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Chen L, Wang J, Geng L, Li Y. Development and validation of a risk prediction model for physical frailty in older adults who are disabled. Geriatr Nurs 2024; 58:26-38. [PMID: 38733746 DOI: 10.1016/j.gerinurse.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024]
Abstract
Physical frailty is highly prevalent among the older adults who are disabled. The aim of this study was to explore the risk factors for physical frailty in older adults who are disabled and construct a nomogram prediction model. The data source was the China Health and Retirement Longitudinal Study (CHARLS). The prediction model was validated with a cohort of 1183 older adults who are disabled. The results showed that sleep quality, depression, fatigue, and chronic disease were the best predictive factors. These factors were used to construct the nomogram model, which showed good concordance and accuracy. The prediction model yielded an Area under the curve (AUC) value of 0.760. Calibration curves showed significant agreement between the nomogram model and actual observations. Receiver operating characteristic (ROC) and Decision curve analysis (DCA) showed that the nomogram had good predictive performance. The nomogram is contributed to the screening of specific populations by clinicians.
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Affiliation(s)
- Lijing Chen
- The Fifth People's Hospital of Zhuhai, Zhuhai, China
| | - Jiaxian Wang
- Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Li Geng
- The Fifth People's Hospital of Zhuhai, Zhuhai, China
| | - Yi Li
- The Fifth People's Hospital of Zhuhai, Zhuhai, China.
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Milton-Cole R, Kazeem K, Gibson A, Guerra S, Sheehan KJ. Effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults post hip fracture: a systematic review and meta-analysis. Osteoporos Int 2024; 35:227-242. [PMID: 37831102 DOI: 10.1007/s00198-023-06923-3] [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: 03/07/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
This study determines the effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults after hip fracture. Ovid MEDLINE, Embase, Global Health, APAPsych, CENTRAL, CIHAHL, PEDro and Open Grey were searched from database inception to June 10, 2022 for definitive, pilot or feasibility randomised controlled trials of rehabilitation interventions (versus any comparator) which reported depressive symptoms among older adults post hip fracture. Nonrandomised trials and those not published in English were excluded. Selection, quality appraisal (Cochrane Risk of Bias 2) and extraction in duplicate. Results were synthesised narratively and with meta-analysis (Hedge's g for intervention effect, I2 for heterogeneity). Eight trials (1146 participants) were included. Interventions were predominantly face-to-face exercise rehabilitation (range three to 56 sessions) at home versus usual care. Three trials were assigned overall low risk of bias, three some concerns and two high risk. The pooled effect of rehabilitation on depressive symptoms at intervention end favoured the intervention group (Hedges's g -0.43; 95% CI: -0.87, 0.01; four trials). Three trials demonstrated no between group difference following adjustment for baseline depressive symptoms. One trial found lower odds of depression when the intervention additionally included falls prevention, nutrition consultation and depression management. There is a potential benefit of exercise rehabilitation interventions on depressive symptoms after hip fracture. A mechanism for benefit may relate to baseline symptom severity, exercise frequency, frequency of health professional contacts, addition of a psychological component or of the quality of the underlying trials. To appropriately inform clinical guidelines, further appropriately powered trials with follow-up are warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: CRD42022342099.
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Affiliation(s)
- Rhian Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Kareema Kazeem
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Alexander Gibson
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Stefanny Guerra
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Katie Jane Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK.
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Wang L, Wang X, Zhang R, He C. Emerging trends and prospects in telerehabilitation for hip fracture: Bibliometric and visualization study. Digit Health 2024; 10:20552076241255465. [PMID: 38798887 PMCID: PMC11128182 DOI: 10.1177/20552076241255465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Background Telerehabilitation provide distant physical rehabilitation services and help overcome the barriers associated with face-to-face interventions for hip fractures. This study aims to analyse the progress of the application of telerehabilitation in hip fracture and reveal its research profile, hotspots and development trends. Methods The articles and reviews related to telerehabilitation in hip fracture were retrieved from 1992 to 2024. A bibliometric visualization and comparative analysis of countries, institutions, journals, authors, references and keywords were conducted using Java-based CiteSpace and VOSviewer. Results A total of 79 documents were obtained. Spain was the most academically influential country. The University of Granada was the most prolific institution. The author Ariza-vega P listed first in terms of publications and citations. Most publications were published in high academic impact journals. The major frontier keywords were "older adults," "functional recovery," "reliability," "mortality," "rehabilitation," "mobility" and "quality of life." The most popular keywords from 2020 to 2024 were "geriatric medicine," "family caregiver" and "digital health." Conclusions The historical and prospective perspective in telerehabilitation following hip fracture were presented. A primary focus in the early years was the impact of telerehabilitation on functional independence for hip fracture patients. Future outcomes are expected to include patient satisfaction, health-related quality of life and psychiatric symptoms. Exercise was also designed to eliminate travel burdens and strengthen self-efficacy, and improve the physical and psychosocial function of hip fracture patients. This work will provide a fundamental reference as well as a directional guide for future research.
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Affiliation(s)
- Liqiong Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Xiangxiu Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Ruishi Zhang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Chengqi He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
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Milton-Cole R, O'Connell MDL, Sheehan KJ, Ayis S. The role of depression in the association between physiotherapy frequency and duration and outcomes after hip fracture surgery: secondary analysis of the physiotherapy hip fracture sprint audit. Eur Geriatr Med 2023; 14:999-1010. [PMID: 37329488 PMCID: PMC10587201 DOI: 10.1007/s41999-023-00808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE It is not known whether the association between the frequency and duration of physiotherapy and patient outcomes varies for those with and without depression. This study aims to evaluate whether the associations between the frequency and duration of physiotherapy after hip fracture surgery and discharge home, surviving at 30 days post-admission, and being readmitted 30 days post discharge vary by depression diagnosis. METHODS Data were from 5005 adults aged 60 and over included in the UK Physiotherapy Hip Fracture Sprint Audit who had undergone surgery for a nonpathological first hip fracture. Logistic regression models were used to estimate the unadjusted and adjusted odds ratios and their 95% confidence intervals for the associations between physiotherapy frequency and duration and outcomes. RESULTS Physiotherapy frequency and duration were comparable between patients with and without depression (42.1% and 44.6%). The average adjusted odds for a 30-min increase in physiotherapy duration for those with and without depression for discharge home were 1.05 (95% CI 0.85-1.29) vs 1.16 (95% CI 1.05-1.28, interaction p = 0.36), for 30-day survival were 1.26 (95% CI 1.06-1.50) vs 1.11 (95% CI 1.05-1.17, interaction p = 0.45) and for readmission were 0.89 (95% CI 0.81-0.98) vs 0.97 (95% CI 0.93-1.00, interaction p = 0.09). None of the interaction tests reached formal significance, but the readmission models were close (p = 0.09). CONCLUSION Results suggest physiotherapy duration may be negatively associated with readmission in those with depression but not those without depression, while no clear difference in the other outcomes was noted.
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Affiliation(s)
- Rhian Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Matthew D L O'Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Katie Jane Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Salma Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
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Liu C, Shi L, He J, Wang L, Min N, Wang F, Zhao M, Liu J, Zhang Y. Effects of depressive symptoms on osteoporotic bone metabolism and prognosis of joint replacement surgery in elderly male patients with femoral neck fracture. Asian J Surg 2023; 46:3687-3692. [PMID: 37422387 DOI: 10.1016/j.asjsur.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVE To investigate the effect of depressive symptoms on osteoporotic bone metabolism and prognosis of joint replacement surgery in elderly male patients with femoral neck fractures. METHOD 102 elderly male patients with femoral neck fractures hospitalized in the Beijing Hospital from January 2017 to January 2019 were included. The patients with femoral neck fractures were divided into the depression group and the control group. The observation indicators included: bone mineral density, serum alkaline phosphatase, serum calcium, serum phosphorus, 25-hydroxy-vitamin D, osteocalcin, Type I procollagen amino-terminal propeptide, serum β-isomer of C-terminal telopeptide of type I collagen, hip function scores, and pain visual analogue scale at pre- and post-operative examinations. RESULTS The BMD was significantly lower in the depressed group than in the control group [either for lumbar spine or hip, P < 0.05]. Serum 25-(OH)-D levels and serum OC levels were lower (both P < 0.05) in the depression group, while serum -CTX levels were higher in the depression group than in the control group (P < 0.05). Depression severity (GDS score) was negatively correlated with BMD (r = -0.456, P < 0.05), 25(OH)D (r = -0.546, P < 0.05), and OC (r = -0.215, P < 0.05), while positively correlated with β-CTX (r = 0.372, P < 0.05). The Harris scores of the depression group were lower than the control group (P < 0.001). In the control group, VAS scores decrease at 12 months postoperatively while in the depressed group, VAS scores increased (P < 0.001). CONCLUSION Depression is a risk factor for low bone mineral density and fracture, and adversely affects functional recovery and pain relief after artificial femoral head replacement. Special care should be taken for those patients with depressive symptoms in orthopedic practice.
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Affiliation(s)
- Chi Liu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lei Shi
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jing He
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lin Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Nan Min
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Fei Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Maoyu Zhao
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Junchuan Liu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yaonan Zhang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
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Panza F, Solfrizzi V, Sardone R, Dibello V, Castellana F, Zupo R, Stallone R, Lampignano L, Bortone I, Mollica A, Berardino G, Ruan Q, Altamura M, Bellomo A, Daniele A, Lozupone M. Depressive and Biopsychosocial Frailty Phenotypes: Impact on Late-life Cognitive Disorders. J Alzheimers Dis 2023:JAD230312. [PMID: 37355907 DOI: 10.3233/jad-230312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
In older age, frailty is a detrimental transitional status of the aging process featuring an increased susceptibility to stressors defined by a clinical reduction of homoeostatic reserves. Multidimensional frailty phenotypes have been associated with all-cause dementia, mild cognitive impairment (MCI), Alzheimer's disease (AD), AD neuropathology, vascular dementia, and non-AD dementias. In the present article, we reviewed current evidence on the existing links among depressive and biopsychosocial frailty phenotypes and late-life cognitive disorders, also examining common pathways and mechanisms underlying these links. The depressive frailty phenotype suggested by the construct of late-life depression (LLD) plus physical frailty is poorly operationalized. The biopsychosocial frailty phenotype, with its coexistent biological/physical and psychosocial dimensions, defines a biological aging status and includes motivational, emotional, and socioeconomic domains. Shared biological pathways/substrates among depressive and biopsychosocial frailty phenotypes and late-life cognitive disorders are hypothesized to be inflammatory and cardiometabolic processes, together with multimorbidity, loneliness, mitochondrial dysfunction, dopaminergic neurotransmission, specific personality traits, lack of subjective/objective social support, and neuroendocrine dysregulation. The cognitive frailty phenotype, combining frailty and cognitive impairment, may be a risk factor for LLD and vice versa, and a construct of depressive frailty linking physical frailty and LLD may be a good dementia predictor. Frailty assessment may enable clinicians to better target the pharmacological and psychological treatment of LLD. Given the epidemiological links of biopsychosocial frailty with dementia and MCI, multidomain interventions might contribute to delay the onset of late-life cognitive disorders and other adverse health-related outcomes, such as institutionalization, more frequent hospitalization, disability, and mortality.
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Affiliation(s)
- Francesco Panza
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
- "Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Vincenzo Solfrizzi
- "Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Rodolfo Sardone
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Vittorio Dibello
- "Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Fabio Castellana
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Roberta Zupo
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Roberta Stallone
- Neuroscience and Education, Human Resources Excellence in Research, University of Foggia, Foggia, Italy
| | - Luisa Lampignano
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Ilaria Bortone
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Anita Mollica
- Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giuseppe Berardino
- Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy
| | - Qingwei Ruan
- Laboratory of Aging, Anti-aging & Cognitive Performance, Shanghai Institute of Geriatrics and Gerontology, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatrics, Huadong Hospital, Shanghai Medical 14 College, Fudan University, Shanghai, China
| | - Mario Altamura
- Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonio Daniele
- Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy
- Neurology Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Madia Lozupone
- Department of Translational Biomedicine and Neuroscience "DiBraiN", University of Bari Aldo Moro, Bari, Italy
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Su SF, Lin SN. Effects of comprehensive geriatric care on depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence in older persons receiving hip-fracture surgery: A meta-analysis. Int J Nurs Pract 2022; 28:e13099. [PMID: 35978458 DOI: 10.1111/ijn.13099] [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: 01/03/2021] [Revised: 06/04/2022] [Accepted: 07/23/2022] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence of comprehensive geriatric care in patients receiving hip-fracture surgery. BACKGROUND Hip fractures among older persons result in restricted activities of daily living, longer hospital stays, frequent emergency department visits and re-presentation to hospital, which may increase depressive symptoms and death risk. The benefits of comprehensive geriatric care have not been determined. DESIGN A five-step Cochrane collaboration meta-analysis was used. DATA SOURCES Randomized controlled trials published from 1980 to 2020 in which comprehensive geriatric care was provided following hip-fracture surgery were retrieved from the Cochrane Library, Clinical Key, Embase, MEDLINE, OVID and PubMed databases. Indicators were depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence. REVIEW METHODS The Group Reading Assessment, Risk of Bias 2.0 tool, modified Jadad scale and Comprehensive Meta-Analysis Version 3 software were used. RESULTS Overall, 1291 patients from six randomised controlled trials were included. Comprehensive geriatric care improved depressive symptoms and lowered emergency department visits but did not improve re-hospitalization rates or discharge to the same residence. CONCLUSION Comprehensive geriatric care should include depression management and individualized care plans. Further depression-related studies are required to verify their benefits.
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Affiliation(s)
- Shu-Fen Su
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Shu-Ni Lin
- Department of Nursing, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
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Özbay H, Atçı T, Adanır O, Alagöz E, Çay T. Effects of social stress and fluoxetine treatment on fracture healing in a rat femur fracture model. Injury 2022; 53:362-367. [PMID: 34857371 DOI: 10.1016/j.injury.2021.11.049] [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: 07/05/2021] [Revised: 11/13/2021] [Accepted: 11/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mental stress and depressive disorders have negative effect on bone biology and increase fracture risk. Fluoxetine is a widely used selective serotonin reuptake inhibitor in the treatment of these disorders. We aimed to evaluate the effects of social stress and fluoxetine treatment on fracture healing. METHODS This study was performed with 32 male Sprague-Dawley® rats. Rats were randomly divided into four groups with eight rats in each group. Social stress regimen was performed in groups 3 and 4 for 15 days. Placebo for groups 1 and 3 and fluoxetine for groups 2 and 4 was administrated. Rat femur open (osteotomy) fracture model was performed. Placebo and fluoxetine were continued to be given to the same groups for four weeks until sacrification of animals. Sacrificed right femurs of subjects were evaluated histologically and radiologically. The obtained data were statistically analyzed using the SPSS 23 (Statistical Package for the Social Sciences) program. RESULTS Fracture healing score that evaluates the fracture healing quantitatively based on histological scale and bone mineral density of group 3 were significantly lower than other groups, and there was no significant difference between other groups. Inflammation score of group 2 was significantly lower than group 3. Group 1 had higher new callus formation/original cortex volume than group 2 and group 3. In immunohistochemical evaluation, the H-score of BMP-7/osteoblast in group 3 was lower than in group 1. The H-score of CD34 in group 3 was lower than in group 1. DISCUSSION The positive and negative effects of fluoxetine, which is used in the treatment of depressive disorders, on wound, tendon, or bone healing have been shown in the literature. In this study, we showed the negative effects of depression on the early stages of fracture healing. Although fluoxetine had no detrimental effect on fracture healing in non-depressive rats, impaired fracture healing was reversed and better radiological and histological findings were obtained in depressive rats treated with fluoxetine. Our findings indicate that fluoxetine, which minimizes the negative effects of social stress on bone healing, can be used safely in the treatment of depressive disorders in patients with fractures.
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Affiliation(s)
- Hakan Özbay
- Ağrı Training and Research Hospital, Orthopedics and Traumatology Department, Ağrı, Turkey; University of Health Science, Bağcılar Training and Research Hospital, Orthopedics and Traumatology Department, Istanbul, Turkey.
| | - Tolgahan Atçı
- University of Health Science, Bağcılar Training and Research Hospital, Orthopedics and Traumatology Department, Istanbul, Turkey; Sorgun State Hospital, Orthopedics and Traumatology Department, Yozgat, Turkey
| | - Oktay Adanır
- University of Health Science, Bağcılar Training and Research Hospital, Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Ender Alagöz
- University of Health Science, Bağcılar Training and Research Hospital, Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Tuğçe Çay
- University of Health Science, Bağcılar Training and Research Hospital, Orthopedics and Traumatology Department, Istanbul, Turkey
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Qin HC, Luo ZW, Chou HY, Zhu YL. New-onset depression after hip fracture surgery among older patients: Effects on associated clinical outcomes and what can we do? World J Psychiatry 2021; 11:1129-1146. [PMID: 34888179 PMCID: PMC8613761 DOI: 10.5498/wjp.v11.i11.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/25/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hip fracture in the elderly is a worldwide medical problem. New-onset depression after hip fracture has also received attention because of its increasing incidence and negative impact on recovery.
AIM To provide a synthesis of the literature addressing two very important questions arising from postoperative hip fracture depression (PHFD) research: the risk factors and associated clinical outcomes of PHFD, and the optimal options for intervention in PHFD.
METHODS We searched the PubMed, Web of Science, EMBASE, and PsycINFO databases for English papers published from 2000 to 2021.
RESULTS Our results showed that PHFD may result in poor clinical outcomes, such as poor physical function and more medical support. In addition, the risk factors for PHFD were summarized, which made it possible to assess patients preoperatively. Moreover, our work preliminarily suggested that comprehensive care may be the optimal treatment option for PHFDs, while interdisciplinary intervention can also be clinically useful.
CONCLUSION We suggest that clinicians should assess risk factors for PHFDs preoperatively, and future research should further validate current treatment methods in more countries and regions and explore more advanced solutions.
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Affiliation(s)
- Hao-Cheng Qin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Heng-Yi Chou
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu-Lian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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Milton-Cole R, Ayis S, Lambe K, O'Connell MDL, Sackley C, Sheehan KJ. Prognostic factors of depression and depressive symptoms after hip fracture surgery: systematic review. BMC Geriatr 2021; 21:537. [PMID: 34627160 PMCID: PMC8502369 DOI: 10.1186/s12877-021-02514-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patients with hip fracture and depression are less likely to recover functional ability. This review sought to identify prognostic factors of depression or depressive symptoms up to 1 year after hip fracture surgery in adults. This review also sought to describe proposed underlying mechanisms for their association with depression or depressive symptoms. Methods We searched for published (MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection) and unpublished (OpenGrey, Greynet, BASE, conference proceedings) studies. We did not impose any date, geographical, or language limitations. Screening (Covidence), extraction (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist), and quality appraisal (Quality in Prognosis Studies tool) were completed in duplicate. Results were summarised narratively. Results In total, 37 prognostic factors were identified from 12 studies included in this review. The quality of the underlying evidence was poor, with all studies at high risk of bias in at least one domain. Most factors did not have a proposed mechanism for the association. Where factors were investigated by more than one study, the evidence was often conflicting. Conclusion Due to conflicting and low quality of available evidence it is not possible to make clinical recommendations based on factors prognostic of depression or depressive symptoms after hip fracture. Further high-quality research investigating prognostic factors is warranted to inform future intervention and/or stratified approaches to care after hip fracture. Trial registration Prospero registration: CRD42019138690. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02514-1.
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Affiliation(s)
- R Milton-Cole
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK.
| | - S Ayis
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - K Lambe
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - M D L O'Connell
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - C Sackley
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK.,Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - K J Sheehan
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
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Barros MPD, Bachi ALL, Santos JDMBD, Lambertucci RH, Ishihara R, Polotow TG, Caldo-Silva A, Valente PA, Hogervorst E, Furtado GE. The poorly conducted orchestra of steroid hormones, oxidative stress and inflammation in frailty needs a maestro: Regular physical exercise. Exp Gerontol 2021; 155:111562. [PMID: 34560197 DOI: 10.1016/j.exger.2021.111562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022]
Abstract
This review outlines the various factors associated with unhealthy aging which includes becoming frail and dependent. With many people not engaging in recommended exercise, facilitators and barriers to engage with exercise must be investigated to promote exercise uptake and adherence over the lifespan for different demographics, including the old, less affluent, women, and those with different cultural-ethnic backgrounds. Governmental and locally funded public health messages and environmental facilitation (gyms, parks etc.) can play an important role. Studies have shown that exercise can act as a conductor to balance oxidative stress, immune and endocrine functions together to promote healthy aging and reduce the risk for age-related morbidities, such as cardiovascular disease and atherosclerosis, and promote cognition and mood over the lifespan. Like a classic symphony orchestra, consisting of four groups of related musical instruments - the woodwinds, brass, percussion, and strings - the aging process should also perform in harmony, with compassion, avoiding the aggrandizement of any of its individual parts during the presentation. This review discusses the wide variety of molecular, cellular and endocrine mechanisms (focusing on the steroid balance) underlying this process and their interrelationships.
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Affiliation(s)
- Marcelo Paes de Barros
- Institute of Physical Activity Sciences and Sports (ICAFE), MSc/PhD Interdisciplinary Program in Health Sciences, Cruzeiro do Sul University, 01506-000 São Paulo, Brazil.
| | - André Luís Lacerda Bachi
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04025-002, Brazil; Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, Brazil
| | | | | | - Rafael Ishihara
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Santos 11015-020, SP, Brazil
| | - Tatiana Geraldo Polotow
- Institute of Physical Activity Sciences and Sports (ICAFE), MSc/PhD Interdisciplinary Program in Health Sciences, Cruzeiro do Sul University, 01506-000 São Paulo, Brazil
| | - Adriana Caldo-Silva
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019) at Faculty of Sport Science and Physical Education, (FCDEF-UC), Portugal
| | - Pedro Afonso Valente
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019) at Faculty of Sport Science and Physical Education, (FCDEF-UC), Portugal
| | - Eef Hogervorst
- Applied Cognitive Research National Centre for Sports and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Guilherme Eustáquio Furtado
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Institute Polytechnic of Maia, Porto, Portugal; University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019) at Faculty of Sport Science and Physical Education, (FCDEF-UC), Portugal.
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12
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Zedda N, Bramanti B, Gualdi-Russo E, Ceraico E, Rinaldo N. The biological index of frailty: A new index for the assessment of frailty in human skeletal remains. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 176:459-473. [PMID: 34418072 DOI: 10.1002/ajpa.24394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Frailty is the physiological stress that individuals suffer during their life. In past populations, frailty is conventionally assessed through the occurrence of different biomarkers of biological stress. Some efforts have been made to propose indexes that combine all biomarkers. However, these indices have some critical limitations: they cannot be used on incomplete skeletons, do not consider the severity and/or healing of lesions, and assign equal importance to different biomarkers. To address these limitations, we propose a new index to assess frailty in skeletal individuals. MATERIAL AND METHODS By statistically analyzing a large amount of osteological data available from the Museum of London, and using a Logit model, we were able to define a different weight for each reported biomarker of frailty, based on their importance in increasing the risk of premature death for the individuals. RESULTS The biological index of frailty (BIF) is the weighted mean of all biomarkers scored on the individuals, according to a different degree of importance assigned to each one. It also considers the severity and healing of the biomarkers when this is relevant to diagnose frailty. We applied BIF on a sample of Monastics and Non-Monastics from medieval England and compared it with the skeletal index of frailty (SFI). DISCUSSION BIF is the first frailty index that gives a different weight to each skeletal biomarker of stress, considers both severity and healing of the lesions, and can be applied on partial skeletal remains. The comparison with SFI showed that BIF is applicable to a larger number of skeletal individuals, revealing new differences between the Monastic and the Non-Monastic groups.
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Affiliation(s)
- Nicoletta Zedda
- Department of Neurosciences and Rehabilitation, Faculty of Medicine, University of Ferrara, Ferrara, Italy
| | - Barbara Bramanti
- Department of Neurosciences and Rehabilitation, Faculty of Medicine, University of Ferrara, Ferrara, Italy
| | - Emanuela Gualdi-Russo
- Department of Neurosciences and Rehabilitation, Faculty of Medicine, University of Ferrara, Ferrara, Italy
| | - Elena Ceraico
- Department of Neurosciences and Rehabilitation, Faculty of Medicine, University of Ferrara, Ferrara, Italy
| | - Natascia Rinaldo
- Department of Neurosciences and Rehabilitation, Faculty of Medicine, University of Ferrara, Ferrara, Italy
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13
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Bentley C, Potter C, Yakoub KM, Brock K, Homer V, Toman E, Taylor AE, Shaheen F, Gilligan LC, Athwal A, Barton D, Carrera R, Young K, Desai A, McGee K, Ermogenous C, Sur G, Greig CA, Hazeldine J, Arlt W, Lord JM, Foster MA. A prospective, phase II, single-centre, cross-sectional, randomised study investigating Dehydroepiandrosterone supplementation and its Profile in Trauma: ADaPT. BMJ Open 2021; 11:e040823. [PMID: 34312190 PMCID: PMC8314713 DOI: 10.1136/bmjopen-2020-040823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/16/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The improvements in short-term outcome after severe trauma achieved through early resuscitation and acute care can be offset over the following weeks by an acute systemic inflammatory response with immuneparesis leading to infection, multiorgan dysfunction/multiorgan failure (MOF) and death. Serum levels of the androgen precursor dehydroepiandrosterone (DHEA) and its sulfate ester DHEAS, steroids with immune-enhancing activity, are low after traumatic injury at a time when patients are catabolic and immunosuppressed. Addressing this deficit and restoring the DHEA(S) ratio to cortisol may provide a range of physiological benefits, including immune modulatory effects. OBJECTIVE Our primary objective is to establish a dose suitable for DHEA supplementation in patients after acute trauma to raise circulating DHEA levels to at least 15 nmol/L. Secondary objectives are to assess if DHEA supplementation has any effect on neutrophil function, metabolic and cytokine profiles and which route of administration (oral vs sublingual) is more effective in restoring circulating levels of DHEA, DHEAS and downstream androgens. METHODS AND ANALYSIS A prospective, phase II, single-centre, cross-sectional, randomised study investigating Dehydroepiandrosterone supplementation and its profile in trauma, with a planned recruitment between April 2019 and July 2021, that will investigate DHEA supplementation and its effect on serum DHEA, DHEAS and downstream androgens in trauma. A maximum of 270 patients will receive sublingual or oral DHEA at 50, 100 or 200 mg daily over 3 days. Females aged ≥50 years with neck of femur fracture and male and female major trauma patients, aged 16-50 years with an injury severity score ≥16, will be recruited. ETHICS AND DISSEMINATION This protocol was approved by the West Midlands - Coventry and Warwickshire Research Ethics Committee (Reference 18/WM/0102) on 8 June 2018. Results will be disseminated via peer-reviewed publications and presented at national and international conferences. TRIAL REGISTRATION This trial is registered with the European Medicines Agency (EudraCT: 2016-004250-15) and ISRCTN (12961998). It has also been adopted on the National Institute of Health Research portfolio (CPMS ID:38158). TRIAL PROGRESSION The study recruited its first patient on 2 April 2019 and held its first data monitoring committee on 8 November 2019. DHEA dosing has increased to 100 mg in both male cohorts and remains on 50 mg in across all female groups.
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Affiliation(s)
- Conor Bentley
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Claire Potter
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- D3B, CRUK Clinical Trials Unit, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Kamal Makram Yakoub
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Kristian Brock
- D3B, CRUK Clinical Trials Unit, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Victoria Homer
- D3B, CRUK Clinical Trials Unit, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Emma Toman
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Angela E Taylor
- Institute of Metabolism and Systems Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Fozia Shaheen
- Institute of Metabolism and Systems Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Lorna C Gilligan
- Institute of Metabolism and Systems Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Amrita Athwal
- D3B, CRUK Clinical Trials Unit, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Darren Barton
- D3B, CRUK Clinical Trials Unit, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Ronald Carrera
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Katie Young
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Amisha Desai
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Kirsty McGee
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Christos Ermogenous
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Gurneet Sur
- D3B, CRUK Clinical Trials Unit, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- NIHR Birmingham Liver Biomedical Research Unit Clinical Trials Group (D3B team), CRUK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Carolyn A Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Birmingham, UK
| | - Jon Hazeldine
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- National Institute of Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Janet M Lord
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- National Institute of Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Mark A Foster
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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14
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Mangione KK, Posner MA, Craik RL, Wolff EF, Fortinsky RH, Beamer BA, Binder EF, Orwig DL, Magaziner J, Resnick B. Using Treatment Fidelity Measures to Understand Walking Recovery: A Secondary Analysis From the Community Ambulation Project. Phys Ther 2021; 101:6210027. [PMID: 33823028 PMCID: PMC8520021 DOI: 10.1093/ptj/pzab109] [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] [Received: 07/20/2020] [Revised: 12/30/2020] [Accepted: 02/24/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Physical therapist intervention studies can be deemed ineffective when, in fact, they may not have been delivered as intended. Measurement of treatment fidelity (TF) can address this issue. The purpose of this study was to describe TF of a home-based intervention, identify factors associated with TF, and examine whether components of TF were associated with the outcome of change in 6-minute walk distance (∆6MWD). METHODS This is a secondary analysis of community-dwelling hip fracture participants who completed standard therapy and were randomly assigned to the active intervention (Push). Push was 16 weeks of lower extremity strengthening, function, and endurance training. TF was defined as delivery (attendance rate, exercise duration) and receipt (progression in training load, heart rate reserve [HRR] during endurance training, and exercise position [exercise on floor]). The outcome was ∆6MWD. Independent variables included baseline (demographic and clinical) measures. Descriptive statistics were calculated; linear and logistic regressions were performed. RESULTS Eighty-nine participants were included in this analysis; 59 (66%) had attendance of 75% or greater. Participants walked for 20 minutes or more for 78% of sessions. The average training load increased by 22%; the mean HRR was 35%; and 61 (69%) participants exercised on the floor for at least 75% of sessions. Regression analyses showed that a higher body mass index and greater baseline 6MWD were related to components of TF; 4 out of 5 components of TF were significantly related to ∆6MWD. The strongest TF relationship showed that those who exercised on the floor improved by 62 m (95% CI = 31-93 m) more than those who did not get on the floor. CONCLUSIONS Measures of TF should extend beyond attendance rate. This analysis demonstrates how measures of TF, including program attendance, progression in training load, endurance duration, and exercising on the floor were significantly related to improvement in 6MWD in participants post hip fracture. IMPACT This careful analysis of treatment fidelity assured that the intervention was delivered and received as intended. Analysis of data from a large trial with participants after hip fracture showed that regular attendance, frequent endurance training for 20 minutes, increases in lower extremity training loads, and exercising on the floor were associated with improvements in the outcome of 6-minute-walk distance. The strongest association with improvement was exercising on the floor.
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Affiliation(s)
- Kathleen K Mangione
- Department of Physical Therapy, Arcadia University, 450 S Easton Rd, Glenside, Pennsylvania, USA,Address all correspondence to Dr Mangione at:
| | - Michael A Posner
- Department of Mathematics and Statistics, Villanova University, Villanova, Pennsylvania, USA
| | - Rebecca L Craik
- College of Health Science, Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Edward F Wolff
- Department of Computer Science and Mathematics, Arcadia University, Glenside, Pennsylvania, USA
| | - Richard H Fortinsky
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Brock A Beamer
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,Geriatric Research, Education, and Clinical Center at the Veterans Affairs Maryland Health Care System, Baltimore, Maryland, USA
| | - Ellen F Binder
- Division of Geriatrics and Nutritional Science, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Denise L Orwig
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jay Magaziner
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
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15
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Hay D, Jamal MS, Al-Tawil K, Petohazi A, Gulli V, Bednarczuk NF, Baldwin-Smith R, Gibbons J, Sinha J. The effect of the COVID-19 pandemic on mental health associated trauma, admissions and fractures at a London major trauma centre. Ann R Coll Surg Engl 2021; 103:114-119. [PMID: 33559558 PMCID: PMC9773921 DOI: 10.1308/rcsann.2020.7026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.
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Affiliation(s)
- D Hay
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - MS Jamal
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - K Al-Tawil
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - A Petohazi
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - V Gulli
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - NF Bednarczuk
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - R Baldwin-Smith
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - J Gibbons
- GKT School of Medical Education, Kings College London, London, UK
| | - J Sinha
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
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16
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Heidari ME, Naghibi Irvani SS, Dalvand P, Khadem M, Eskandari F, Torabi F, Shahsavari H. Prevalence of depression in older people with hip fracture: A systematic review and meta-analysis. Int J Orthop Trauma Nurs 2020; 40:100813. [PMID: 33317987 DOI: 10.1016/j.ijotn.2020.100813] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hip fracture disrupts general health and is one of the most common physical injuries in the elderly. Depression is the most common mood disorder in older people and one of the main complications of hip fractures. AIM AND METHODS We conducted a meta-analysis to estimate the prevalence of depression in older people with hip fractures. Relevant literature published until July 2019 was obtained and screened according to established inclusion criteria. Two researchers independently carried out quality assessment and data extraction before the meta-analysis. We calculated proportions with 95% confidence intervals (CI). To investigate the sources of heterogeneity, we performed subgroup analyses based on study design, follow-up duration, type of fracture, and gender. RESULTS Twenty-seven studies with a combined sample size of 11958 were included. The overall prevalence of depression in older people with hip fracture was 23% (95% CI: 0.18 to 0.29). The lowest and highest prevalence of depression was in Asia (0.19) and America (0.27) respectively. CONCLUSION In this systematic review and meta-analysis the estimated prevalence of depression among older hip fracture patients was 23%. Further research is needed to identify strategies for preventing and treating mood disorders in this population.
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Affiliation(s)
- Mohammad Eghbal Heidari
- Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, School of Nursing Midwifery, Tehran University of Medical Sciences, Nosrat St, Tohid Sq, Tehran, Iran
| | - Seyed Sina Naghibi Irvani
- Shahid Beheshti University of Medical Sciences, Research Institute for Endocrine Science, Tehran, Iran.
| | - Pegah Dalvand
- Department of Mathematics, Shahrood University of Technology, Shahrood, Iran
| | - Mohaddeseh Khadem
- Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, School of Nursing Midwifery, Tehran University of Medical Sciences, Nosrat St, Tohid Sq, Tehran, Iran
| | - Fereshte Eskandari
- Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, School of Nursing Midwifery, Tehran University of Medical Sciences, Nosrat St, Tohid Sq, Tehran, Iran
| | - Fatemeh Torabi
- Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, School of Nursing Midwifery, Tehran University of Medical Sciences, Nosrat St, Tohid Sq, Tehran, Iran
| | - Hooman Shahsavari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, School of Nursing Midwifery, Tehran University of Medical Sciences, Nosrat St, Tohid Sq, Tehran, Iran
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17
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Southwell J, Potter C, Wyatt D, Sadler E, Sheehan KJ. Older adults' perceptions of early rehabilitation and recovery after hip fracture surgery: a UK qualitative study. Disabil Rehabil 2020; 44:940-947. [PMID: 32609547 DOI: 10.1080/09638288.2020.1783002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose: To explore older adult's perceptions of early rehabilitation and recovery after hip fracture, as a complement to the UK standards for acute physiotherapy after hip fracture.Methods: In-depth semi-structured interviews with 15 adults aged 60 years or more in hospital after hip fracture surgery. A thematic analysis approach with interpretation informed by Bury's biographical disruption theoretical framework.Results: Participants voiced the importance of self-determination, professional support, meaningful feedback, and social capital after hip fracture. Collaborative working with staff was required for meeting the UK standards. Participants voiced anxieties about their hip fracture when considered in conjunction with their age and co-existing conditions, anticipating a disruption to their previous physical and social activities. This new, more dependent, life situation was not acceptable to participants.Conclusions: This study suggests hip fracture alone, was not perceived as a biographical disruption by older adults although it is presented as a potential tipping point in the loss of independence, contributing to the wider disruption of advancing age and co-existing conditions. For successful implementation of the UK standards, goal setting should consider patients in the wider context of their advancing age and co-existing conditions to empower them to define a fresh narrative of self.Implications for rehabilitationHip fracture was perceived as a potential tipping point in the loss of independence, contributing to the wider disruption of advancing age and co-existing conditions.Participants expressed uncertainty over their ability to recover their previous identity in the absence of professional support and/or social capital.Healthcare professionals need to educate and empower older adults to take charge of their own recovery.For successful implementation of the UK standards for acute physiotherapy, there is a need to contextualize goal setting to empower patients to define a fresh narrative of self.
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Affiliation(s)
- Jessica Southwell
- School of Population Health and Environmental Sciences, Kings College London, London, UK
| | - Chris Potter
- Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - David Wyatt
- School of Population Health and Environmental Sciences, Kings College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Euan Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Katie Jane Sheehan
- School of Population Health and Environmental Sciences, Kings College London, London, UK
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18
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Hlaing WY, Thosingha O, Chanruangvanich W. Health-related quality of life and its determinants among patients with hip fracture after surgery in Myanmar. Int J Orthop Trauma Nurs 2020; 37:100752. [PMID: 32029362 DOI: 10.1016/j.ijotn.2020.100752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hip fracture has been regarded as a significant international health problem because of its negative impacts on things such as Health-Related Quality of Life (HRQOL). The determinants of HRQOL among patients with hip fracture after surgery during transition of recovery are still not clearly understood. OBJECTIVE To study HRQOL factors and determine the predictive power of elements such as age, gender, co-morbid disease, Body Mass Index (BMI), depression or social support on HRQOL among patients with hip fracture after surgery in Myanmar. DESIGN Descriptive correlational predictive study. SETTING Yangon Orthopaedic Hospital and Mandalay Orthopaedic Hospital in Myanmar. RESULTS The mean age was 60 years (range = 18-91). The level of HRQOL at the 6th week after surgery was moderate. In stepwise multiple regression analysis, gender (β = -.109, p = .044), depressive symptoms (β = -.564, p = .000) and social support (β = .287, p = .000) were the determinants of HRQOL. These three factors accounted for 59.1% of variance to explain HRQOL. CONCLUSION In order to facilitate a healthy transition, comprehensive rehabilitation, including depressive symptoms screening and enhancing social support, and the health care services with less cost and psychosocial support especially for women, are recommended.
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Affiliation(s)
- Win Yadanar Hlaing
- Master of Nursing Science (International Program, Adult Health Nursing), Faculty of Nursing, Mahidol University, 2 Wang Lang Road, Bangkok, 10700, Thailand.
| | - Orapan Thosingha
- Acting Associate Dean for Research Innovation and International Affair, Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
| | - Wallada Chanruangvanich
- Surgical Nursing Department, Faculty of Nursing, Mahidol University, 2 Wang Lang Road, Bangkok, 10700, Thailand.
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19
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Modarresi S, Suh N, Walton DM, MacDermid JC. Depression affects the recovery trajectories of patients with distal radius fractures: A latent growth curve analysis. Musculoskelet Sci Pract 2019; 43:96-102. [PMID: 31374477 DOI: 10.1016/j.msksp.2019.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distal radius fractures (DRFs) are common and can lead to substantial pain and disability. Most people recover in six months, but some experience persistent pain and disability for one year or longer after injury. Therefore, it is important to understand the factors that can help predict poor recovery. OBJECTIVE To identify recovery trajectories in DRF patients and to determine the factors that can help predict poor recovery. METHODS Recovery was assessed in 318 patients using the Patient-Rated Wrist Evaluation scale at baseline, three, six, and 12 months. Demographic information was collected in addition to the Self-Administered Comorbidity Questionnaire, from which data regarding depression were extracted. Latent growth curve analysis (LGCA) was used to identify the recovery trajectories. Comparisons of proportion between the emergent classes were then conducted using chi-square and Kruskal-Wallis tests. RESULTS The LGCA revealed three distinct trajectories (rapid-recovery: (69%), slow-recovery: (23%), and non-recovery: (8%) as the best fit to the data. The proportion of people with depression was significantly greater in the non-recovery class (24%) compared to the slow (16%, p = 0.04) and rapid-recovery (8%, p = 0.03) classes. Additionally, the proportion of females were significantly lower in the non-recovery (64%, p = 0.03) compared to the slow (85%, p = 0.03) and the rapid-recovery classes (81%, p = 0.048). CONCLUSION Recovery from DRF was best described using three different trajectories. Greater self-reported depression and a lower proportion of females in the non-recovery class were distinguishing factors between the classes. Patients who appear to be in slow-recovery or non-recovery classes may be followed more closely.
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Affiliation(s)
- Shirin Modarresi
- Health & Rehabilitation Science, Western University, London, ON, Canada.
| | - Nina Suh
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Orthopedic Surgery, Western University, London, ON, Canada
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - Joy C MacDermid
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Orthopedic Surgery, Western University, London, ON, Canada; School of Physical Therapy, Western University, London, ON, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
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20
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Chang HY, Fang HL, Ting TT, Liang J, Chuang SY, Hsu CC, Wu CY, Pan WH. The Co-Occurrence Of Frailty (Accumulation Of Functional Deficits) And Depressive Symptoms, And Its Effect On Mortality In Older Adults: A Longitudinal Study. Clin Interv Aging 2019; 14:1671-1680. [PMID: 31631988 PMCID: PMC6775497 DOI: 10.2147/cia.s210072] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose The co-occurrence of frailty and depression in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality have rarely been investigated. We aimed to examine the co-occurrence of frailty and depressive symptoms in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality using all the information from a longitudinal study. Patients and methods We used the Taiwan Longitudinal Study of Aging (TLSA) for this study. TLSA was initiated in 1989 and followed periodically. We included participants from 1989 to 2007, who had data on frailty and depressive symptoms. Frailty was assessed by accumulation of functional deficits in 6 dimensions including disease status, sensory dysfunction, balance, functional limitations, health risk behaviors, and life satisfaction. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). A multistate model with interval censoring was used to examine the transition between states of frailty with or without depressive symptoms, and finally to death. A mixed model was used to examine the relationships between frailty and depressive symptoms. Results The coexistence of frailty and depressive symptoms was associated with higher mortality. Individuals with depressive symptom had a lower probability of reversal to a better state. Previous depression score predicted current frailty, but the coefficient was smaller than that of previous frailty. Previous frailty predicted current depression score, and the coefficient was stronger than that of previous depression. Conclusion Depressive symptoms increased the mortality and decreased the probability of reversal in the frail older adults.
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Affiliation(s)
- Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Ling Fang
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan
| | - Te-Tien Ting
- School of Big Data Management, Soochow University, Taipei, Taiwan
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan
| | - Chin-Yin Wu
- Institute of Sociology, Academia Sinica, Taipei, Taiwan
| | - Wen-Harn Pan
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
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21
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Bentley C, Hazeldine J, Greig C, Lord J, Foster M. Dehydroepiandrosterone: a potential therapeutic agent in the treatment and rehabilitation of the traumatically injured patient. BURNS & TRAUMA 2019; 7:26. [PMID: 31388512 PMCID: PMC6676517 DOI: 10.1186/s41038-019-0158-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/03/2019] [Indexed: 02/07/2023]
Abstract
Severe injuries are the major cause of death in those aged under 40, mainly due to road traffic collisions. Endocrine, metabolic and immune pathways respond to limit the tissue damage sustained and initiate wound healing, repair and regeneration mechanisms. However, depending on age and sex, the response to injury and patient prognosis differ significantly. Glucocorticoids are catabolic and immunosuppressive and are produced as part of the stress response to injury leading to an intra-adrenal shift in steroid biosynthesis at the expense of the anabolic and immune enhancing steroid hormone dehydroepiandrosterone (DHEA) and its sulphated metabolite dehydroepiandrosterone sulphate (DHEAS). The balance of these steroids after injury appears to influence outcomes in injured humans, with high cortisol: DHEAS ratio associated with increased morbidity and mortality. Animal models of trauma, sepsis, wound healing, neuroprotection and burns have all shown a reduction in pro-inflammatory cytokines, improved survival and increased resistance to pathological challenges with DHEA supplementation. Human supplementation studies, which have focused on post-menopausal females, older adults, or adrenal insufficiency have shown that restoring the cortisol: DHEAS ratio improves wound healing, mood, bone remodelling and psychological well-being. Currently, there are no DHEA or DHEAS supplementation studies in trauma patients, but we review here the evidence for this potential therapeutic agent in the treatment and rehabilitation of the severely injured patient.
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Affiliation(s)
- Conor Bentley
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham, Birmingham, B15 2WB UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, Birmingham University Medical School, Birmingham, B15 2TT UK
| | - Jon Hazeldine
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham, Birmingham, B15 2WB UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, Birmingham University Medical School, Birmingham, B15 2TT UK
| | - Carolyn Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, University Hospital Birmingham, Birmingham, UK
| | - Janet Lord
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham, Birmingham, B15 2WB UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, Birmingham University Medical School, Birmingham, B15 2TT UK
- NIHR Biomedical Research Centre, University Hospital Birmingham, Birmingham, UK
| | - Mark Foster
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham, Birmingham, B15 2WB UK
- Royal Centre for Defence Medicine, Birmingham Research Park, Birmingham, B15 2SQ UK
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22
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Simske NM, Audet MA, Kim CY, Benedick A, Vallier HA. Mental illness is associated with more pain and worse functional outcomes after ankle fracture. OTA Int 2019; 2:e037. [PMID: 37662834 PMCID: PMC10473302 DOI: 10.1097/oi9.0000000000000037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/26/2019] [Indexed: 09/05/2023]
Abstract
Objectives To assess clinical and functional outcomes after ankle fracture in patients with preexisting mental illness. Design Retrospective study. Setting Level 1 trauma center. Patients/Participants One thousand three hundred seventy-eight adult patients treated for ankle fractures; 228 (17%) had preexisting mental illness. Intervention Open reduction internal fixation. Main outcome measure Rates of complications and reoperations. Functional outcomes were assessed via Foot Function Index (n = 530) and Short Musculoskeletal Function Assessment (n = 530). Results Depression was the most common mental illness (63%), followed by anxiety (23%). Mental illness was associated with older age, female sex, and preexisting medical comorbidities, including diabetes and obesity. Mental illness was not associated with specific fracture patterns or open injury. Complications occurred no more often in patients with mental illness, but secondary operations (13% vs 7%) were more likely, particularly implant removals (8% vs 4%), both P < .05. Functional outcomes were worse in mentally ill patients as measured by the Foot Function Index (39 vs 30, P = .006) and Short Musculoskeletal Function Assessment Mobility: 45 vs 35, Bothersome: 35 vs 26 and Dysfunction: 35 vs 26, all P < .01. Conclusion Secondary operations were nearly 50% more frequent in patients with mental illness, and functional outcome scores were significantly worse, suggesting that mental illness, unrelated to injury and treatment parameters, has major influence on outcomes. In the future, strategies to identify and treat mental illness prior to and after treatment could improve functional outcomes following ankle fracture.
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Affiliation(s)
- Natasha M Simske
- MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, Ohio
| | - Megan A Audet
- MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, Ohio
| | - Chang-Yeon Kim
- MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, Ohio
| | - Alex Benedick
- MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, Ohio
| | - Heather A Vallier
- MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, Ohio
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Kang YM, Chao TF, Wang TH, Hu YW. Increased risk of pelvic fracture after radiotherapy in rectal cancer survivors: A propensity matched study. Cancer Med 2019; 8:3639-3647. [PMID: 31104362 PMCID: PMC6639197 DOI: 10.1002/cam4.2030] [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: 11/04/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 12/12/2022] Open
Abstract
To determine whether radiotherapy (RT) can increase pelvic fracture risk in rectal cancer survivors. Rectal cancer patients who underwent curative surgery between 1996 and 2011 in Taiwan were retrospectively studied using the National Health Insurance Research Database (NHIRD) of Taiwan. ICD‐9 Codes 808, 805.4‐805.7, 806.4‐806.7, and 820 (including pelvic, sacrum, lumbar, and femoral neck fracture) were defined as pelvic fracture. Propensity scores for RT, age, and sex were used to perform one‐to‐one matches between the RT and non‐RT group. Risks of pelvic and arm fractures were compared by multivariable Cox regression. Of the 32 689 patients, 7807 (23.9%) received RT, and 1616 suffered from a pelvic fracture (incidence rate: 1.17/100 person‐years). The median time to pelvic fracture was 2.47 years. After matching, 6952 patients each in the RT and non‐RT groups were analyzed. RT was associated with an increased risk of pelvic fractures in the multivariable Cox model (hazard ratio (HR): 1.246, 95% confidence interval (CI): 1.037‐1.495, P = 0.019) but not with arm fractures (HR: 1.013, 95% CI: 0.814‐1.259, P = 0.911). Subgroup analyses revealed that RT was associated with a higher pelvic fracture rate in women (HR: 1.431, 95% CI: 1.117‐1.834) but not in men, and the interaction between sex and RT was significant (P = 0.03). The HR of pelvic fracture increased 2‐4 years after RT (HR: 1.707, 95% CI: 1.150‐2.534, P = 0.008). An increased risk of pelvic fracture is noted in rectal cancer survivors, especially women, who receive RT.
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Affiliation(s)
- Yu-Mei Kang
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ti-Hao Wang
- Department of Radiation Oncology, China Medical University Hospital, Taipei, Taiwan
| | - Yu-Wen Hu
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Clinical practice and nursing management of pre-operative skin or skeletal traction for hip fractures in elderly patients: a cross-sectional three-institution study. Int J Orthop Trauma Nurs 2018; 32:32-40. [PMID: 30385307 DOI: 10.1016/j.ijotn.2018.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/25/2018] [Accepted: 10/08/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Femoral fractures are a major healthcare problem worldwide. One of the most difficult issues is their preoperative care, which is still managed by either skeletal or skin traction in some countries, including Italy. These issues are discussed and compared with the contemporary literature. OBJECTIVE This study aims to analyse the distribution of these treatment options within the orthopaedic community and the reasons for their use, as well as to identify how this may impact nursing care in terms of pain management, hygiene care, venous thromboembolism (VTE)prophylaxis and prevention of pressure ulcers. DESIGN For this cross-sectional study, a 12-item survey was administered to the nursing staff, consultants and residents of the Orthopaedic Units in three different hospitals in NorthEastern Italy. The questionnaire investigated the routine use of skeletal or skin traction for the preoperative management of hip fractures in those settings. FINDINGS 136 surveys were completed, providing a response rate of 87.74%. Preoperative traction for hip fractures was still in use in the three hospitals, mainly applied by experienced surgeons for subtrochanteric fractures. Pain management, VTE and pressure ulcer prevention were perceived as worse only with skeletal traction, while hygiene was described as more difficult with both skeletal and skin traction. CONCLUSIONS AND RECOMMENDATIONS Based on the data and the literature revision, skin or skeletal traction for patients with proximal femoral fractures should be discouraged as standard practice. This is supported widely in the international literature, and consideration of knowledge translation strategies should be made to refine current practice in these settings.
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25
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Edelmuth SVCL, Sorio GN, Sprovieri FAA, Gali JC, Peron SF. Comorbidades, intercorrências clínicas e fatores associados à mortalidade em pacientes idosos internados por fratura de quadril. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Comorbidities, clinical intercurrences, and factors associated with mortality in elderly patients admitted for a hip fracture. Rev Bras Ortop 2018; 53:543-551. [PMID: 30245992 PMCID: PMC6148078 DOI: 10.1016/j.rboe.2018.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To analyze comorbidities and clinical complications, and to determine the factors associated with mortality rates of elderly patients admitted with a hip fracture in a tertiary public hospital. Methods Sixty-seven medical records were reviewed in a retrospective cohort study, including patients equal to or older than 65 years admitted to this institution for hip fracture between January 2014 and December 2014. The evaluated items constituted were the following: interval of time between fracture and hospital admission, time between admission and surgical procedure, comorbidities, clinical complications, type of orthopedic procedure, surgical risk, cardiac risk, and patient outcome. Results The average patients’ age in the sample was 77.6 years, with a predominance of the female gender. Most patients (50.7%) had two or more comorbidities. The main clinical complications during hospitalization included cognitive behavioral disorders, respiratory infection and of the urinary tract. The times between fracture and admission and between admission and surgery were more than seven days in most of cases. The mortality rate during hospitalization was 11.9%, and was directly connected to the presence of infections during hospital stay (p = 0.006), to time between admission and surgery longer than seven days (p = 0.005), to the Goldman Cardiac Risk Index class III (p = 0.008), and to age equal to or greater than 85 years (p = 0.031). Conclusion Patients with hip fractures generally present comorbidities, are susceptible to clinical complications, and have an 11.9% mortality rate.
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27
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Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J, Armstrong JJ, Rockwood K. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr 2018; 18:139. [PMID: 29898673 PMCID: PMC6000922 DOI: 10.1186/s12877-018-0823-2] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background The ability of acute care providers to cope with the influx of frail older patients is increasingly stressed, and changes need to be made to improve care provided to older adults. Our purpose was to conduct a scoping review to map and synthesize the literature addressing frailty in the acute care setting in order to understand how to tackle this challenge. We also aimed to highlight the current gaps in frailty research. Methods This scoping review included original research articles with acutely-ill Emergency Medical Services (EMS) or hospitalized older patients who were identified as frail by the authors. We searched Medline, CINAHL, Embase, PsycINFO, Eric, and Cochrane from January 2000 to September 2015. Results Our database search initially resulted in 8658 articles and 617 were eligible. In 67% of the articles the authors identified their participants as frail but did not report on how they measured frailty. Among the 204 articles that did measure frailty, the most common disciplines were geriatrics (14%), emergency department (14%), and general medicine (11%). In total, 89 measures were used. This included 13 established tools, used in 51% of the articles, and 35 non-frailty tools, used in 24% of the articles. The most commonly used tools were the Clinical Frailty Scale, the Frailty Index, and the Frailty Phenotype (12% each). Most often (44%) researchers used frailty tools to predict adverse health outcomes. In 74% of the cases frailty predicted the outcome examined, typically mortality and length of stay. Conclusions Most studies (83%) were conducted in non-geriatric disciplines and two thirds of the articles identified participants as frail without measuring frailty. There was great variability in tools used and more recently published studies were more likely to use established frailty tools. Overall, frailty appears to be a good predictor of adverse health outcomes. For frailty to be implemented in clinical practice frailty tools should help formulate the care plan and improve shared decision making. How this will happen has yet to be determined. Electronic supplementary material The online version of this article (10.1186/s12877-018-0823-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olga Theou
- Department of Medicine, Dalhousie University, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada. .,Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.
| | - Emma Squires
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Kayla Mallery
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Jacques S Lee
- Sunnybrook Health Service, 2075 Bayview Avenue, BG-04, Toronto, ON, M4N 3M5, Canada
| | - Sherri Fay
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Judah Goldstein
- Emergency Health Services, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, B3B 2B2, Canada
| | - Joshua J Armstrong
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B 5E1, Canada
| | - Kenneth Rockwood
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.,Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
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28
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Impact of stress on aged immune system compartments: Overview from fundamental to clinical data. Exp Gerontol 2018; 105:19-26. [DOI: 10.1016/j.exger.2018.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 12/12/2022]
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Scott JE, Mathias JL, Kneebone AC. Depression and anxiety after total joint replacement among older adults: a meta-analysis. Aging Ment Health 2016; 20:1243-1254. [PMID: 26252414 DOI: 10.1080/13607863.2015.1072801] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Patients usually experience good physical recovery after total joint replacement (TJR); however, it is unclear whether mood also improves. The current meta-analysis examined changes in depression and anxiety following TJR in older (≥50 years) patients in order to address this gap in the literature. METHODS Data from 26 studies (4045 TJR, 55 controls) that assessed depression and/or anxiety pre- and post-surgery in TJR patients, with or without a control group, were analyzed. Prevalence rates and Cohen's d effect sizes were used to evaluate changes in the prevalence and severity of depression/anxiety, respectively. RESULTS Approximately 23% of TJR patients had clinically significant levels of depression prior to surgery, which decreased to 13% one year later. The prevalence of anxiety could not be evaluated due to the limited available data. TJR patients did not show any clinically meaningful reductions in symptoms of depression or anxiety, following surgery. Compared to controls, there was no difference in symptom progression over time; although only one study examined this. CONCLUSIONS TJR patients appear to have higher rates of clinically significant symptoms of depression before and after surgery, compared to the general population, however more research with adequate control groups is needed to confirm this. Only a modest improvement in the severity of depression and anxiety symptoms was noted post-surgery. However, existing research is limited; preventing definite conclusions regarding the impact of TJR on mood.
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Affiliation(s)
- J E Scott
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - J L Mathias
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - A C Kneebone
- a School of Psychology , University of Adelaide , Adelaide , Australia.,b Department of Clinical Psychology , Flinders Medical Centre , Bedford Park , Australia
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Tarazona-Santabalbina FJ, Belenguer-Varea Á, Rovira E, Cuesta-Peredó D. Orthogeriatric care: improving patient outcomes. Clin Interv Aging 2016; 11:843-56. [PMID: 27445466 PMCID: PMC4928624 DOI: 10.2147/cia.s72436] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard.
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Affiliation(s)
- Francisco José Tarazona-Santabalbina
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - Ángel Belenguer-Varea
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - Eduardo Rovira
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - David Cuesta-Peredó
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
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Lees H, Walters H, Cox LS. Animal and human models to understand ageing. Maturitas 2016; 93:18-27. [PMID: 27372369 DOI: 10.1016/j.maturitas.2016.06.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 12/12/2022]
Abstract
Human ageing is the gradual decline in organ and tissue function with increasing chronological time, leading eventually to loss of function and death. To study the processes involved over research-relevant timescales requires the use of accessible model systems that share significant similarities with humans. In this review, we assess the usefulness of various models, including unicellular yeasts, invertebrate worms and flies, mice and primates including humans, and highlight the benefits and possible drawbacks of each model system in its ability to illuminate human ageing mechanisms. We describe the strong evolutionary conservation of molecular pathways that govern cell responses to extracellular and intracellular signals and which are strongly implicated in ageing. Such pathways centre around insulin-like growth factor signalling and integration of stress and nutritional signals through mTOR kinase. The process of cellular senescence is evaluated as a possible underlying cause for many of the frailties and diseases of human ageing. Also considered is ageing arising from systemic changes that cannot be modelled in lower organisms and instead require studies either in small mammals or in primates. We also touch briefly on novel therapeutic options arising from a better understanding of the biology of ageing.
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Affiliation(s)
- Hayley Lees
- Department of Biochemistry, University of Oxford, South Parks Road, Oxford, OX1 3QU, UK
| | - Hannah Walters
- Department of Biochemistry, University of Oxford, South Parks Road, Oxford, OX1 3QU, UK
| | - Lynne S Cox
- Department of Biochemistry, University of Oxford, South Parks Road, Oxford, OX1 3QU, UK.
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Atay İM, Aslan A, Burç H, Demirci D, Atay T. Is depression associated with functional recovery after hip fracture in the elderly? J Orthop 2016; 13:115-8. [PMID: 27053834 PMCID: PMC4805860 DOI: 10.1016/j.jor.2015.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 02/01/2015] [Indexed: 12/01/2022] Open
Abstract
AIM The aim of this study was to examine the effects of depression on functional healing and the return to pre-fracture daily activities in elderly patients with a hip fracture. METHODS The study comprised 104 elderly patients, who had a unilateral hip fracture between 2009 and 2012. To evaluate daily activities and functional healing of the cases, the study was designed as a prospective comparative study. RESULTS The analysis results revealed that the change in the mean ADL scores was related to depression at a statistically significant level (p = 0.000). DISCUSSION This study results showed that depression had a negative effect on the daily activity level of these cases.
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Affiliation(s)
- İnci Meltem Atay
- Suleyman Demirel University, Medical School, Department of Psychiatry, 32260 Cünür, Isparta, Turkey
| | - Ahmet Aslan
- Afyonkarahisar State Hospital, Department of Orthopaedics and Traumatology, 03100 Uydukent, Afyonkarahisar, Turkey
| | - Halil Burç
- Suleyman Demirel University, Medical School, Department of Orthopaedics and Traumatology, 32260 Cünür, Isparta, Turkey
| | - Demir Demirci
- Isparta State Hospital, Department of Orthopaedics and Traumatology, 32100 Merkez, Isparta, Turkey
| | - Tolga Atay
- Suleyman Demirel University, Medical School, Department of Orthopaedics and Traumatology, 32260 Cünür, Isparta, Turkey
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Depression and Reduced Bone Mineral Density at the Hip and Lumbar Spine: A Comparative Meta-Analysis of Studies in Adults 60 Years and Older. Psychosom Med 2016; 78:492-500. [PMID: 26716814 DOI: 10.1097/psy.0000000000000292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Older adults with depression are more likely to experience fractures, but it is unclear if this group has reduced bone mineral density (BMD). We conducted a systematic review and meta-analysis to compare BMD in older adults (60 years or older) with or without depression. METHODS Two independent authors conducted searches of major electronic databases from inception till April 2015. Articles that measured BMD (in g/cm) by dual-energy x-ray absorptiometry at the hip or lumbar spine in a sample with depression (including those with major depressive disorder and depressive symptoms, henceforth called "depression") and a control group were included. A random-effects meta-analysis and meta-regression were conducted. RESULTS Eleven publications across 10 unique studies representing 2511 participants with depression (mean [standard deviation] = 67.4 [6.5] years, 41.8% female) and 32,574 matched controls (mean [standard deviation] = 67.5 [5.9] years, 38.9% female) were included. Only one study confirmed a diagnosis of major depressive disorder, seven studies used a screening measure to define depressive symptoms, and two studies categorized depression by antidepressant medication use. Meta-analysis established that BMD is reduced at the hip in older adults with depression (g = -0.141, 95% confidence interval = -0.220 to -0.062, p < .0001, I = 61%). Meta-analysis from seven studies suggests that lumbar spine BMD may be reduced (g = -0.122, 95% confidence interval = -0.250 to 0.005, p = .06, I = 71%). CONCLUSIONS Hip BMD is reduced in older adults with depression, although the effect size is small. Nevertheless, considering the deleterious impact of hip fractures in this population, the results are important. Future research should seek to disentangle the independent effects of depression and antidepressant medication on bone loss in older age.
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Unmet needs and current and future approaches for osteoporotic patients at high risk of hip fracture. Arch Osteoporos 2016; 11:37. [PMID: 27800591 PMCID: PMC5306171 DOI: 10.1007/s11657-016-0292-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/25/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED This review provides a critical analysis of currently available approaches to increase bone mass, structure and strength through drug therapy and of possible direct intra-osseous interventions for the management of patients at imminent risk of hip fracture. PURPOSE Osteoporotic hip fractures represent a particularly high burden in morbidity-, mortality- and health care-related costs. There are challenges and unmet needs in the early prevention of hip fractures, opening the perspective of new developments for the management of osteoporotic patients at imminent and/or at very high risk of hip fracture. Amongst them, preventive surgical intervention needs to be considered. METHODS A European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)/International Osteoporosis Foundation (IOF) working group reviewed the presently available intervention modalities including preventive surgical options for hip fragility. This paper represents a summary of the discussions. RESULTS Prevention of hip fracture is currently based on regular physical activity; prevention of falls; correction of nutritional deficiencies, including vitamin D repletion; and pharmacological intervention. However, efficacy of these various measures to reduce hip fractures is at most 50% and may need months or years before becoming effective. To face the challenges of early prevention of hip fractures for osteoporotic patients at imminent and/or at very high risk of hip fracture, preventive surgical intervention needs further investigation. CONCLUSION Preventive surgical intervention needs to be appraised for osteoporotic patients at imminent and/or at very high risk of hip fracture.
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Abstract
Frailty and depression are important issues affecting older adults. Depressive syndrome may be difficult to clinically disambiguate from frailty in advanced old age. Current reviews on the topic include studies with wide methodological variation. This review examined the published literature on cross-sectional and longitudinal associations between frailty and depressive symptomatology with either syndrome as the outcome, moderators of this relationship, construct overlap, and related medical and behavioral interventions. Prevalence of both was reported. A systematic review of studies published from 2000 to 2015 was conducted in PubMed, the Cochrane Database of Systematic Reviews, and PsychInfo. Key search terms were "frailty", "frail", "frail elderly", "depressive", "depressive disorder", and "depression". Participants of included studies were ≥ 55 years old and community dwelling. Included studies used an explicit biological definition of frailty based on Fried et al's criteria and a screening measure to identify depressive symptomatology. Fourteen studies met the inclusion/exclusion criteria. The prevalence of depressive symptomatology, frailty, or their co-occurrence was greater than 10% in older adults ≥ 55 years old, and these rates varied widely, but less in large epidemiological studies of incident frailty. The prospective relationship between depressive symptomatology and increased risk of incident frailty was robust, while the opposite relationship was less conclusive. The presence of comorbidities that interact with depressive symptomatology increased incident frailty risk. Measurement variability of depressive symptomatology and inclusion of older adults who are severely depressed, have cognitive impairment or dementia, or stroke may confound the frailty syndrome with single disease outcomes, accounting for a substantial proportion of shared variance in the syndromes. Further study is needed to identify medical and behavioral interventions for frailty and depressive symptomatology that prevent adverse sequelae such as falls, disability, and premature mortality.
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Affiliation(s)
- Leslie Vaughan
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Akeesha L Corbin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph S Goveas
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, MI, USA
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Duggal NA, Upton J, Phillips AC, Lord JM. Development of depressive symptoms post hip fracture is associated with altered immunosuppressive phenotype in regulatory T and B lymphocytes. Biogerontology 2015; 17:229-39. [PMID: 26112234 PMCID: PMC4723613 DOI: 10.1007/s10522-015-9587-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/13/2015] [Indexed: 12/18/2022]
Abstract
Hip fracture is a common physical trauma in older adults that is also associated with a high incidence of new onset depression. The immune system declines with age and is also compromised by physical and psychological stress. This study examined whether hip fracture and depressive symptoms had additive effects upon the aged immune system that might contribute to poor health outcomes after hip fracture. We assessed the frequency of regulatory T cells, Tregs (CD4+ CD25+ Foxp3+) and IL10 production by CD4 T cells, and the frequency and IL10 production by regulatory B cells, Bregs (CD19+ CD24hi CD38hi) in 101 hip fracture patients (81 female) 6 weeks after injury and 43 healthy age-matched controls (28 female). 38 hip fracture patients (37 %) developed depressive symptoms. Hip fracture did not have an effect on circulating Tregs frequency but a significant reduction in the frequency of Bregs was observed in patients who developed depression compared with non-depressed patients (p = 0.001) or healthy controls (p < 0.001). Bregs also showed a significant decline in IL10 production in depressed hip fracture patients compared with controls (p = 0.04) and non-depressed patients (p = 0.01). In contrast, there was an increase in IL10 production by CD4 T cells in hip fracture patients with new onset depression compared to hip fracture patients without depression (p = .04) and healthy controls (p = .02). We conclude that the reduced immunity associated with new onset depression post hip fracture could include a contribution by heightened Tregs function.
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Affiliation(s)
| | - Jane Upton
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Anna C Phillips
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Janet M Lord
- School of Immunity and Infection, University of Birmingham, Birmingham, B15 2TT, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK.
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Duggal NA, Upton J, Phillips AC, Hampson P, Lord JM. NK cell immunesenescence is increased by psychological but not physical stress in older adults associated with raised cortisol and reduced perforin expression. AGE (DORDRECHT, NETHERLANDS) 2015; 37:9748. [PMID: 25663421 PMCID: PMC4320126 DOI: 10.1007/s11357-015-9748-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 01/22/2015] [Indexed: 06/04/2023]
Abstract
NK cell cytotoxicity (NKCC) reduces with age and this has been associated previously with increased mortality. The immune response is also modulated by stress, and here, we assessed the effect of the physical stress of hip fracture and the psychological stress of depression on NKCC in an aged immune system. NKCC was assessed in 101 hip fracture patients (81 female) 6 weeks and 6 months after injury and in 50 healthy age-matched controls (28 female). Thirty-eight patients were depressed at 6 weeks post-injury, and NKCC was reduced in patients who developed depression compared with non-depressed hip fracture patients (p = 0.004) or controls (p < 0.02). NKCC remained lower in the depressed patients compared to those without depression 6 months post-fracture (p = 0.017). We found reduced expression of perforin in NK cells of depressed hip fracture patients compared with controls at 6 weeks (p = 0.001) post-fracture. Serum cortisol levels were also elevated in patients with depression compared to non-depressed patients at 6 weeks (p = 0.01) and 6 months (p = 0.05). NK cells treated with dexamethasone showed a concentration-dependent reduction in NKCC and perforin expression. We propose that depression is the major factor affecting NK cell immunity after hip fracture.
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Affiliation(s)
- Niharika Arora Duggal
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, School of Immunity and Infection, University of Birmingham, Birmingham, B15 2TT UK
| | - Jane Upton
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Anna C. Phillips
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Peter Hampson
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, School of Immunity and Infection, University of Birmingham, Birmingham, B15 2TT UK
| | - Janet M. Lord
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, School of Immunity and Infection, University of Birmingham, Birmingham, B15 2TT UK
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Lucas SJ, Breen L, Phillips AC. Exercising our brains, muscles and cells to fight the ageing process. Sci Prog 2015; 98:413-5. [PMID: 26790179 PMCID: PMC10365453 DOI: 10.3184/003685015x14467218232110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Samuel J.E. Lucas
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Leigh Breen
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Anna C. Phillips
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Duggal NA, Upton J, Phillips AC, Hampson P, Lord JM. Depressive symptoms post hip fracture in older adults are associated with phenotypic and functional alterations in T cells. IMMUNITY & AGEING 2014; 11:25. [PMID: 25628751 PMCID: PMC4307912 DOI: 10.1186/s12979-014-0025-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/06/2014] [Indexed: 01/10/2023]
Abstract
Background Ageing is accompanied by reduced immunity, termed immunesenescence. The immune system does not act in isolation and is sensitive to both psychological and physical stress. Hip fracture is a common physical stressor in older adults with a high incidence of new onset depression, which relates to poorer prognosis. We therefore set out to examine the possible synergistic effects of physical stress (hip fracture) and psychological stress (depressive symptoms) on the aged immune system. Results T cell phenotype and function was assessed in 101 hip fracture patients (81 female) 6 weeks after hip fracture and 43 healthy age-matched controls (26 female). 38 fracture patients had depressive symptoms at 6 weeks. T cell frequency (p = .01) and numbers (p = .003) were both lower in depressed hip fracture patients compared to healthy controls. The frequency of senescent CD28-ve (p = .001), CD57+ve (p = .001), KLRG1+ve (p = .03) CD8 T cells, as well as senescent CD28-ve CD4+ve (p = .01) and CD57+ve CD4+ve (p = .003) T cells were higher in depressed hip fracture patients compared with healthy controls and the frequency of CD28-ve CD8 T cells was also higher when compared to patients with hip fracture alone (p = .01). Additionally, activated CD69+ve (p = .005) and HLADR+ve (p < .001) CD8 T cells, were also higher in depressed hip fracture patients compared to healthy controls. On examining cytokine production by activated T cells, a significant increase in TNFα (p = .03) and IL6 (p = .04) production was observed in CD4 T cells from hip fracture patients with depressive symptoms compared to healthy controls. Conclusions As none of the patients in the study had a prior history of depression, our data suggest that the development of depressive symptoms in hip fracture patients is associated with altered T cell phenotype and increased pro-inflammatory function which is not seen in patients who do not develop depression after hip fracture. Treating depressive symptoms promptly in hip fracture patients may therefore improve immunity and outcomes in these patients. Electronic supplementary material The online version of this article (doi:10.1186/s12979-014-0025-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Niharika Arora Duggal
- School of Immunity and Infection, University of Birmingham, Birmingham, B15 2TT UK ; MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research and, University of Birmingham, Birmingham, B15 2TT UK
| | - Jane Upton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Anna C Phillips
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research and, University of Birmingham, Birmingham, B15 2TT UK ; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Peter Hampson
- School of Immunity and Infection, University of Birmingham, Birmingham, B15 2TT UK ; MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research and, University of Birmingham, Birmingham, B15 2TT UK
| | - Janet M Lord
- School of Immunity and Infection, University of Birmingham, Birmingham, B15 2TT UK ; MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research and, University of Birmingham, Birmingham, B15 2TT UK
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Abstract
OBJECTIVES This study prospectively followed a cohort of orthopaedic trauma patients to identify risk factors that contribute to depression in patients with skeletal injuries. DESIGN Prospective cohort study. SETTING Level I trauma center. PATIENTS One hundred ten orthopaedic trauma patients admitted as inpatients. INTERVENTION None. MAIN OUTCOME MEASUREMENTS Patient Health Questionnaire (PHQ-9) scores. RESULTS One hundred ten patients were enrolled at the time of injury in which 22 patients had moderate-to-major depression and 36 patients had mild depression. Forty-eight patients completed the follow-up surveys that were taken, on average, 9 months after the date of injury. Factors that were significant for mild depression (PHQ-9 >4) at the time of injury included a history of illegal drug use (P = 0.037) and a lower Duke Social Support and Stress Scale (DUSOCS) support score (P = 0.002). The duke social support and stress scale score had a negative Pearson correlation coefficient with PHQ-9 (n = -0.18, P = 0.03). Factors that were significant for moderate-to-major depression (PHQ-9 >9) at the time of injury were a history of a psychiatric diagnosis (P = 0.0009) and unemployment at injury (P = 0.039). Both a history of psychiatric diagnosis and an elevated PHQ-9 score at the time of injury were predictors of having depression at 9 months (P = 0.02 and P = 0.001, respectively). Also, patients with Medicaid insurance had a significant increase in their depression scores at 9 months (P = 0.02). CONCLUSION Depression was quite prevalent in our patient sample. A previous psychiatric diagnosis predisposed patients to depression. The socioeconomic status was also a predictive factor for increased depression scores at 9 months. Patients with a higher feeling of support from friends and family had an inverse correlation for depression. Employment also seems to have a protective effect against depression. Surprisingly, the severity of injury did not affect the depression score. Targeted consultation with a mental health care provider may obviate any morbidity that is associated with depression in an injured patient. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Increased risk of major depression in the three years following a femoral neck fracture--a national population-based follow-up study. PLoS One 2014; 9:e89867. [PMID: 24626193 PMCID: PMC3953077 DOI: 10.1371/journal.pone.0089867] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/23/2014] [Indexed: 11/29/2022] Open
Abstract
Femoral neck fracture is common in the elderly, and its impact has increased in aging societies. Comorbidities, poor levels of activity and pain may contribute to the development of depression, but these factors have not been well addressed. This study aims to investigate the frequency and risk of major depression after a femoral neck fracture using a nationwide population-based study. The Taiwan Longitudinal Health Insurance Database was used in this study. A total of 4,547 patients who were hospitalized for femoral neck fracture within 2003 to 2007 were recruited as a study group; 13,641 matched non-fracture participants were enrolled as a comparison group. Each patient was prospectively followed for 3 years to monitor the occurrence of major depression. Cox proportional-hazards models were used to compute the risk of major depression between members of the study and comparison group after adjusting for residence and socio-demographic characteristics. The most common physical comorbidities that were present after the fracture were also analyzed. The incidences of major depression were 1.2% (n = 55) and 0.7% (n = 95) in the study and comparison groups, respectively. The stratified Cox proportional analysis showed a covariate-adjusted hazard ratio of major depression among patients with femoral neck fracture that was 1.82 times greater (95% CI, 1.30–2.53) than that of the comparison group. Most major depressive episodes (34.5%) presented within the first 200 days following the fracture. In conclusion, patients with a femoral neck fracture are at an increased risk of subsequent major depression. Most importantly, major depressive episodes mainly occurred within the first 200 days following the fracture.
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Duggal NA, Beswetherick A, Upton J, Hampson P, Phillips AC, Lord JM. Depressive symptoms in hip fracture patients are associated with reduced monocyte superoxide production. Exp Gerontol 2014; 54:27-34. [PMID: 24512764 DOI: 10.1016/j.exger.2014.01.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/23/2014] [Accepted: 01/31/2014] [Indexed: 12/15/2022]
Abstract
Ageing is accompanied by reduced functioning of the immune system, termed immunesenescence which is associated with increased risk of infection and mortality. However the immune system does not operate in isolation and can be modified by many environmental factors, including stress. In this study we determined whether physical stress (hip fracture) and psychological distress (depressive symptoms) had additive effects upon the aged immune system, specifically on monocyte numbers and function. We assessed immune function in 101 hip fracture patients (81 female) 6weeks and 6months after injury and 43 healthy age matched controls (28 females). Thirty-eight of the hip fracture group were found to be depressed at the 6week sampling. No differences in peripheral monocyte count, distribution of monocyte subsets or TNFα secretion were observed between hip fracture patients and healthy controls. However we observed significantly reduced superoxide production in response to Escherichia coli in the monocytes of hip fracture patients who developed depressive symptoms compared with non-depressed hip fracture patients (p=0.002) or healthy controls (p=0.008) 6weeks after the fracture which remained decreased 6months following injury. In previous studies we have shown an effect of depression on neutrophil superoxide generation in hip fracture patients, suggesting a particular susceptibility of this aspect of immune cell function to psychological stress.
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Affiliation(s)
- Niharika Arora Duggal
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK; MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Amy Beswetherick
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK
| | - Jane Upton
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Peter Hampson
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK; MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Anna C Phillips
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Janet M Lord
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK; MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK.
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Abstract
PURPOSE OF REVIEW Lifestyle factors play a role in both the genesis and recovery from fragility fracture. The purpose of this review is to summarize recent evidence for exercise and nutrition in the management of hip fracture. RECENT FINDINGS Recent randomized controlled trials of exercise have primarily consisted of isolated resistance training or multimodal home-based programs. More robust, long-term, or supervised training is generally associated with greater clinical benefits, including muscle strength, mobility, and function. Recent nutritional interventions have included multinutrient supplements, nutritional counseling and support, and vitamin D/calcium supplementation. Isolated nutritional interventions have not consistently shown significant impact on long-term outcomes after hip fracture, although improvements in body weight, biochemical indices, complication rates, and mobility have been reported. Overall, there is marked heterogeneity in the robustness of responses seen to hip fracture treatment studies. Few large, long-term, multicomponent interventions with clinically relevant outcomes of functional independence, need for residential care, mortality, and quality of life have been reported. SUMMARY Evidence-based approaches to hip fracture should include comprehensive risk-factor assessment and treatment for sarcopenia/dynapenia, balance impairment, undernutrition of protein, energy, vitamin D and calcium, depression, cognitive impairment, sensory impairment, social isolation, and comorbid illness with exercise, nutrition and other modalities.
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Affiliation(s)
- Maria A Fiatarone Singh
- aExercise and Sport Science, Faculty of Health Sciences bSydney Medical School cUniversity of Sydney, New South Wales, Australia
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