with a greater likelihood of high WC (as dichotomized) and a greater average WC (continuous).
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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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Isobe N, Ikawa F, Tominaga A, Kuroki K, Sadatomo T, Mizoue T, Hamasaki O, Matsushige T, Abiko M, Mitsuhara T, Kinoshita Y, Takeda M, Kurisu K. Factors Related to Frailty Associated with Clinical Deterioration After Meningioma Surgery in the Elderly. World Neurosurg 2018; 119:e167-e173. [DOI: 10.1016/j.wneu.2018.07.080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 11/26/2022]
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Buch A, Keinan-Boker L, Kis O, Carmeli E, Izkhakov E, Ish-Shalom M, Berner Y, Shefer G, Marcus Y, Stern N. Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly - a preliminary study. Clin Interv Aging 2018; 13:1907-1918. [PMID: 30349209 PMCID: PMC6183587 DOI: 10.2147/cia.s176446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose Unwanted weight loss is one of the established criteria for the diagnosis of frailty. However, the relevance of this criterion to detect frailty in obese older adults has not been assessed. In particular, with the exception of malignancy, unwanted weight loss is not commonly seen in older obese subjects. Therefore, we tested the possibility that some obesity phenotypes and/or diabetes might be more useful in the detection of frailty in this setting. Patients and methods A preliminary cross-sectional study of 50 consecutive subjects was conducted at The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center. Inclusion criteria were: young elderly (aged 65–75 years), with general and/or abdominal obesity, without cancer. Frailty was assessed directly using the Fried model, the five-item fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale. Eventually, in the assessment of frailty, the weight loss criterion was replaced by one or several of obesity/diabetes-related variables each time: severity of obesity by body mass index, waist circumference (and their interaction), body fat, and diabetes. The receiver operating characteristic curves for functional impairment indices were plotted to compare the usefulness of the frailty accepted and adjusted models. Results The prevalence of frailty and pre-frailty in this cohort were 7/50 (14%) and 27/50 (54%), respectively, but unwanted weight loss was seen in three subjects (6%) only. The level of abdominal obesity had the strongest correlation with functional score (r=0.292, P<0.05). Frailty models which included either severe abdominal obesity or diabetes in lieu of unwanted weight loss had good sensitivity rates per each frailty score as compared with the original Fried model. Conclusion For detecting and/or screening for the frailty syndrome in obese young elderly, the level of abdominal obesity or diabetes may provide a useful marker.
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Affiliation(s)
- Assaf Buch
- The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, .,The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel, .,Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel,
| | - Lital Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel.,Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Ofer Kis
- The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel,
| | - Eli Carmeli
- The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, .,The Department of Physical Therapy, University of Haifa, Haifa, Israel
| | - Elena Izkhakov
- The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, .,The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel,
| | - Maya Ish-Shalom
- The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, .,The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel,
| | - Yitshal Berner
- The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel, .,Meir Medical Center, Kfar Saba, Israel
| | - Gabi Shefer
- The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, .,The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel,
| | - Yonit Marcus
- The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, .,The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel,
| | - Naftali Stern
- The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, .,The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel,
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Whole-Body Vibration Increases Cardiopulmonary Performance in the Elderly. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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