1
|
De Luca V, Femminella GD, Patalano R, Formosa V, Lorusso G, Rivetta C, Di Lullo F, Mercurio L, Rea T, Salvatore E, Korkmaz Yaylagul N, Apostolo J, Silva RC, Dantas C, van Staalduinen WH, Liotta G, Iaccarino G, Triassi M, Illario M. Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16050. [PMID: 36498125 PMCID: PMC9739796 DOI: 10.3390/ijerph192316050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care.
Collapse
Affiliation(s)
- Vincenzo De Luca
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Grazia Daniela Femminella
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Valeria Formosa
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Grazia Lorusso
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Cristiano Rivetta
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Federica Di Lullo
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Lorenzo Mercurio
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Teresa Rea
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Elena Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | | | - Joao Apostolo
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - Rosa Carla Silva
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | | | | | - Giuseppe Liotta
- Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Guido Iaccarino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maria Triassi
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maddalena Illario
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| |
Collapse
|
2
|
Brown MJ, Nkwonta CA, Kaur A, James T, Haider MR, Weissman SB, Hansen NB, Heckman TG, Li X. Intervention program needs for older adults living with HIV who are childhood sexual abuse survivors. Aging Ment Health 2022; 26:2195-2201. [PMID: 34766546 PMCID: PMC9095752 DOI: 10.1080/13607863.2021.1998358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/17/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Childhood sexual abuse (CSA) prevalence estimates range from 8-11% among older adults and may range from 16 to 22% among older adults living with HIV (OALH). CSA experiences can still impact the quality of life of older adults. To the best of our knowledge, however, there are no CSA-focused interventions tailored for OALH. Using a qualitative approach, this study characterized the desired components of a trauma-focused intervention for OALH who are CSA survivors. METHODS Twenty-four (24) adults aged 50 years of age or older who were living with HIV and had experienced CSA were recruited from a large HIV immunology center in South Carolina. Participants completed in-depth, qualitative, semi-structured interviews. We iteratively examined verbatim transcripts using thematic analysis. RESULTS Three main themes emerged: program format and modality, program content, and program coordinator. Most participants expressed a desire for a trauma-focused intervention program in which the CSA experience was addressed and they could talk to someone either individually, as a group, and/or both. CONCLUSION A trauma-focused intervention addressing CSA may be helpful for OALH who are CSA survivors. Future research should focus on designing and implementing age-appropriate interventions addressing the CSA experience, increasing resilience, and developing adaptive coping skills.
Collapse
Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Titilayo James
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Mohammad Rifat Haider
- Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Sharon B. Weissman
- School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Nathan B. Hansen
- Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Timothy G. Heckman
- Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| |
Collapse
|
3
|
Thet D, Siritientong T, Sangarlangkarn A, Lwin HMS, Phonphithak S, Apornpong T, Avihingsanon A. Deterioration of Nutritional Status and Its Negative Association with Depression Among Older HIV-Infected Asian Population: A Four-Year Longitudinal Study. AIDS Res Hum Retroviruses 2021; 38:592-600. [PMID: 34541868 DOI: 10.1089/aid.2021.0087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There is limited evidence about the long-term changes in nutritional status among the elderly people living with human immunodeficiency virus (PLWH). We aimed to investigate the changes in nutritional status and related factors over 4 years in the elderly PLWH. The longitudinal study was conducted prospectively among 250 PLWH, 50 years of age and older, receiving antiretroviral therapy (ART). The Mini Nutritional Assessment (MNA) and Thai Depression Scale (TDS) to assess nutritional status and depression, respectively, were performed at the outpatient clinic both at baseline and 4-year follow-up. Majority were male (60.8%) with median age of 58 years. The median CD4 was 612.5 cells/mm3 and 98% had HIV RNA <50 copies/mL. Median duration of ART was 20 years. Median body mass index was 23.1 kg/m2. The most common ART were rilpivirine (45.2%) and dolutegravir (18.8%). Fifty-one patients (20.4%) deteriorated in nutritional status and mean MNA scores declined (25.8 vs. 24.8, p < .001) at follow-up period. In multivariate analysis, high TDS scores (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.17-1.52), polypharmacy (OR, 1.35; 95% CI, 1.10-1.65), and high-density lipoprotein cholesterol (HDL-C) levels (OR, 1.04; 95% CI, 1.01-1.07) were associated factors of deterioration in nutritional status. In this 4-year longitudinal follow-up, 20% of the aging PLWH have deterioration of nutritional status. High TDS scores (depression), polypharmacy, and high HDL-C were significantly associated with declining nutritional status. Our findings highlight the importance of screening and monitoring nutritional and depression status in routine HIV treatment and care for geriatric HIV-infected population.
Collapse
Affiliation(s)
- Daylia Thet
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Tippawan Siritientong
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Burn and Wound Care, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Aroonsiri Sangarlangkarn
- Division of General Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Hay Mar Su Lwin
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
4
|
Liu X, Cao J, Zhu Z, Zhao X, Zhou J, Deng Q, Zhang L, Wang H. Nutritional risk and nutritional status in hospitalized older adults living with HIV in Shenzhen, China: a cross-sectional study. BMC Infect Dis 2021; 21:618. [PMID: 34187374 PMCID: PMC8244224 DOI: 10.1186/s12879-021-06322-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nutrition is a crucial factor that can impact morbidity and mortality in older people living with HIV (PLWH). Studies on nutritional risk and nutritional status in all age groups in PLWH have been conducted. However, few studies have focused on nutritional risk in older PLWH. This study aimed to describe the nutritional risk and nutritional status in older PLWH, and explore factors associated with nutritional risk and undernutrition status. METHODS We conducted a cross-sectional study. We recruited participants aged 50 years or older from the Third People's Hospital of Shenzhen from January 2016 to May 2019. Nutritional risk and nutritional status were evaluated by the Nutritional Risk Screening 2002 (NRS 2002) tool, body mass index (BMI), albumin level, and prealbumin level on the first day of admission. Logistic regression models were used to identify the factors associated with undernutrition based on the BMI, albumin, and prealbumin criteria. RESULTS A total of 196 older PLWH were included in the analysis. We found that 36% of hospitalized older PLWH had nutritional risk, and 12-56% of them had undernutrition based on the BMI, albumin, and prealbumin criteria. An increased nutritional risk score was associated with older age (β = 0.265 CI [0.021, 0.096], P = 0.002), a higher viral load (β = - 0.186 CI [- 0.620, - 0.037], P = 0.028), a lower BMI (β = - 0.287 CI [- 0.217, - 0.058], P = 0.001), and a lower albumin level (β = - 0.324 CI [- 8.896, - 1.230], P = 0.010). The CD4 count was associated with the prevalence of undernutrition based on the albumin criterion (OR = 15.637 CI [2.742, 89.178], P = 0.002). CONCLUSION Our study indicated that nutritional screening, assessment, and management should be routinely performed in hospitalized older PLWH. HIV-specific measures should be used to assess nutritional risk, and albumin, BMI, and other assessments should be used in combination to identify undernutrition in older PLWH.
Collapse
Affiliation(s)
- Xiaoning Liu
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jing Cao
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Zheng Zhu
- Fudan University School of Nursing, Shanghai, China. .,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
| | - Xia Zhao
- Peking Union Medical College Hospital, Beijing, China
| | - Jing Zhou
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Qiuxia Deng
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Liyuan Zhang
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Hui Wang
- The Third People's Hospital of Shenzhen, Shenzhen, China.
| |
Collapse
|
5
|
Sangarlangkarn A, Appelbaum JS. Comprehensive Geriatric Assessment in Older Persons With HIV. Open Forum Infect Dis 2020; 7:ofaa485. [PMID: 33241066 PMCID: PMC7672420 DOI: 10.1093/ofid/ofaa485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022] Open
Abstract
With increased longevity related to the advent of antiretroviral therapy, there are increasing proportions of older persons with HIV (PWH). Prior studies have demonstrated increased prevalence of geriatric syndromes in older PWH and recommended the Comprehensive Geriatric Assessment (CGA) in this population. However, there is currently no peer-reviewed literature that outlines how to perform the CGA in PWH in the clinical setting. In this article, we offer a review on how to perform the CGA in PWH, outline domains of the CGA and their importance in PWH, and describe screening tools for each domain focusing on tools that have been validated in PWH, are easy to administer, and/or are already commonly used in the field of geriatrics.
Collapse
Affiliation(s)
- Aroonsiri Sangarlangkarn
- Section of Geriatrics, Division of General Internal Medicine, Department of Internal Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Jonathan S Appelbaum
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| |
Collapse
|
6
|
Sangarlangkarn A, Apornpong T, Justice AC, Avihingsanon A. Screening tools for targeted comprehensive geriatric assessment in HIV-infected patients 50 years and older. Int J STD AIDS 2019; 30:1009-1017. [PMID: 31431156 DOI: 10.1177/0956462419841478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Many people living with HIV (PLWH) are aging with geriatric syndromes, but few undergo comprehensive geriatric assessment (CGA) due to limited resources. Our study evaluates tools to identify aging PLWH who may forego CGA. We conducted a cross-sectional study on 357 PLWH ≥50 years old at the Red Cross, Thailand. Tools evaluated were the Veterans Aging Cohort Study Index (VACSI) and G-8, which is predictive among older cancer patients. CGA consists of eight tests: history of fall within 12 months, timed-up-and-go test (TUG), activities of daily living (ADL), instrumental ADL (IADL), Montreal cognitive assessment (MoCA), Thai depression scale (TDS), mini nutritional assessment (MNA), and HIV symptom index (HSI). We considered ≥2 impaired domains on CGA to be abnormal results. Forty-nine percent (n = 175) had ≥2 impaired domains on CGA. Few participants had experienced a fall (11%) or abnormal TUG/ADL/IADL (<2%), and only MoCA/TDS/MNA/HSI were analyzed. A VACSI < 17 produces 85% sensitivity (Se) and 30% specificity (Sp) (area under the ROC curve [AUC] = 63, 95%CI 58–69) and G-8 > 15.5 produces 90%Se and 33%Sp (AUC = 74, 95%CI 69–79) in identifying patients with <2 impaired domains. A G-8 > 13.5 produces 91%Se and 77%Sp (AUC = 89, 95%CI 86–92) in ruling out abnormal nutrition. Patients with VACSI < 17 and G-8 > 15.5 may forego CGA due to low likelihood of abnormal cognition, mood, nutrition, or symptom burden.
Collapse
Affiliation(s)
- Aroonsiri Sangarlangkarn
- 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Tanakorn Apornpong
- 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Amy C Justice
- 2 Yale University School of Medicine, West Haven, CT, USA
| | - Anchalee Avihingsanon
- 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,3 Department of Medicine, Division of Allergy and Immunology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
7
|
Negin J, Rozea A, Martiniuk ALC. HIV behavioural interventions targeted towards older adults: a systematic review. BMC Public Health 2014; 14:507. [PMID: 24884947 PMCID: PMC4049807 DOI: 10.1186/1471-2458-14-507] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 05/20/2014] [Indexed: 11/14/2022] Open
Abstract
Background The increasing number of people living with HIV aged 50 years and older has been recognised around the world yet non-pharmacologic HIV behavioural and cognitive interventions specifically targeted to older adults are limited. Evidence is needed to guide the response to this affected group. Methods We conducted a systematic review of the available published literature in MEDLINE, Embase and the Education Resources Information Center. A search strategy was defined with high sensitivity but low specificity to identify behavioural interventions with outcomes in the areas of treatment adherence, HIV testing uptake, increased HIV knowledge and uptake of prevention measures. Data from relevant articles were extracted into excel. Results Twelve articles were identified all of which originated from the Americas. Eight of the interventions were conducted among older adults living with HIV and four for HIV-negative older adults. Five studies included control groups. Of the included studies, four focused on general knowledge of HIV, three emphasised mental health and coping, two focused on reduced sexual risk behaviour, two on physical status and one on referral for care. Only four of the studies were randomised controlled trials and seven – including all of the studies among HIV-negative older adults – did not include controls at all. A few of the studies conducted statistical testing on small samples of 16 or 11 older adults making inference based on the results difficult. The most relevant study demonstrated that using telephone-based interventions can reduce risky sexual behaviour among older adults with control reporting 3.24 times (95% CI 1.79-5.85) as many occasions of unprotected sex at follow-up as participants. Overall however, few of the articles are sufficiently rigorous to suggest broad replication or to be considered representative and applicable in other settings. Conclusions More evidence is needed on what interventions work among older adults to support prevention, adherence and testing. More methodological rigourised needed in the studies targeting older adults. Specifically, including control groups in all studies is needed as well as sufficient sample size to allow for statistical testing. Addition of specific bio-marker or validated behavioural or cognitive outcomes would also strengthen the studies.
Collapse
Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, Australia.
| | | | | |
Collapse
|
8
|
Teixeira J, Mota T, Fernandes JC. Nutritional evaluation of alcoholic inpatients admitted for alcohol detoxification. Alcohol Alcohol 2011; 46:558-60. [PMID: 21632576 DOI: 10.1093/alcalc/agr062] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIMS To assess nutritional risk of alcoholic patients admitted for alcohol detoxification. METHODS Screening of nutritional risk of alcoholic patients using the Malnutrition Universal Screening Tool. RESULTS Fifty-three percentage patients at presentation were rated as being at medium or high risk of malnutrition. CONCLUSION Malnutrition should be actively considered and screened for in alcoholic patients admitted for alcohol detoxification due to its high prevalence and benefits obtained from treatment.
Collapse
|