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Carrasco PM, Crespo DP, García AIR, Ibáñez ML, Rubio BM, Montenegro-Peña M. Predictive factors and risk and protection groups for loneliness in older adults: a population-based study. BMC Psychol 2024; 12:238. [PMID: 38671496 PMCID: PMC11055238 DOI: 10.1186/s40359-024-01708-7] [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: 05/02/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Loneliness is considered a public health problem, particularly among older adults. Although risk factors for loneliness have been studied extensively, fewer studies have focused on the protected and risk groups that these factors configure. Our objective is to analyze the variables and latent factors that predict loneliness in older adults and that enable risk and protected groups to be configured. METHODS We employed an epidemiological, cross-sectional survey that was carried out on a random sample of 2060 people over 65 years extracted from the census. A structured telephone interview was used to assess mental and physical health, habits, quality of life, and loneliness, applying the COOP-Wonca, Goldberg General Health (GHQ-12), and Barber Questionnaires. RESULTS Predictors of loneliness were: mental health, living alone, quality of life, depressive symptoms, low educational level, and some deficiency situations such as having no one to turn to for help. The factors extracted (Factorial Analysis) were: a subjective experience of poor health, objective isolation, and psychological isolation. We established at risk and protected groups ("Decision Tree" procedure), and loneliness was referred to by 73.2% of the people living alone and with poor mental health and quality of life (risk group). By contrast, only 0.8% of people living with others, with good mental health and good quality of life felt loneliness (protected group). CONCLUSION In a well-developed city, subjective and objective factors are associated with loneliness. These factors, especially those associated with at risk or protected groups, must be considered to develop strategies that address loneliness.
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Affiliation(s)
| | - David Prada Crespo
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain
- Department of Basic Psychology I, Faculty of Psychology, National University of Distance Education of Madrid, Madrid, Spain
| | | | | | | | - Mercedes Montenegro-Peña
- Centre for the Prevention of Cognitive Impairment, Madrid Salud, Madrid, Spain.
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain.
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2
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Alharbi K, Blakeman T, van Marwijk H, Reeves D, Tsang JY. Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review. BMJ Open 2022; 12:e054780. [PMID: 35649605 PMCID: PMC9161080 DOI: 10.1136/bmjopen-2021-054780] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/24/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Identifying and managing the needs of frail people in the community is an increasing priority for policy makers. We sought to identify factors that enable or constrain the implementation of interventions for frail older persons in primary care. DESIGN A rapid realist review. DATA SOURCES Cochrane Library, SCOPUS and EMBASE, and grey literature. The search was conducted in September 2019 and rerun on 8 January 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We considered all types of empirical studies describing interventions targeting frailty in primary care. ANALYSIS We followed the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and publication criteria for our synthesis to systematically analyse and synthesise the existing literature and to identify (intervention-context-mechanism-outcome) configurations. We used normalisation processes theory to illuminate mechanisms surrounding implementation. RESULTS Our primary research returned 1755 articles, narrowed down to 29 relevant frailty intervention studies conducted in primary care. Our review identified two families of interventions. They comprised: (1) interventions aimed at the comprehensive assessment and management of frailty needs; and (2) interventions targeting specific frailty needs. Key factors that facilitate or inhibit the translation of frailty interventions into practice related to the distribution of resources; patient engagement and professional skill sets to address identified need. CONCLUSION There remain challenges to achieving successful implementation of frailty interventions in primary care. There were a key learning points under each family. First, targeted allocation of resources to address specific needs allows a greater alignment of skill sets and reduces overassessment of frail individuals. Second, earlier patient involvement may also improve intervention implementation and adherence. PROSPERO REGISTRATION NUMBER The published protocol for the review is registered with PROSPERO (CRD42019161193).
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Affiliation(s)
- Khulud Alharbi
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Thomas Blakeman
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Harm van Marwijk
- Division of Primary Care and Public Health, University of Brighton, Falmer, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - David Reeves
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jung Yin Tsang
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
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3
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Liu T, Wang C, Sun J, Chen W, Meng L, Li J, Cao M, Liu Q, Chen C. The Effects of an Integrated Exercise Intervention on the Attenuation of Frailty in Elderly Nursing Homes: A Cluster Randomized Controlled Trial. J Nutr Health Aging 2022; 26:222-229. [PMID: 35297463 DOI: 10.1007/s12603-022-1745-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The frail elderly have an increased risk of frailty because of reduced physical activity, cognitive ability and quality of life. This study aims to evaluate the effects of integrated exercise intervention on the attenuation of frailty in elderly nursing home residents. DESIGN This study was a cluster randomized controlled trial. SETTING AND PARTICIPANTS 146 elderly frailty people from 8 elderly nursing homes in Harbin, China, were randomly assigned into the intervention group and control group after obtaining their informed consent. INTERVENTION The intervention group performed integrated exercise interventions for 12 months, while the control group only continued with their daily activities. MEASUREMENTS Sociodemographic, health-related data, frailty levels, gait parameters, cognition, and quality of life were evaluated. RESULTS The mean age of participants was 80.74± 2.89 years, and 70.37% (n=95) were female. The Difference-in-difference regression showed that, compared with the control group, phenotypic frailty score (β3 =-1.40, p < 0.001) and stride time (β3 = -0.38, p <0.001) decreased significantly in the intervention group, stride velocity (β3 = 0.24, p < 0.001), step length (β3 = 0.08, p <0.001), cadence (β3 = 17.79, p < 0.001), MMSE total score (β3 = 1.90, p < 0.001) and QOL total score (β3 = 11.84, p < 0.001) increased significantly in the intervention group. CONCLUSION The integrated exercise intervention can effectively improve the attenuation of frailty, gait parameters, cognitive function, and quality of life in elderly nursing homes. We can use the findings of this study as a reference for the design of activities for the elderly nursing home residents, to provide them with appropriate exercises, improve their physical functions, and improve or delay their frailty level, which is principally important for developing countries in east Asia where rehabilitation resources are generally scarce.
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Affiliation(s)
- T Liu
- Chen Chen, PhD. Department of the Ward 5 of Acupuncture and Moxibustion, the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, No. 144, Gogol Road, Harbin City 150040, Heilongjiang Province, China. Telephone: +0451-87093470;
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4
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Lim J, Park H, Lee H, Lee E, Lee D, Jung HW, Jang IY. Longitudinal impact of oral health on geriatric syndromes and clinical outcomes in community-dwelling older adults. BMC Geriatr 2021; 21:482. [PMID: 34481482 PMCID: PMC8418721 DOI: 10.1186/s12877-021-02416-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/04/2021] [Indexed: 02/03/2023] Open
Abstract
Background Oral health is essential for daily living and plays a pivotal role in overall health conditions and well-being. This study evaluated the impact of self-reported oral health on geriatric conditions, institutionalization, and mortality. Methods This study analyzed the population of the Aging Study of Pyeongchang Rural Area that had undergone geriatric assessments between 2016 and 2017. The oral health status of the participants was determined using three items from the General Oral Health Assessment Index, and the participants were classified into three groups according to the total sum of the scores as good (3), fair (4–7), or poor (8–15). The outcomes were the incidence of geriatric syndromes at 2 years and the composite outcome of mortality and institutionalization. Results Among the 1189 participants, 44.1 % were women, and the mean age of the study population was 75.0 years. Good, fair, and poor oral health were observed in 597 (50.2 %), 406 (34.1 %), and 186 (15.6 %) individuals, respectively. Worsening oral health status was associated with the incidences of various geriatric syndromes at follow-up, and these associations were attenuated after adjusting for baseline demographic and geriatric parameters. Similarly, the significant association between baseline oral health status and the incidence of the composite outcome was attenuated after adjusting for demographic and geriatric parameters. Conclusions Oral health affected the geriatric health conditions in this prospective, longitudinal cohort of community-dwelling older adults. The correlations and interactions of oral health status with other functional parameters may deserve consideration as a geriatric domain. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02416-2.
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Affiliation(s)
- Jihye Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hyungchul Park
- Department of Gastroenterology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Heayon Lee
- Divison of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Jingwan-dong, Eunpyeong-gu, Seoul, South Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Danbi Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea. .,PyeongChang Health Center and County Hospital, 11 Noseong-ro, Pyeongchang-eup, Pyeongchang-gun, Gangwon-do, Gangneung, Republic of Korea.
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5
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Romera-Liebana L, Orfila F, Segura JM, Real J, Fabra ML, Möller M, Lancho S, Ramirez A, Marti N, Cullell M, Bastida N, Martinez D, Giné M, Cendrós P, Bistuer A, Perez E, Fabregat MA, Foz G. Effects of a Primary Care-Based Multifactorial Intervention on Physical and Cognitive Function in Frail, Elderly Individuals: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2019; 73:1688-1674. [PMID: 29346524 PMCID: PMC6248206 DOI: 10.1093/gerona/glx259] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Indexed: 01/10/2023] Open
Abstract
Background Detecting and managing frailty at early stages can prevent disability and other adverse outcomes. The study aim was to evaluate whether a multifactorial intervention program could modify physical and cognitive frailty parameters in elderly individuals. Methods We conducted a multicenter, randomized, single-blind, parallel-group trial in community-living prefrail/frail elderly individuals in Barcelona. A total of 352 patients, aged ≥65 years old with positive frailty screening, was randomized into two groups to receive a 12-week multidisciplinary intervention or usual care, with concealed allocation. The intervention consisted of: exercise training, intake of hyperproteic nutritional shakes, memory training, and medication review. Main outcome assessments with multivariate analysis were conducted at 3 and 18 months. Results A total of 347 participants (98.6%) completed the study, mean age 77.3 years, 89 prefrail subjects (25.3%), and 75.3% female (n = 265). Eighteen-month assessments were performed in 76% of the sample. After 3 and 18 months, adjusted means difference between-groups showed significant improvements for the intervention group in all comparisons: Short Physical Performance Battery score improved 1.58 and 1.36 points (p < .001), handgrip strength 2.84 and 2.49 kg (p < .001), functional reach 4.3 and 4.52 cm (p < .001), and number of prescriptions decreased 1.39 and 1.09 (p < .001), respectively. Neurocognitive battery also showed significant improvements across all dimensions at 3 and 18 months. Conclusions A physical, nutritional, neurocognitive, and pharmacological multifaceted intervention was effective in reversing frailty measures both at short-term and 18 months. Lasting benefits of a multi-intervention program among frail elderly individuals encourage its prioritization.
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Affiliation(s)
- Laura Romera-Liebana
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain.,Universitat Autonoma de Barcelona, Spain.,Institut Universitari d'Investigació en Atenció Primaria Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Francesc Orfila
- Institut Universitari d'Investigació en Atenció Primaria Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Institut Catala De La Salut, Gerencia Barcelona Ciutat, Spain
| | - Josep Maria Segura
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain.,Institut Universitari d'Investigació en Atenció Primaria Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Jordi Real
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigacio en Atenció Primaria Jordi Gol (IDIAP Jordi Gol), Spain.,Epidemiologia i Salut Pública, Universitat Internacional de Catalunya, Barcelona, Spain.,CIBERDEM, Badalona, Spain
| | - Maria Lluïsa Fabra
- Rehabilitation Unit, Drassanes Health Centre, Institut Català de la Salut, Barcelona, Spain
| | - Mercedes Möller
- Rehabilitation Unit, Drassanes Health Centre, Institut Català de la Salut, Barcelona, Spain
| | - Santiago Lancho
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Anna Ramirez
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Nuria Marti
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Montserrat Cullell
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Nuria Bastida
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Dolors Martinez
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Maria Giné
- Blanquerna Universitat Ramon Llull Facultat de Psicologia Ciencies de l'Educacio i de l'Esport, Barcelona, Spain
| | | | - Anna Bistuer
- Rehabilitation Unit, Drassanes Health Centre, Institut Català de la Salut, Barcelona, Spain
| | - Elena Perez
- Institut Català d'Assistencia i Serveis Socials (ICASS), Barcelona, Spain
| | | | - Gonçal Foz
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
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6
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Gilardi F, Scarcella P, Proietti MG, Capobianco G, Rocco G, Capanna A, Mancinelli S, Marazzi MC, Palombi L, Liotta G. Frailty as a predictor of mortality and hospital services use in older adults: a cluster analysis in a cohort study. Eur J Public Health 2019; 28:842-846. [PMID: 29590362 PMCID: PMC6148968 DOI: 10.1093/eurpub/cky006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Lowering mortality and hospitalization of older adults is one of the main goals of public health to improve both health systems’ sustainability and older adults’ quality of life. The aim of this study is to identify the determinants associated with mortality and the use of hospital services in the population older than 64 years of age. Methods A randomized sample from the population of the Lazio region (Italy) above the age of 64 was enrolled in 2014 by the administration of a questionnaire to assess frailty; the rates of use of hospital services and mortality in the year following the enrolment have been retrieved by the regional database. Univariable and multivariable analyses addressed the association of health status, social and economic variables with health outcomes. Results One thousand two hundred and eighty persons were recruited; 52 deaths were reported at 1 year of follow-up (robust 1.8%, frail 10.1% and very frail 19.1%, P < 0.001). The mean rate of use of hospital services was 692.2 per 1000 observation/year (robust 589.5, frail 1191.1 and very frail 848.4, P < 0.001). In the multivariate analysis, the higher rate of use of hospital services was independently associated with functional status, social support, psychological/psychiatric discomfort, availability of home care services and physical health. Conclusions Frailty, as a multidimensional issue, is also a strong predictor of survival in the short term. The use of the hospital services by older adults is associated mainly with functional status, social resources, psycho-physical status and health service organization factors.
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Affiliation(s)
- Francesco Gilardi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Paola Scarcella
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Giovanni Capobianco
- Geriatric Division, Hospital Sant'Eugenio, Local Health Unit Roma 2, Rome, Italy
| | | | - Alessandra Capanna
- School of Specialization in Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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7
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Castell MV, Gutiérrez-Misis A, Sánchez-Martínez M, Prieto MA, Moreno B, Nuñez S, Triano R, de Antonio MP, Mateo C, Cano MD, Garrido A, Julian R, Polentinos E, Rodriguez-Barrientos R, Otero Puime A. Effectiveness of an intervention in multicomponent exercise in primary care to improve frailty parameters in patients over 70 years of age (MEFAP-project), a randomised clinical trial: rationale and study design. BMC Geriatr 2019; 19:25. [PMID: 30691405 PMCID: PMC6348680 DOI: 10.1186/s12877-018-1024-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/28/2018] [Indexed: 01/06/2023] Open
Abstract
Background Physical activity may reverse frailty in the elderly, but we encounter barriers to the implementation of exercise programs in this population. Our main aim is to evaluate the effect of a multicomponent physical activity program, versus regular medical practice, on reverting pre-frailty status among the elderly, 12 months post-intervention. Methods Randomized parallel group multicenter clinical trial located in primary care setting, among non-dependent and pre-frail patients > 70 years old, including 190 patients (95 intervention, 95 control group). Intervention: Multicomponent physical activity program (MEFAP, for its acronym in Spanish) with twelve 1.5 h-weekly sessions comprised of: 1. Informative session; 2. Exercises for improving aerobic resistance, muscle strength, propioception-balance and flexibility; and 3. Handing out of at-home exercise chart (twice/week). Main variable: pre-frailty according to the Fried phenotype. Secondary variables: sociodemographic, clinical and functional variables; exercise program adherence, patient satisfaction with the program and quality of life. We will perform an intention-to-treat analysis by comparing the retrogression from pre-frailty (1 or 2 Fried criteria) to robust status (0 Fried criteria) by the end of the intervention, 6 months and 12 months post-intervention. The accumulated incidence in each group will be calculated, as well as the relative risk (RR) and the number needed to treat (NNT) with their corresponding 95% confidence intervals. Protocol was approved by the Ethics Committee Hospital la Paz. Discussion Within the context of regular clinical practice, our results will provide evidence regarding the effects of exercise interventions on frailty among pre-frail older adults, a key population given their significant potential for functional, physical, and mental health improvement. Trial registration NCT03568084. Registered 26 June 2018. Date of enrollment of the first participant to the trial: July 2nd 2018.
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Affiliation(s)
- M V Castell
- Doctor Castroviejo Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain.,Medicine Department, Family Medicine and Primary Care Division, School of Medicine, Autonoma University of Madrid, C/ Arzobispo Morcillo, 2-4, 28049, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - A Gutiérrez-Misis
- Medicine Department, Family Medicine and Primary Care Division, School of Medicine, Autonoma University of Madrid, C/ Arzobispo Morcillo, 2-4, 28049, Madrid, Spain. .,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
| | - M Sánchez-Martínez
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Health Sciences Department, "Santa Teresa de Jesús" Catholic University of Avila, Avila, Spain
| | - M A Prieto
- Valdelasfuentes Primary Care Health Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - B Moreno
- Reina Victoria Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - S Nuñez
- Torrelaguna Primary Care Health Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - R Triano
- Miraflores Primary Care Health Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - M P de Antonio
- Colmenar Viejo Norte Primary Care Health Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - C Mateo
- Fuencarral Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - M D Cano
- Medicine Department, Family Medicine and Primary Care Division, School of Medicine, Autonoma University of Madrid, C/ Arzobispo Morcillo, 2-4, 28049, Madrid, Spain.,Fuencarral Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - A Garrido
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Barrio del Pilar Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - R Julian
- Doctor Castroviejo Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - E Polentinos
- Research Network in Health Services and Chronic Diseases (REDISSEC), Madrid, Spain.,Family and Community Teaching Unit Norte. Primary Care Management. Madrid Health Service, Madrid, Spain
| | - R Rodriguez-Barrientos
- Research Network in Health Services and Chronic Diseases (REDISSEC), Madrid, Spain.,Research support Unit. Primary Care Management. Madrid Health Service, Madrid, Spain
| | - A Otero Puime
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Preventive Medicine and Public Health Department. Family Medicine and Primary Care Unit. School of Medicine, Autonoma University of Madrid, Madrid, Spain
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8
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Buckinx F, Croisier JL, Charles A, Petermans J, Reginster JY, Rygaert X, Bruyere O. Normative data for isometric strength of 8 different muscle groups and their usefulness as a predictor of loss of autonomy among physically active nursing home residents: the SENIOR cohort. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2019; 19:258-265. [PMID: 31475932 PMCID: PMC6737556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To provide normative values for isometric strength of 8 different muscle groups among nursing home residents and to investigate their predictive value for the decline of autonomy. METHODS This is an analysis of the 1-year follow-up of the SENIOR cohort. At baseline, isometric muscle strength of residents has been assessed for 8 muscle groups using the MicroFET2. The cut-off threshold for low relative isometric muscle strength was defined as the lower quartile. The outcome was the 1-year loss of autonomy (i.e. a decrease of ≥1 point on the ADL scale between baseline and 12-month follow-up). Logistic regressions were carried out to assess the predictive value of isometric muscle strength for the loss of autonomy. RESULTS 204 subjects (83.2±8.99 years, 72.5% women) were included. Threshold values of isometric strength were: knee flexors=0.94, knee extensors=1.07, ankle flexors=0.77, ankle extensors=0.88, hip abductors=0.78, hip extensors=0.79, elbow flexors=0.99 and elbow extensors= 0.71 N/kg. After adjustment for age and sex, the cut-off values for knee extensors (p=0.04) and for ankle extensors (p=0.03) were significantly predictive of loss of autonomy. CONCLUSIONS The normative values for knee extensors and ankle extensors are independent predictors for loss of autonomy.
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Affiliation(s)
- Fanny Buckinx
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium. WHO Collaborating Centre for Public Health Aspects of Muscu loskeletal Health and Ageing, Belgium,Corresponding author: Fanny Buckinx, PhD, CHU Sart-Tilman, B23, Quartier Hôpital, Avenue Hippocrate, 13, 4000 Liège, Belgium E-mail:
| | | | - Alexia Charles
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium. WHO Collaborating Centre for Public Health Aspects of Muscu loskeletal Health and Ageing, Belgium
| | | | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium. WHO Collaborating Centre for Public Health Aspects of Muscu loskeletal Health and Ageing, Belgium
| | - Xavier Rygaert
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium. WHO Collaborating Centre for Public Health Aspects of Muscu loskeletal Health and Ageing, Belgium
| | - Olivier Bruyere
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium. WHO Collaborating Centre for Public Health Aspects of Muscu loskeletal Health and Ageing, Belgium
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9
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Antimisiaris D, Cutler T. Managing Polypharmacy in the 15-Minute Office Visit. PHYSICIAN ASSISTANT CLINICS 2018. [DOI: 10.1016/j.cpha.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Abstract
Polypharmacy is an underappreciated factor in undesirable patient outcomes. In older adults, polypharmacy is considered a syndrome of harm and presents a challenge to primary care providers. The United States has one of the highest medication use rates per capita in the world. With the aging population, and polypharmacy a significant part of the lives of older adults, management of polypharmacy poses both a growing challenge and an opportunity for all health care providers. This article provides an overview of skills to improve medication use management in older adults living with polypharmacy.
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Affiliation(s)
- Demetra Antimisiaris
- Pharmacy and Medication Management Program, Department of Pharmacology and Toxicology, University of Louisville, 501 East Broadway, Suite 240, Louisville, KY 40202, USA; Department of Neurology, University of Louisville, 501 East Broadway, Suite 240, Louisville, KY 40202, USA; Department of Family Medicine and Geriatrics, University of Louisville, 501 East Broadway, Suite 240, Louisville, KY 40202, USA.
| | - Timothy Cutler
- Department of Clinical Pharmacy, UCSF School of Pharmacy, 533 Parnassus Avenue U585, UCSF POBox 0622, San Francisco, CA 94117, USA
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Liotta G, Canhao H, Cenko F, Cutini R, Vellone E, Illario M, Kardas P, Poscia A, Sousa RD, Palombi L, Marazzi MC. Active Ageing in Europe: Adding Healthy Life to Years. Front Med (Lausanne) 2018; 5:123. [PMID: 29780804 PMCID: PMC5946166 DOI: 10.3389/fmed.2018.00123] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 04/12/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Helena Canhao
- CEDOC, EpiDoC Unit, NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Fabian Cenko
- Catholic University “Our Lady of Good Counsel”, Tirana, Albania
| | - Rita Cutini
- Sociology, University for Foreigners “Dante Alighieri”, Reggio Calabria, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Andrea Poscia
- Institute of Hygiene, University of Sacred Heart, Rome, Italy
| | - Rute Dinis Sousa
- CEDOC, EpiDoC Unit, NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
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12
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Frailty, Sarcopenia and Falls. PERSPECTIVES IN NURSING MANAGEMENT AND CARE FOR OLDER ADULTS 2018. [DOI: 10.1007/978-3-319-76681-2_2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fougère B, Morley JE, Little MO, De Souto Barreto P, Cesari M, Vellas B. Interventions Against Disability in Frail Older Adults: Lessons Learned from Clinical Trials. J Nutr Health Aging 2018; 22:676-688. [PMID: 29806856 DOI: 10.1007/s12603-017-0987-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
As the population ages, the number of older people with frailty is expected to increase worldwide with consequent rising of expenditures for healthcare and long-term care. Effective methods for preventing or delaying the onset of disability are urgently required. Frailty is a common and important geriatric condition characterized by age-associated declines in multiple physiological mechanisms, leading to increased vulnerability to stressors and higher risk for adverse health outcomes. Significant advancements have been made in the understanding of the frailty pathophysiological background. Given its multidimensional nature, reversing frailty requires a comprehensive approach. In this context, several studies testing the effects of pharmacological approach, physical activity, nutritional intervention, or cognitive training showed evidence of efficacy in frail older adults. Important innovations in ongoing trials include the development of multidomain interventions. Challenges include the use of trial designs, the development of standardized, sensitive outcome measures, and the need for interventions that can be implemented in resource-poor settings. In this viewpoint paper, based on recent literature, our aim was to identify relevant studies performed to reverse or delay disability in frail older adults.
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Affiliation(s)
- B Fougère
- Bertrand Fougère, Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France. Tel: +33561145657 ; fax: +33561145640. E-mail:
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Serra-Prat M, Sist X, Domenich R, Jurado L, Saiz A, Roces A, Palomera E, Tarradelles M, Papiol M. Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: a randomised controlled trial. Age Ageing 2017; 46:401-407. [PMID: 28064172 DOI: 10.1093/ageing/afw242] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background evidence on the effectiveness of interventions to prevent frailty is scarce. Objective to assess the effect of an intervention in preventing frailty progression in pre-frail older people. Study design a randomised, open label, controlled trial with two parallel arms. Population community-dwelling pre-frail older people (≥70 years) consulting in primary care. Intervention nutritional assessment (and derivation to a Nutritional Unit for usual care in the event of nutritional risk) and a physical activity programme including aerobic exercise and a set of mixed strengthening, balance and coordination exercises. Control group patients receiving the usual care. Main outcome measure prevalence of frailty (Fried criteria) at 12 months. Secondary outcomes measures functional capacity (Barthel index), falls and nutritional status (Short-Form Mini Nutritional Assessment) on follow-up at 12 months. Results one hundred and seventy-two participants were recruited and randomised (mean age: 78.3 years; mean number of Fried criteria: 1.45). Thirty-nine participants (22.6%) were dropped out during the study. At follow-up, 4.9% of the intervention group and 15.3% of the control group had evolved to frailty, for a crude odds ratio (OR) of 0.29 (95% confidence interval [CI]: 0.08-1.08; P = 0.052) and an adjusted (by age, gender and number of co-morbidities) OR of 0.19 (95% CI: 0.04-0.95; P = 0.044). Intervention group showed a higher outdoors walking hour per day (0.97 versus 0.73; P = 0.019) but no difference was observed in muscle strength, gait speed or other functional indicators. Conclusion an intervention focused on physical exercise and maintaining good nutritional status may be effective in preventing frailty in community-dwelling pre-frail older individuals. ClinicalTrials.gov identifier NCT02138968.
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Affiliation(s)
- M Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
- Centro de Investiación Biomédica en Red de EnfermedadesHepáticas y Digestivas (CIBEREHD), ISCIII, Madrid, Spain
| | - X Sist
- Research Unit, Consorci Sanitari del Maresme, Mataró,Barcelona, Spain
| | - R Domenich
- ABS Mataró Centre, Consorci Sanitari del Maresme, Mataró,Barcelona, Spain
| | - L Jurado
- ABS Cirera-Molins, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - A Saiz
- ABS Mataró Centre, Consorci Sanitari del Maresme, Mataró,Barcelona, Spain
| | - A Roces
- ABS Cirera-Molins, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - E Palomera
- Research Unit, Consorci Sanitari del Maresme, Mataró,Barcelona, Spain
| | - M Tarradelles
- Research Unit, Consorci Sanitari del Maresme, Mataró,Barcelona, Spain
| | - M Papiol
- ABS Argentona, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
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15
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Yannakoulia M, Ntanasi E, Anastasiou CA, Scarmeas N. Frailty and nutrition: From epidemiological and clinical evidence to potential mechanisms. Metabolism 2017; 68:64-76. [PMID: 28183454 DOI: 10.1016/j.metabol.2016.12.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 11/25/2016] [Accepted: 12/06/2016] [Indexed: 12/25/2022]
Abstract
Frailty is a geriatric condition characterized by unintentional weight loss, low muscle strength, feeling of exhaustion, reduced physical activity capacity and slow walking speed. Theoretically, nutrition is a factor closely related to the frailty syndrome: all frailty criteria are more or less affected by poor eating habits, whereas frailty itself may have a negative effect on eating and, thus, on the nutritional status. Indeed, research data suggest an association between frailty and specific constituents of diet, namely protein and energy intake, as well as intakes of specific micronutrients. Furthermore, healthy dietary patterns, such as the Mediterranean diet, have been linked to the frailty prevention. In the present narrative review, we critically evaluate cross-sectional, prospective and intervention studies examining the relationship between diet and frailty development and prevention. Potential mechanisms linking nutrition and frailty as well as directions for future research are discussed.
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Affiliation(s)
- Mary Yannakoulia
- School of Health Sciences and Education, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
| | - Eva Ntanasi
- School of Health Sciences and Education, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece; Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian, University of Athens, Greece
| | - Costas A Anastasiou
- School of Health Sciences and Education, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Nikolaos Scarmeas
- Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian, University of Athens, Greece; Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, NY, New York, USA
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16
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Piggott DA, Erlandson KM, Yarasheski KE. Frailty in HIV: Epidemiology, Biology, Measurement, Interventions, and Research Needs. Curr HIV/AIDS Rep 2016; 13:340-348. [PMID: 27549318 PMCID: PMC5131367 DOI: 10.1007/s11904-016-0334-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Frailty is a critical aging-related syndrome marked by diminished physiologic reserve and heightened vulnerability to stressors, predisposing to major adverse clinical outcomes, including hospitalization, institutionalization, disability, and death in the general population of older adults. As the proportion of older adults living with HIV increases in the era of antiretroviral therapy, frailty is increasingly recognized to be of significant clinical and public health relevance to the HIV-infected population. This article reviews current knowledge on the epidemiology and biology of frailty and its potential role as a target for reducing disparities in outcomes in HIV; conceptual frameworks and current approaches to frailty measurement; existing data on frailty interventions; and important areas for future research focus necessary to develop and advance effective strategies to prevent or ameliorate frailty and its marked adverse consequences among people living with HIV.
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Affiliation(s)
- Damani A Piggott
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Kevin E Yarasheski
- Department of Medicine, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8127, St. Louis, MO, 63110, USA.
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17
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Liotta G, Orfila F, Vollenbroek-Hutten M, Roller-Winsberger R, Illario M, Musian D, Alvino S, O’Caoimh R, Cano A, Molloy W, Iaccarino G, Marazzi MC, Inzerilli MC, Madaro O, Paul C, Csonka P, Vince AC, Menditto E, Maggio M, Scarcella P, Gilardi F, Lucaroni F, Abete P, Girardi V, Barra R, Palombi L. The European Innovation Partnership on Active and Healthy Ageing Synergies: Protocol for a Prospective Observational Study to Measure the Impact of a Community-Based Program on Prevention and Mitigation of Frailty (ICP - PMF) in Community-Dwelling Older Adults. Transl Med UniSa 2016; 15:53-66. [PMID: 27896228 PMCID: PMC5120751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim of this paper is to describe the protocol of the study "Impact of a Community-based Program on Prevention and Mitigation of Frailty in community-dwelling older adults" developed in the framework of the European Innovation Partnership on Active and Healthy Ageing. This proposal has been developed by the Partnership Action groups on frailty, fall prevention and polypharmacy in older. The proposal wants to assess the impact of community-based programs aimed to counteract three main outcomes related to frailty: hospitalization, institutionalization and death. Bringing together researchers from seven European countries, the proposal aims to achieve the critical mass and the geographical extension enough to provide information useful to all older European citizens. An observational study will be carried out to calculate the incidence of the different outcomes in relation to the various interventions that will be assessed; results will be compared with data coming from already established national, regional and local dataset using the observed/expected approach. The sample will be made up by at least 2000 citizens for each outcome. All the citizens will be assessed at the baseline with two multidimensional questionnaires: the RISC questionnaire and the Short Functional Geriatric Evaluation questionnaire. The outcomes will be assessed every six-twelve months.
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Affiliation(s)
- G Liotta
- Corresponding Author: Giuseppe Liotta; e-mail:
| | - F Orfila
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - M Vollenbroek-Hutten
- Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, University of Twente, Enschede, The Netherlands
- Ziekenhuis Groep Twente, Almelo, The Netherlands
| | | | - M Illario
- DISMET, Federico II University Naples, Italy
| | | | | | - R O’Caoimh
- Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - A Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Spain
| | - W Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland
| | - G Iaccarino
- Department of Medicine, University of Salerno, Baronissi, Salerno
| | | | - MC Inzerilli
- Community of Sant’Egidio - Long Live the Elderly program, Rome Italy
- Rome Municipality, Italy
| | - O Madaro
- Community of Sant’Egidio - Long Live the Elderly program, Rome Italy
| | - C Paul
- ICBAS, University of Porto, Portugal
| | - P Csonka
- Educators’ Centre Association, Pecs, Hungary
| | - AC Vince
- Educators’ Centre Association, Pecs, Hungary
| | - E Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II 17University of Parma, Italy
| | - M Maggio
- University-Hospital of Parma, Emilia Romagna Region Italy
| | - P Scarcella
- Biomedicine and Prevention Dept. – University of Rome Tor Vergata, Rome, Italy
| | - F Gilardi
- Biomedicine and Prevention Dept. – University of Rome Tor Vergata, Rome, Italy
| | - F Lucaroni
- Biomedicine and Prevention Dept. – University of Rome Tor Vergata, Rome, Italy
| | - P Abete
- Medical University of Graz, Austria
| | - V Girardi
- Associazione Salute in Collina, Naples, Italy
| | - R Barra
- Associazione Salute in Collina, Naples, Italy
| | - L Palombi
- Biomedicine and Prevention Dept. – University of Rome Tor Vergata, Rome, Italy
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18
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Vaingankar JA, Chong SA, Abdin E, Picco L, Chua BY, Shafie S, Ong HL, Chang S, Seow E, Heng D, Chiam PC, Subramaniam M. Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults. Geriatr Gerontol Int 2016; 17:1444-1454. [DOI: 10.1111/ggi.12891] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/04/2016] [Accepted: 07/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Siow Ann Chong
- Research Division; Institute of Mental Health; Singapore
| | | | - Louisa Picco
- Research Division; Institute of Mental Health; Singapore
| | | | - Saleha Shafie
- Research Division; Institute of Mental Health; Singapore
| | - Hui Lin Ong
- Research Division; Institute of Mental Health; Singapore
| | - Sherilyn Chang
- Research Division; Institute of Mental Health; Singapore
| | - Esmond Seow
- Research Division; Institute of Mental Health; Singapore
| | | | - Peak Chiang Chiam
- Department of Geriatric Psychiatry; Institute of Mental Health; Singapore
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Santos-Eggimann B, Sirven N. Screening for frailty: older populations and older individuals. Public Health Rev 2016; 37:7. [PMID: 29450049 PMCID: PMC5810062 DOI: 10.1186/s40985-016-0021-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/02/2016] [Indexed: 11/20/2022] Open
Abstract
The concept of frailty as a health dimension in old age is recent and has its origin in the development of geriatric medicine. Initially an unformulated clinical intuition, it is now defined by a diminished physiological reserve of multiple organs that exposes older individuals to increased vulnerability to stressors and a higher risk of adverse outcomes. The operational definition of frailty, however, is still debated. From a diversity of models, two emerged in the early 2000s from epidemiological studies conducted in large population-based aging cohorts. The body of research emphasized prospective associations between a frailty phenotype and a range of adverse outcomes or between a frailty index measuring the accumulation of deficits and death. A few studies showed promising spontaneous remissions in the early stages of frailty, raising expectations for effective interventions. Transitions between frailty stages and effective interventions on frailty nevertheless remain two fields needing further investigation. More recently, these tools have been applied as screening instruments in clinical settings to guide individual decision-making and orient treatments. New questions are raised by the use of instruments developed to screen frailty in epidemiological research for assessing individual situations. Inquiring whether frailty screening is relevant opens a Pandora’s box of doubts and debates. There are many reasons to screen for frailty both from a public health and a clinical perspective that are only exacerbated by the current demographic evolution. Open questions remain about the feasibility of frailty screening, the properties of screening tools, the relevance of an integration of socioeconomic dimensions into screening tools, and the effectiveness of interventions targeting frailty. Fifteen years after the publication of the Fried and Rockwood landmark papers proposing operational definitions of frailty, this article presents an overview of current perspectives and issues around frailty screening in populations and in individuals.
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Affiliation(s)
- Brigitte Santos-Eggimann
- 1Institute of Social and Preventive Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Nicolas Sirven
- 2LIRAES, University of Paris Descartes, Sorbonne-Paris-Cité, 45 rue des Saints Pères, 75006 Paris, France
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20
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Pretransplant frailty is associated with decreased survival after lung transplantation. J Heart Lung Transplant 2015; 35:173-8. [PMID: 26679297 DOI: 10.1016/j.healun.2015.10.014] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/03/2015] [Accepted: 10/14/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Frailty is a condition of increased vulnerability to adverse health outcomes. Although frailty is an important prognostic factor for many conditions, the effect of frailty on mortality in lung transplantation is unknown. Our objective was to assess the association of frailty with survival after lung transplantation. METHODS We performed a retrospective cohort analysis of all adult lung transplant recipients at our institution between 2002 and 2013. Frailty was assessed using the frailty deficit index, a validated instrument that assesses cumulative deficits for up to 32 impairments and measures the proportion of deficits present (with frailty defined as >0.25). We examined the association between frailty and survival, adjusting for age, sex, and bilateral (vs single) lung transplant using Cox proportional hazard regression models. RESULTS Among 144 lung transplant patients, 102 (71%) completed self-reported questionnaires necessary to assess the frailty deficit index within 1 year before lung transplantation. Frail patients (n = 46) had an increased risk of death, with an adjusted hazard ratio (HR) of 2.24 (95% confidence interval [CI], 1.22-4.19; p = 0.0089). Frailty was not associated with an increased duration of mechanical ventilation (median, 2 vs 2 days; p = 0.26), intensive care unit length of stay (median, 7.5 vs 6 days; p = 0.36) or hospital length of stay after transplantation (median, 14 vs 10.5 days; p = 0.26). CONCLUSIONS Pre-transplant frailty was independently associated with decreased survival after lung transplantation. Pre-transplant frailty may represent an important area for intervention to improve candidate selection and lung transplant outcomes.
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Abstract
‘Ageing well’ has been declared a global health priority by the World Health Organisation and the role of sarcopenia and frailty in late-life health is receiving increasing attention. Frailty is the decline in an individual's homeostatic function, strength and physiologic reserves leading to increased vulnerability, while sarcopenia describes the loss of muscle mass and function with age. The conceptual definitions of these conditions have been widely agreed but there is a lack of consensus on how to measure them. We review the different operational definitions described in the literature and the evidence that, whatever definition used, the prevalence and clinical impact of these conditions is high. We also consider the commonality of low physical function to both conditions, a feature which could provide a pragmatic way forward in terms of identifying those at risk. Objective measures of physical function such as usual walking speed are simple and feasible measures, extensively validated against health outcomes. Additionally, clinical applications of sarcopenia and frailty are reviewed with particular consideration to their potential role in the management of older people undergoing surgery. Frailty appears to outperform traditional anaesthetic and surgical risk scores in terms of its association with post-operative complications, length of hospital stay, institutionalisation and mortality. However, even within this sub-specialty area there is wide variation in the approaches used to measure frailty and there is an urgent need for studies to utilise established, validated and reproducible methods to identify sarcopenia and frailty in their study participants, in order to expedite scientific development.
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Abstract
This article first reports the spontaneous course of frailty conditions, and then focuses on randomized, controlled frailty interventions (such as physical exercise, nutrition, combined exercise plus nutrition, and multifactorial interventions) or metaanalysis in community-dwelling older adults or volunteers published in 2012, 2013, and 2014. The main take-home messages that emerge from recent literature are summarized.
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Affiliation(s)
- Jean-Pierre Michel
- Geriatric Department, Geneva University, 40 A Route de Malagnou, Geneva 1208, Switzerland.
| | - Alfonso J Cruz-Jentoft
- Head of the Geriatric Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 1, Madrid 28034, Spain
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Dag Hammarskjöldsv. 14B, Uppsala Science Park, 75185 Uppsala, Sweden
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