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Yu BY, Hu XM, Matala R, Mo YH, Liu JL, Jin JG, Zhang SH, Ou YQ, Yang Y, Dong HJ. Association between trajectories of systolic blood pressure and frailty outcome in middle-aged and older adults. J Nutr Health Aging 2024; 28:100202. [PMID: 38460319 DOI: 10.1016/j.jnha.2024.100202] [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: 12/10/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES The association between blood pressure and frailty outcome in the middle-aged and older population remains controversial. This study aimed to examine the relationship between trajectories of systolic blood pressure (SBP) and new-onset frailty. DESIGN Cohort study with a 7-year follow-up. SETTING AND PARTICIPANTS Data were derived from 4 waves (2011, 2013, 2015 and 2018) of the China Health and Retirement Longitudinal Study and 6168 participants aged ≥45 years were included in the study. METHODS The frailty index (FI) was constructed based on 40 scored items, with FI ≥ 0.25 defined as frailty. We identified the 5-year trajectory of SBP by latent class trajectory modeling. The association between SBP trajectories and frailty was explored based on hazard ratios (HR) by four Cox proportional hazards models. Furthermore, we also investigated the relationship between mean SBP and systolic blood pressure variability (SBPV) and frailty. RESULTS 6168 participants were included in this study with a mean age of 59 years. We identified five trajectories based on SBP, which are maintained low-stable SBP (T0), moderate-stable SBP (T1), remitting then increasing SBP (T2), increasing then remitting SBP (T3), and remaining stable at high SBP levels (T4). During the 7-year follow-up period, frailty outcome occurred in 1415 participants. After adjusting for other confounders, the two trajectories labeled "T2" and "T4" were associated with a higher risk of frailty compared with T0. In addition, elevated SBP and increased SBPV were associated with risk of frailty. CONCLUSIONS Higher risk of frailty occurred in two trajectories, remitting then increasing and remaining stable at high SBP levels, were associated with a relatively higher risk of frailty.
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Affiliation(s)
- B Y Yu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - X M Hu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - R Matala
- Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, One University Place, Rensselaer, NY, 12144
| | - Y H Mo
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - J L Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - J G Jin
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - S H Zhang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Y Q Ou
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Y Yang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
| | - H J Dong
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Nyingchi People's Hospital, Nyingchi, 860000, Tibet, China.
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Damanti S, Cilla M, Vitali G, Tiraferri V, Pomaranzi C, De Rubertis G, De Lorenzo R, Di Lucca G, Scotti R, Messina E, Dell’Acqua R, Guffanti M, Cinque P, Castagna A, Rovere-Querini P, Tresoldi M. Exploring the Association between Delirium and Malnutrition in COVID-19 Survivors: A Geriatric Perspective. Nutrients 2023; 15:4727. [PMID: 38004121 PMCID: PMC10674410 DOI: 10.3390/nu15224727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Older individuals face an elevated risk of developing geriatric syndromes when confronted with acute stressors like COVID-19. We assessed the connection between in-hospital delirium, malnutrition, and frailty in a cohort of COVID-19 survivors. Patients aged ≥65, hospitalized in a tertiary hospital in Milan for SARS-CoV-2 pneumonia, were enrolled and screened for in-hospital delirium with the 4 'A's Test (4AT) performed twice daily (morning and evening) during hospital stay. Malnutrition was assessed with the malnutrition universal screening tool (MUST) at hospital admission and with the mini-nutritional assessment short-form (MNA-SF) one month after hospital discharge. Frailty was computed with the frailty index one month after hospital discharge. Fifty patients (median age 78.5, 56% male) were enrolled. At hospital admission, 10% were malnourished. The 13 patients (26%) who developed delirium were frailer (7 vs. 4), experienced a higher in-hospital mortality (5 vs. 3), and were more malnourished one month after discharge (3 of the 4 patients with delirium vs. 6 of the 28 patients without delirium who presented at follow up). The 4AT scores correlated with the MNA-SF scores (r = -0.55, p = 0.006) and frailty (r = 0.35, p = 0.001). Frailty also correlated with MUST (r = 0.3, p = 0.04), MNA-SF (r = -0.42, p = 0.02), and hospitalization length (r = 0.44, p = 0.001). Delirium, malnutrition, and frailty are correlated in COVID-19 survivors. Screening for these geriatric syndromes should be incorporated in routine clinical practice.
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Affiliation(s)
- Sarah Damanti
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
- General Medicine and Continuity of Care Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
| | - Marta Cilla
- Center for Liver Disease, Division of Internal Medicine and Hepatology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Giordano Vitali
- General Medicine and Continuity of Care Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
| | - Valeria Tiraferri
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Chiara Pomaranzi
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Giulia De Rubertis
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Rebecca De Lorenzo
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Giuseppe Di Lucca
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (G.D.L.); (R.S.); (M.T.)
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (G.D.L.); (R.S.); (M.T.)
| | - Emanuela Messina
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Raffaele Dell’Acqua
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Monica Guffanti
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Paola Cinque
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Antonella Castagna
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Patrizia Rovere-Querini
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
- General Medicine and Continuity of Care Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
- Division of Immunology, Transplantation & Infectious Diseases, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (G.D.L.); (R.S.); (M.T.)
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Lovett M, Koto P, Shetty N. Assessing clinical frailty scale scoring by junior medical learners on an inpatient geriatrics consultation service. GERONTOLOGY & GERIATRICS EDUCATION 2023:1-10. [PMID: 37660357 DOI: 10.1080/02701960.2023.2253180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
The Clinical Frailty Scale (CFS) is incorporated into our institution's comprehensive geriatric assessment (CGA). CGAs and CFS scoring are completed by junior medical trainees on the Geriatric consult service. The agreement between CFS score assignment by junior trainees and Geriatrics trained individuals in this setting is unknown. Importantly, these scores assign a frailty level that impacts care pathways. We conducted a retrospective chart review from April-June 2019. A Geriatric medicine subspecialty resident assigned retrospective CFS scores based on data from the CGA. We compared scores to determine the level of agreement using the Cohen and Conger's Kappa inter-rater agreement metric and assessed whether patient characteristics influenced the likelihood of agreement between raters using a generalized linear model. Medical students assessed 43% (46/108) of patients (n = 13), and 57% (62/108) were assessed by PGY1s (n = 10). Inter-rater agreement measures showed substantial agreement overall and for PGY1s, but dropped to a moderate agreement for medical students. The retrospective inter-rater agreement of the CFS showed substantial agreement overall and decreased when limited to medical students, highlighting the need for interventions to improve the understanding of frailty early in medical training.
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Affiliation(s)
- M Lovett
- Medicine, Dalhousie University, Halifax, Canada
| | - P Koto
- Medicine, Dalhousie University, Halifax, Canada
| | - N Shetty
- Medicine, Dalhousie University, Halifax, Canada
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Greeley B, Low H, Kelly R, McDermid R, Song X. Preserving the discreteness of deficits during coding leads to a lower frailty index in individuals living in long-term care. Mech Ageing Dev 2023; 214:111851. [PMID: 37453658 DOI: 10.1016/j.mad.2023.111851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
This study assesses two coding approaches on the frailty index (FI). Two FI were calculated using 43 variables from 29,758 older adults (84.6 ± 8 years old; 64 % female) in long-term care. Scores were coded as 0, 0.5, or 1 regardless of the number of levels (grouped), or preserved (e.g., a 4 level variable was coded as 0, 0.33, 0.67, or 1; discrete). Grouped and discrete FI were compared with each ordinal variable removed but all other ordinal variables included. This was repeated until 28 unique (14 grouped, 14 discrete) FI had been constructed each with one ordinal variable removed per FI. FI was correlated to age and mortality separated by sex. The median grouped (0.302 (0.221-0.372)) was higher relative to the discrete (0.237 (0.170-0.307)) FI. The discrete (r = 0.91, r = 0.87) and grouped (r = 0.93, r = 0.87) FI showed similar relationships to age and mortality. Removal of any ordinal variable reduced grouped FI by 0.004 or 0.016, whereas removal led to both increases (range: 0.003-0.001) and reductions (range: 0.002-0.008) for discrete FI. A grouped approach inflates FI. A discrete approach provides a more accurate measure of frailty.
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Affiliation(s)
- Brian Greeley
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada
| | - Hilary Low
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada
| | - Ronald Kelly
- Long-term Care and Assisted Living Access, Fraser Health, New Westminster, British Columbia, Canada
| | - Robert McDermid
- Critical Care, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada
| | - Xiaowei Song
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada.
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Boateng R, Yawson AE, Adoma PO. Rural-urban and socio-demographic differentials in perceived health state among aging population in Ghana. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:92. [PMID: 37658469 PMCID: PMC10474759 DOI: 10.1186/s41043-023-00433-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/19/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND The variations in health between rural and urban population have become an increasingly significant public health concern in developing countries including Ghana where urbanization is occurring. Whereas urbanization results in improved access to healthcare services, the concomitant negative consequences of urbanization coupled with unfavorable compositional and contextual attributes can affect the health of populations. The study sought to examine the effect of rural-urban residence and selected socio-demographic factors on perceived health state among aging population by employing a nationally representative data collected by the WHO from 2014 to 2015. METHODS The data were derived from the WHO Study on Aging wave 2 released in 2019. A total of 4511 individuals, made up of 1018 adults between 18 and 49 years and 3493 respondents within the ages of 50 years and above, were involved in this study. The study examined the Spearman's rho correlations between perceived health, rural-urban residence, age, sex, marital status, ever schooled, current work state, religion, and regional location. Subsequently, the study employed a multivariable ordinal logistic regression model to test the effect of the selected biosocial and contextual variables on perceived health state. RESULTS The selected socio-demographic variables significantly correlated with health state, except for rural-urban residence. However, the predictive ability of rural-urban residence and the socio-demographic variables on perceived health state were strongly ascertained. It was observed that age, sex, rural-urban residence, and current state of work among aging populations were significant predictors of perceived health state as demonstrated by odds ratios and significant p values. The contextual factor of regional location was the most significant variable that increases the perceived health state of respondents in the study. CONCLUSIONS Continues engagement in work-related activities, an individual's age within the aging continuum and regional location coupled with its environmental and ecological attributes, may significantly influence the development of positive perception toward health state, which forms a vital constituent of an individual health seeking behavior.
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Jamieson H, Nishtala P, Bergler HU, Weaver S, Pickering J, Ailabouni N, Abey-Nesbit R, Gullery C, Deely J, Gee S, Hilmer S, Mangin D. Deprescribing Anticholinergic and Sedative Drugs to Reduce Polypharmacy in Frail Older Adults Living in the Community: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2023; 78:1692-1700. [PMID: 36692224 PMCID: PMC10460556 DOI: 10.1093/gerona/glac249] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Polypharmacy is associated with poor outcomes in older adults. Targeted deprescribing of anticholinergic and sedative medications may improve health outcomes for frail older adults. Our pharmacist-led deprescribing intervention was a pragmatic 2-arm randomized controlled trial stratified by frailty. We compared usual care (control) with the intervention of pharmacists providing deprescribing recommendations to general practitioners. METHODS Community-based older adults (≥65 years) from 2 New Zealand district health boards were recruited following a standardized interRAI needs assessment. The Drug Burden Index (DBI) was used to quantify the use of sedative and anticholinergic medications for each participant. The trial was stratified into low, medium, and high-frailty. We hypothesized that the intervention would increase the proportion of participants with a reduction in DBI ≥ 0.5 within 6 months. RESULTS Of 363 participants, 21 (12.7%) in the control group and 21 (12.2%) in the intervention group had a reduction in DBI ≥ 0.5. The difference in the proportion of -0.4% (95% confidence interval [CI]: -7.9% to 7.0%) provided no evidence of efficacy for the intervention. Similarly, there was no evidence to suggest the effectiveness of this intervention for participants of any frailty level. CONCLUSION Our pharmacist-led medication review of frail older participants did not reduce the anticholinergic/sedative load within 6 months. Coronavirus disease 2019 (COVID-19) lockdown measures required modification of the intervention. Subgroup analyses pre- and post-lockdown showed no impact on outcomes. Reviewing this and other deprescribing trials through the lens of implementation science may aid an understanding of the contextual determinants preventing or enabling successful deprescribing implementation strategies.
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Affiliation(s)
- Hamish Jamieson
- Department of Medicine, Burwood Hospital, University of Otago, Christchurch, New Zealand
| | - Prasad S Nishtala
- Department of Pharmacy and Pharmacology, Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Hans Ulrich Bergler
- Department of Medicine, Burwood Hospital, University of Otago, Christchurch, New Zealand
| | - Susan K Weaver
- Department of Medicine, Burwood Hospital, University of Otago, Christchurch, New Zealand
| | - John W Pickering
- Department of Medicine, Burwood Hospital, University of Otago, Christchurch, New Zealand
| | - Nagham J Ailabouni
- The Pharmacy Australian Centre of Excellence (PACE), School of Pharmacy, University of Queensland, Brisbane, Queensland, South Australia, Australia
- UniSA Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Rebecca Abey-Nesbit
- Department of Medicine, Burwood Hospital, University of Otago, Christchurch, New Zealand
| | - Carolyn Gullery
- Planning, Funding and Decision Support, Canterbury District Health Board, General Manager of Planning, Funding and Decision Support; Lightfoot Solutions, Healthcare Systems, Specialist Advisor, Berkshire, UK
| | - Joanne Deely
- Burwood Academy Trust, Christchurch, New Zealand
| | - Susan B Gee
- Psychiatry of Old Age Academic Unit, Canterbury District Health Board, Christchurch, New Zealand
| | - Sarah N Hilmer
- Geriatric Pharmacology, Faculty of Medicine and Health, Northern Clinical School, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Dee Mangin
- Primary Care Research Group, University of Otago, Christchurch, New Zealand
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Arora A, Cummins DD, Wague A, Mendelis J, Samtani R, McNeill I, Theologis AA, Mummaneni PV, Berven S. Preoperative medical assessment for adult spinal deformity surgery: a state-of-the-art review. Spine Deform 2023; 11:773-785. [PMID: 36811703 PMCID: PMC10261200 DOI: 10.1007/s43390-023-00654-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/21/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION The purpose of this study is to provide a state-of-the-art review regarding risk factors for perioperative complications in adult spinal deformity (ASD) surgery. The review includes levels of evidence for risk factors associated with complications in ASD surgery. METHODS Using the PubMed database, we searched for complications, risk factors, and adult spinal deformity. The included publications were assessed for level of evidence as described in clinical practice guidelines published by the North American Spine Society, with summary statements generated for each risk factor (Bono et al. in Spine J 9:1046-1051, 2009). RESULTS Frailty had good evidence (Grade A) as a risk for complications in ASD patients. Fair evidence (Grade B) was assigned for bone quality, smoking, hyperglycemia and diabetes, nutritional status, immunosuppression/steroid use, cardiovascular disease, pulmonary disease, and renal disease. Indeterminate evidence (Grade I) was assigned for pre-operative cognitive function, mental health, social support, and opioid utilization. CONCLUSIONS Identification of risk factors for perioperative complications in ASD surgery is a priority for empowering informed choices for patients and surgeons and managing patient expectations. Risk factors with grade A and B evidence should be identified prior to elective surgery and modified to reduce the risk of perioperative complications.
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Affiliation(s)
- Ayush Arora
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Daniel D Cummins
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Aboubacar Wague
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Joseph Mendelis
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Rahul Samtani
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Ian McNeill
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University California, San Francisco, San Francisco, CA, USA
| | - Sigurd Berven
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA.
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Walsh B, Fogg C, Harris S, Roderick P, de Lusignan S, England T, Clegg A, Brailsford S, Fraser SDS. Frailty transitions and prevalence in an ageing population: longitudinal analysis of primary care data from an open cohort of adults aged 50 and over in England, 2006-2017. Age Ageing 2023; 52:7147101. [PMID: 37140052 PMCID: PMC10158172 DOI: 10.1093/ageing/afad058] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/16/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION frailty is common in older adults and is associated with increased health and social care use. Longitudinal information is needed on population-level incidence, prevalence and frailty progression to plan services to meet future population needs. METHODS retrospective open cohort study using electronic health records of adults aged ≥50 from primary care in England, 2006-2017. Frailty was calculated annually using the electronic Frailty Index (eFI). Multistate models estimated transition rates between each frailty category, adjusting for sociodemographic characteristics. Prevalence overall for each eFI category (fit, mild, moderate and severe) was calculated. RESULTS the cohort included 2,171,497 patients and 15,514,734 person-years. Frailty prevalence increased from 26.5 (2006) to 38.9% (2017). The average age of frailty onset was 69; however, 10.8% of people aged 50-64 were already frail in 2006. Estimated transitions from fit to any level of frailty were 48/1,000 person-years aged 50-64, 130/1,000 person-years aged 65-74, 214/1,000 person-years aged 75-84 and 380/1,000 person-years aged ≥ 85. Transitions were independently associated with older age, higher deprivation, female sex, Asian ethnicity and urban dwelling. Mean time spent in each frailty category decreased with age, with the longest period spent in severe frailty at all ages. CONCLUSIONS frailty is prevalent in adults aged ≥50 and time spent in successive frailty states is longer as frailty progresses, resulting in extended healthcare burden. Larger population numbers and fewer transitions in adults aged 50-64 present an opportunity for earlier identification and intervention. A large increase in frailty over 12 years highlights the urgency of informed service planning in ageing populations.
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Affiliation(s)
- Bronagh Walsh
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Carole Fogg
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Scott Harris
- School of Primary Care, Population Science & Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Roderick
- School of Primary Care, Population Science & Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tracey England
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Andrew Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
| | - Sally Brailsford
- Southampton Business School, University of Southampton, Southampton, UK
| | - Simon D S Fraser
- School of Primary Care, Population Science & Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Molinari-Ulate M, Mahmoudi A, Franco-Martín MA, van der Roest HG. Psychometric characteristics of comprehensive geriatric assessments (CGAs) for long-term care facilities and community care: A systematic review. Ageing Res Rev 2022; 81:101742. [PMID: 36184026 DOI: 10.1016/j.arr.2022.101742] [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: 05/09/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Comprehensive Geriatric Assessments (CGAs) have been incorporated as an integrated care approach effective to face the challenges associated to uncoordinated care, risk of hospitalization, unmet needs, and care planning experienced in older adult care. As they assessed different dimensions, is important to inform about the content and psychometric properties to guide the decisions when selecting and implementing them in practice. This systematic review provides a comprehensive insight on the strengths and weaknesses of the CGAs used in long-term care settings and community care. METHODS A systematic search was conducted in PubMed, CINAHL, and Web of Science Core Collection. Studies published up to July 13, 2021, were considered. Quality appraisal was performed for the included studies. RESULTS A total of 10 different CGAs were identified from 71 studies included. Three instruments were reported for long-term care settings, and seven for community care. The content was not homogenous and differed in terms of the detail and clearness of the areas being evaluated. Evidence for good to excellent validity and reliability was reported for various instruments. CONCLUSIONS Setting more specific and clear domains, associated to the special needs of the care setting, could improve informed decisions at the time of selecting and implementing a CGA. Considering the amount and quality of the evidence, the instrument development trajectory, the validation in different languages, and availability in different care settings, we recommend the interRAI LTCF and interRAI HC to be used for long-term facilities and community care.
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Affiliation(s)
- Mauricio Molinari-Ulate
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Spain; Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain.
| | - Aysan Mahmoudi
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Spain; Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain.
| | - Manuel A Franco-Martín
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Spain; Psychiatric and Mental Health Department, Zamora Healthcare Complex, Zamora, Spain.
| | - Henriëtte G van der Roest
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, the Netherlands.
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10
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Abey-Nesbit R, Bergler U, Pickering JW, Nishtala PS, Jamieson H. Development and validation of a frailty index compatible with three interRAI assessment instruments. Age Ageing 2022; 51:6653477. [PMID: 35930721 DOI: 10.1093/ageing/afac178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND a Frailty Index (FI) calculated by the accumulation of deficits is often used to quantify the extent of frailty in individuals in specific settings. This study aimed to derive a FI that can be applied across three standardised international Residential Assessment Instrument assessments (interRAI), used at different stages of ageing and the corresponding increase in support needs. METHODS deficit items common to the interRAI Contact Assessment (CA), Home Care (HC) or Long-Term Care Facilities assessment (LTCF) were identified and recoded to form a cumulative deficit FI. The index was validated using a large dataset of needs assessments of older people in New Zealand against mortality prediction using Kaplan Meier curves and logistic regression models. The index was further validated by comparing its performance with a previously validated index in the HC cohort. RESULTS the index comprised 15 questions across seven domains. The assessment cohort and their mean frailty (SD) were: 89,506 CA with 0.26 (0.15), 151,270 HC with 0.36 (0.15) and 83,473 LTCF with 0.41 (0.17). The index predicted 1-year mortality for each of the CA, HC and LTCF, cohorts with area under the receiver operating characteristic curves (AUCs) of 0.741 (95% confidence interval, CI: 0.718-0.762), 0.687 (95%CI: 0.684-0.690) and 0.674 (95%CI: 0.670-0.678), respectively. CONCLUSIONS the results for this multi-instrument FI are congruent with the differences in frailty expected for people in the target settings for these instruments and appropriately associated with mortality at each stage of the journey of progressive ageing.
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Affiliation(s)
| | - Ulrich Bergler
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - John W Pickering
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Prasad S Nishtala
- Centre for Therapeutic Innovation, Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
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11
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Zampino M, Polidori MC, Ferrucci L, O’Neill D, Pilotto A, Gogol M, Rubenstein L. Biomarkers of aging in real life: three questions on aging and the comprehensive geriatric assessment. GeroScience 2022; 44:2611-2622. [PMID: 35796977 PMCID: PMC9261220 DOI: 10.1007/s11357-022-00613-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/19/2022] [Indexed: 01/07/2023] Open
Abstract
Measuring intrinsic, biological age is a central question in medicine, which scientists have been trying to answer for decades. Age manifests itself differently in different individuals, and chronological age often does not reflect such heterogeneity of health and function. We discuss here the value of measuring age and aging using the comprehensive geriatric assessment (CGA), cornerstone of geriatric medicine, and operationalized assessment tools for prognosis. Specifically, we review the benefits of employing the multidimensional prognostic index (MPI), which collects information about eight domains relevant for the global assessment of the older person (functional and cognitive status, nutrition, mobility and risk of pressure sores, multi-morbidity, polypharmacy, and co-habitation), in the evaluation of the functional status, and in the prediction of health outcomes for older adults. Further integration of biological markers of aging into multidimensional prognostic tools is warranted, as well as actions which could facilitate prognostic assessments for older persons in all healthcare settings.
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Affiliation(s)
- Marta Zampino
- grid.94365.3d0000 0001 2297 5165Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD USA
| | - M. Cristina Polidori
- grid.6190.e0000 0000 8580 3777Aging Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Cologne Excellence Cluster On Cellular Stress- Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Luigi Ferrucci
- grid.94365.3d0000 0001 2297 5165Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD USA
| | - Desmond O’Neill
- grid.413305.00000 0004 0617 5936Tallaght University Hospital and Trinity College Dublin, Tallaght University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland
| | - Alberto Pilotto
- grid.450697.90000 0004 1757 8650Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy ,grid.7644.10000 0001 0120 3326Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Manfred Gogol
- grid.10423.340000 0000 9529 9877Trauma Department, Orthogeriatric Unit, Hannover Medical School, Hannover, Germany ,grid.7700.00000 0001 2190 4373Institute of Gerontology, University of Heidelberg, Heidelberg, Germany
| | - Laurence Rubenstein
- grid.266900.b0000 0004 0447 0018Department of Geriatric Medicine, University of Oklahoma, Oklahoma City, OK USA
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Huang S, Wang Y, Chen L, Chen X. Use of a frailty index based upon routine laboratory data to predict complication and mortality in older community-acquired pneumonia patients. Arch Gerontol Geriatr 2022; 101:104692. [DOI: 10.1016/j.archger.2022.104692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/19/2022] [Accepted: 03/20/2022] [Indexed: 11/17/2022]
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13
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The Older Persons' Index of Multiple Deprivation: Measuring the deprivation circumstances of older populations in Aotearoa New Zealand. Health Place 2022; 76:102850. [PMID: 35777248 DOI: 10.1016/j.healthplace.2022.102850] [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: 11/08/2021] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/22/2022]
Abstract
Existing indices of multiple deprivation exclude indicators specifically relevant to the population aged ≥65 years. In this study we create a whole-of-population cohort of people aged ≥65 years living in private dwellings and who completed the 2013 New Zealand Census of Populations and Dwellings to create an Older Persons' Index of Multiple Deprivation (OPIMD). We combined 22 indicators representing 6 domains of deprivation (Income, Housing, Health, Assets, Connectedness and Geographic access) to establish this individual-level measure of deprivation. We used smoking data from the census to validate the OPIMD and describe the geography of the OPIMD by District Health Board, contrasting these patterns with a conventional area deprivation index. The OPIMD has the potential to inform policies concerning resource allocation for the older population. An accompanying website with an interactive atlas and an online OPIMD calculator is available for wider use of the data. Further research is required to explore associations between the OPIMD and other major health and social outcomes affecting this population.
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Detecting Acute Deterioration in Older Adults Living in Residential Aged Care: A Scoping Review. J Am Med Dir Assoc 2022; 23:1517-1540. [PMID: 35738427 DOI: 10.1016/j.jamda.2022.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/18/2022] [Accepted: 05/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To explore models, processes, or tools implemented in residential aged care (RAC) to support registered nurses (RNs) to identify and respond to the acute deterioration of residents. DESIGN Scoping literature review of English Language articles published in peer reviewed journals. SETTINGS AND PARTICIPANTS Studies were conducted in RAC facilities providing long-term 24-hour medical, nursing, and social care for people age 65 years or older with age-related disability. METHODS We completed a MESH term and key word search of MEDLINE, Embase, CINAHL, PubMed, and Google Scholar. Included studies had (1) part of the intervention based in RAC; (2) had a direct impact on RAC day to day practice; and (3) contained or provided access to the detail of the intervention. Data was charted by author, date, country, study design and the components, genesis, and efficacy of the methods used to identify and respond to acute deterioration. RESULTS We found 46 studies detailing models of care, clinical patterns of acute deterioration, and deterioration detection tools. It was not possible to determine which element of the models care had the greatest impact on RN decision making. The clinical patterns of acute deterioration painted a picture of acute deterioration in the frail. There was limited evidence to support the use of existing deterioration detection tools in the RAC population. CONCLUSION AND IMPLICATIONS We found no straight forward systematic method to support RAC RNs to identify and respond to the acute deterioration of residents. This is an important practice gap. The clinical pattern of acute deterioration described in the literature has the potential to be used for the development of a tool to support RAC RNs to identify and respond to the acute deterioration of residents.
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Rasiah J, Gruneir A, Oelke ND, Estabrooks C, Holroyd-Leduc J, Cummings GG. Instruments to assess frailty in community dwelling older adults: A systematic review. Int J Nurs Stud 2022; 134:104316. [DOI: 10.1016/j.ijnurstu.2022.104316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
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Nystrøm V, Lurås H, Moger T, Leonardsen ACL. Finding good alternatives to hospitalisation: a data register study in five municipal acute wards in Norway. BMC Health Serv Res 2022; 22:715. [PMID: 35637492 PMCID: PMC9153207 DOI: 10.1186/s12913-022-08066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In Norway, municipal acute wards (MAWs) have been implemented in primary healthcare since 2012. The MAWs were intended to offer decentralised acute medical care 24/7 for patients who otherwise would be admitted to hospital. The aim of this study was to assess whether the MAW represents the alternative to hospitalisation as intended, through 1) describing the characteristics of patients intended as candidates for MAWs by primary care physicians, 2) exploring the need for extended diagnostics prior to admission in MAWs, and 3) exploring factors associated with patients being transferred from the MAWs to hospital. METHODS The study was based on register data from five MAWs in Norway in the period 2014-2020. RESULTS In total, 16 786 admissions were included. The median age of the patients was 78 years, 60% were women, and the median length of stay was three days. Receiving oral medication (OR 1.23, 95% CI 1.09-1.40), and the MAW being located nearby the hospital (OR 2.29, 95% CI 1.92-2.72) were factors associated with patients admitted to MAW after extended diagnostics. Patients needing advanced treatment, such as oxygen therapy (OR 2.13, 95% CI 1.81-2.51), intravenous medication (OR 1.60, 95% CI 1.45-1.81), intravenous fluid therapy (OR 1.32, 95% CI 1.19-1.47) and MAWs with long travel distance from the MAW to the hospital (OR 1.46, 95% CI 1.22-1.74) had an increased odds for being transferred to hospital. CONCLUSIONS Our findings indicate that MAWs do not represent the alternative to hospitalisation as intended. The results show that patients receiving extended diagnostics before admission to MAW got basic treatment, while patients in need of advanced medical treatment were transferred to hospital from a MAW. This indicates that there is still a potential to develop MAWs in order to fulfil the intended health service level.
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Affiliation(s)
- Vivian Nystrøm
- Department of Health, Welfare and Organisation, Østfold University College, Postal Box Code (PB) 700, 1757 Halden, Norway
- Department of Health Management and Health Economics, University of Oslo, 1089 Blindern, Postal Box Code (PB), 0317 Oslo, Norway
| | - Hilde Lurås
- Health Services Research Unit, Akershus University Hospital, Postal box code (PB) 1000 1478 Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | - Tron Moger
- Department of Health Management and Health Economics, University of Oslo, 1089 Blindern, Postal Box Code (PB), 0317 Oslo, Norway
| | - Ann-Chatrin Linqvist Leonardsen
- Department of Health, Welfare and Organisation, Østfold University College, Postal Box Code (PB) 700, 1757 Halden, Norway
- Østfold Hospital Trust, Grålum, Norway
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Shen F, Chen J, Yang R, Yang J, Li H. Association between control status of blood pressure and frailty among middle-aged and older adults with hypertension in China: a longitudinal study. BMJ Open 2022; 12:e056395. [PMID: 35288389 PMCID: PMC8921919 DOI: 10.1136/bmjopen-2021-056395] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the association between blood pressure (BP) control and frailty among middle-aged and older populations with hypertension in China from 2013 to 2018. DESIGN Prospective longitudinal study. SETTING This study analysed data from the China Health and Retirement Longitudinal Study, a nationally representative survey administered in 28 provinces of China. PARTICIPANTS A total of 3254 participants diagnosed with hypertension previous to 2013 were taken into analysis. 1932 participants who were not frail in 2013 were enrolled to calculate relative risk. OUTCOME MEASURES The frailty score was constructed following Rookwood's Cumulative deficit frailty index, with a score >0.25 defined as frailty (outcome variable). The self-reported status of BP control (exposure variable) represented the general status of the participant's BP level. A fixed-effects model was used to analyse the association between BP control and frailty. A Cox proportional hazard model was further used to further calculate the relative risk of frailty for different BP control levels. RESULTS The fixed-effects model showed that compared with well-controlled BP, poorly controlled BP exhibited a positive association with frailty score (β=0.015; 95% CI 0.011 to 0.019; p<0.001). The Cox proportional hazard model also revealed a higher risk of frailty in the poorly controlled group (HR=1.96; 95% CI 1.49 to 2.56; p<0.001). Based on subgroup analyses, poorly controlled BP was positively associated with frailty in respondents aged <60 years old (fix-effects model: β=0.015, p=0.021; Cox model: HR=2.25, p<0.001), but not significant among those aged ≥75 years old. CONCLUSIONS We provide new evidence of a negative association between BP control and frailty risk, but the findings differ among different age groups. Individualised strategies for BP management should be developed, especially for older hypertension patients.
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Affiliation(s)
| | - Jiangyun Chen
- School of Health Management, Southern Medical University, Guangzhou, China
- Health Management Institute, Southern Medical University, Guangzhou, China
| | | | - Jun Yang
- Wuhan Red Cross Hospital, Wuhan, China
| | - Haomiao Li
- Department of Sociology, Huazhong Agricultural University, Wuhan, China
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18
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Bloomfield K, Wu Z, Tatton A, Calvert C, Peel N, Hubbard R, Jamieson H, Hikaka J, Boyd M, Bramley D, Connolly MJ. An interRAI derived frailty index predicts acute hospitalizations in older adults residing in retirement villages: A prospective cohort study. PLoS One 2022; 17:e0264715. [PMID: 35235598 PMCID: PMC8890727 DOI: 10.1371/journal.pone.0264715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/11/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives The development of frailty tools from electronically recorded healthcare data allows frailty assessments to be routinely generated, potentially beneficial for individuals and healthcare providers. We wished to assess the predictive validity of a frailty index (FI) derived from interRAI Community Health Assessment (CHA) for outcomes in older adults residing in retirement villages (RVs), elsewhere called continuing care retirement communities. Design Prospective cohort study. Setting and participants 34 RVs across two district health boards in Auckland, Aotearoa New Zealand (NZ). 577 participants, mean age 81 years; 419 (73%) female; 410 (71%) NZ European, 147 (25%) other European, 8 Asian (1%), 7 Māori (1%), 1 Pasifika (<1%), 4 other (<1%). Methods interRAI-CHA FI tool was used to stratify participants into fit (0–0.12), mild (>0.12–0.24), moderate (>0.24–0.36) and severe (>0.36) frail groups at baseline (the latter two grouped due to low numbers of severely frail). Primary outcome was acute hospitalization; secondary outcomes included long-term care (LTC) entry and mortality. The relationship between frailty and outcomes were explored with multivariable Cox regression, estimating hazard ratios (HRs) and 95% confidence intervals (95%CIs). Results Over mean follow-up of 2.5 years, 33% (69/209) of fit, 58% (152/260) mildly frail and 79% (85/108) moderate-severely frail participants at baseline had at least one acute hospitalization. Compared to the fit group, significantly increased risk of acute hospitalization were identified in mildly frail (adjusted HR = 1.88, 95%CI = 1.41–2.51, p<0.001) and moderate-severely frail (adjusted HR = 3.52, 95%CI = 2.53–4.90, p<0.001) groups. Similar increased risk in moderate-severely frail participants was seen in LTC entry (adjusted HR = 5.60 95%CI = 2.47–12.72, p<0.001) and mortality (adjusted HR = 5.06, 95%CI = 1.71–15.02, p = 0.003). Conclusions and implications The FI derived from interRAI-CHA has robust predictive validity for acute hospitalization, LTC entry and mortality. This adds to the growing literature of use of interRAI tools in this way and may assist healthcare providers with rapid identification of frailty.
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Affiliation(s)
- Katherine Bloomfield
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
- * E-mail:
| | - Zhenqiang Wu
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Waitematā District Health Board, Auckland, New Zealand
| | | | - Nancye Peel
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Ruth Hubbard
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna Hikaka
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
| | - Martin J. Connolly
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
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Gilmore N, Xu H, Kehoe L, Kleckner AS, Moorthi K, Lei L, Mohamed MR, Loh KP(M, Culakova E, Flannery M, Ramsdale E, Duberstein PR, Canin B, Kamen C, Giri G, Watson E, Patil A, Onitilo AA, Burnette B, Janelsins M, Mohile SG. Evaluating the association of frailty with communication about aging-related concerns between older patients with advanced cancer and their oncologists. Cancer 2022; 128:1101-1109. [PMID: 34762734 PMCID: PMC8837685 DOI: 10.1002/cncr.34010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND A geriatric assessment (GA) intervention improves communication about aging-related concerns, but its effect on communication in patients with various levels of frailty is unknown. METHODS This was a secondary analysis of a nationwide trial of patients aged ≥70 years with incurable cancer and impairment on 1 or more GA domains (ClinicalTrials.gov Identifier NCT02107443; principal investigator Supriya G. Mohile). Practice sites were randomized to either the GA-intervention or usual care. Frailty was assessed with a deficit accumulation index (range, 0-1), and patients were stratified as robust (0 to <0.2), prefrail (0.2 to <0.35), or frail (≥0.35). The clinic visit after the GA-intervention was audio-recorded, transcribed, and coded to evaluate the number and quality of conversations about aging-related concerns. Linear mixed models examined differences in the number and quality of conversations within and between arms. All P values were 2-sided. RESULTS Patients (n = 541) were classified as robust (27%), prefrail (42%), or frail (31%). In the usual care arm, frail patients (vs robust ones) engaged in more aging-related conversations (adjusted mean difference, 1.73; 95% confidence interval [CI], 0.59-2.87), conversations of higher quality (difference, 1.12; 95% CI, 0.24-2.0), and more discussions about evidence-based recommendations (difference, 0.71; 95% CI, 0.04-1.38; all P values ≤ .01). Similarly, in the GA intervention arm, frail patients (vs robust ones) engaged in more aging-related conversations (difference, 2.49; 95% CI, 1.51-3.47), conversations of higher quality (difference, 1.31; 95% CI, 0.56-2.06), and more discussions about evidence-based recommendations (difference, 0.87; 95% CI, 0.32-1.42; all P values ≤ .01). Furthermore, the GA-intervention significantly improved the number and quality of conversations in all patients: robust, prefrail, and frail (all P values ≤ .01). CONCLUSIONS Patients with higher degrees of frailty and those exposed to the GA-intervention had more and higher quality conversations about aging-related concerns with oncologists. LAY SUMMARY A geriatric assessment (GA) intervention improves communication about aging-related concerns, but its effect on communication in patients with various levels of frailty is unknown. This study conducted a secondary analysis of a nationwide trial of patients aged ≥70 years with incurable cancer and 1 or more GA domain impairments. Patients were stratified as robust, prefrail, or frail. The number and quality of conversations about aging-related concerns that occurred during the clinic visit after the GA-intervention were determined. Patients with higher degrees of frailty and those in the GA intervention arm had more and higher quality conversations about aging-related concerns with oncologists.
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Affiliation(s)
| | - Huiwen Xu
- University of Rochester Medical Center, Rochester, NY
| | - Lee Kehoe
- University of Rochester Medical Center, Rochester, NY
| | | | - Kiran Moorthi
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | - Eva Culakova
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | - Beverly Canin
- SCOREboard Stakeholder Advisory Group, University of Rochester Medical Center, Rochester, NY
| | - Charles Kamen
- University of Rochester Medical Center, Rochester, NY
| | - Gilbert Giri
- University of Rochester Medical Center, Rochester, NY
| | - Erin Watson
- University of Rochester Medical Center, Rochester, NY
| | | | | | - Brian Burnette
- Cancer Research of Wisconsin and Northern Michigan (CROWN)
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Abstract
Biology of aging is an active and rapidly expanding area of biomedical research. Over the years, focus of work in this field has been gradually shifting from studying the effects and symptoms of aging to searching for mechanisms of the aging process. Progress of this work led to an additional shift from looking for “the mechanism” of aging and formulating the corresponding “theories of aging” to appreciation that aging represents a net result of multiple physiological changes and their intricate interactions. It was also shown that mechanisms of aging include nutrient-dependent signaling pathways which have been remarkably conserved in the course of the evolution. Another important development in this field is increased emphasis on searching for pharmacological and environmental interventions that can extend healthspan or influence other aspects of aging. Progress in understanding the key role of aging as a risk factor for chronic disease provides impetus for these studies. Data from the recent pandemic provided additional evidence for the impact of age on resilience. Progress of work in this area also was influenced by major analytical and technological advances, including greatly improved methods for the study of gene expression, protein, lipids, and metabolites profiles, enhanced ability to produce various genetic modifications and novel approaches to assessment of biological age. Progress in research on the biology of aging provides reasons for optimism about the chances that safe and widely applicable anti-aging interventions with significant benefits for both individual and public health will be developed in the not too distant future.
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Affiliation(s)
- Andrzej Bartke
- Department of Internal Medicine, Southern Illinois University School of Medicine, 801 N. Rutledge St., P. O. Box 19628, Springfield, IL, 62794-9628, USA.
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Stuck AK, Mangold JM, Wittwer R, Limacher A, Bischoff-Ferrari HA. Ability of 3 Frailty Measures to Predict Short-Term Outcomes in Older Patients Admitted for Post-Acute Inpatient Rehabilitation. J Am Med Dir Assoc 2021; 23:880-884. [PMID: 34687605 DOI: 10.1016/j.jamda.2021.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the ability of 3 commonly used frailty measures to predict short-term clinical outcomes in older patients admitted for post-acute inpatient rehabilitation. DESIGN Observational cohort study. SETTING AND PARTICIPANTS Consecutive patients (n = 207) admitted to a geriatric inpatient rehabilitation facility. METHODS Frailty on admission was assessed using a frailty index, the physical frailty phenotype, and the Clinical Frailty Scale (CFS). Predictive capacity of the frailty instruments was analyzed for (1) nonhome discharge, (2) readmission to acute care, (3) functional decline, and (4) prolonged length of stay, using multivariate logistic regression models and receiver operating characteristic (ROC) curves. RESULTS The number of patients classified as frail was 91 (44.0%) with the frailty index, 134 (64.7%) using the frailty phenotype, and 151 (73.0%) with the CFS. The 3 frailty measures revealed acceptable discriminatory accuracy for nonhome discharge (area under the curve ≥ 0.7) but differed in their predictive ability: the adjusted odds ratio (OR) for nonhome discharge was highest for the CFS [6.2, 95% confidence interval (CI) 1.8-21.1], compared to the frailty index (4.1, 95% CI 2.0-8.4) and the frailty phenotype (OR 2.9, 95% CI 1.2-6.6). For the other outcomes, discriminatory accuracy based on ROC tended to be lower and predictive ability varied according to frailty measure. Readmission to acute care from inpatient rehabilitation was predicted by all instruments, most pronounced by the frailty phenotype (OR 5.4, 95% CI 1.6-18.8) and the frailty index (OR 2.5, 95% CI 1.1-5.6), and less so by the CFS (OR 1.4, 95% CI 0.5-3.8). CONCLUSIONS AND IMPLICATIONS Frailty measures may contribute to improved prediction of outcomes in geriatric inpatient rehabilitation. The choice of the instrument may depend on the individual outcome of interest and the corresponding discriminatory ability of the frailty measure.
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Affiliation(s)
- Anna K Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Joel M Mangold
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rachel Wittwer
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Heike A Bischoff-Ferrari
- Department of Aging Medicine, University Hospital Zurich, Zurich, Switzerland; Centre on Aging and Mobility, University Hospital Zurich, University of Zurich, Zurich, Switzerland; University Clinic for Aging Medicine, City Hospital Zurich, Waid, Zurich, Switzerland
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Lohman T, Bains G, Berk L, Lohman E. Predictors of Biological Age: The Implications for Wellness and Aging Research. Gerontol Geriatr Med 2021; 7:23337214211046419. [PMID: 34595331 PMCID: PMC8477681 DOI: 10.1177/23337214211046419] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/14/2021] [Accepted: 08/18/2021] [Indexed: 12/26/2022] Open
Abstract
As healthspan and lifespan research breakthroughs have become more commonplace, the need for valid, practical markers of biological age is becoming increasingly paramount. The accessibility and affordability of biological age predictors that can reveal information about mortality and morbidity risk, as well as remaining years of life, has profound clinical and research implications. In this review, we examine 5 groups of aging biomarkers capable of providing accurate biological age estimations. The unique capabilities of these biomarkers have far reaching implications for the testing of both pharmaceutical and non-pharmaceutical interventions designed to slow or reverse biological aging. Additionally, the enhanced validity and availability of these tools may have increasingly relevant clinical value. The authors of this review explore those implications, with an emphasis on lifestyle modification research, and provide an overview of the current evidence regarding 5 biological age predictor categories: Telomere length, composite biomarkers, DNA methylation “epigenetic clocks,” transcriptional predictors of biological age, and functional age predictors.
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Affiliation(s)
- Trevor Lohman
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Gurinder Bains
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Lee Berk
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Everett Lohman
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
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Brown AD, Li B, Gabriel S, Cusimano RJ, Chung J, Horlick E, Osten MD, Ouzounian M, Roche-Nagle G. Association Between Sarcopenia and Adverse Events Following Transcatheter Aortic Valve Implantation. CJC Open 2021; 4:173-179. [PMID: 35198934 PMCID: PMC8843889 DOI: 10.1016/j.cjco.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022] Open
Abstract
Background Sarcopenia, the age-related loss of skeletal muscle mass/function, has been identified as a marker of frailty. We examined the association between sarcopenia and adverse events following transcatheter aortic valve implantation (TAVI). Methods A retrospective cohort study was conducted at Toronto General Hospital. All patients who underwent TAVI in the time period 2007-2017 with preoperative computed tomography were included. Skeletal muscle index (SMI) was calculated radiographically using psoas muscle area at the L3 vertebral level, divided by height. Various measures of sarcopenia, including mean SMI, SMI below the sex-specific median, and SMI in the lowest sex-specific quartile were calculated. The primary outcome was postoperative adverse events, defined as a composite of in-hospital mortality and morbidity including cardiovascular, pulmonary, neurologic, access-related, and gastrointestinal complications. Univariate and multivariate logistic regression were performed to determine the association between sarcopenia and adverse events. Results A total of 468 patients (mean age: 80.7 years) were included. Baseline comorbidity burden was high, particularly congestive heart failure (93.4%). Postoperative adverse events occurred in 62 patients (13.2%). Univariate logistic regression demonstrated that postoperative adverse events were correlated with mean SMI (odds ratio [OR] 0.81, 95% confidence interal [CI] 0.66-0.97), events were less than the SMI (OR 2.16, 95% CI 1.24-3.84), and SMI in the sex-specific lowest quartile (OR 2.34, 95% CI 1.33-4.07). On multivariate analysis, SMI in the sex-specific lowest quartile was an independent predictor of adverse events (OR 2.53, 95% CI 1.41-4.50). Conclusions Sarcopenia defined by radiologic psoas muscle measurements was independently associated with in-hospital mortality and morbidity following TAVI.
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Affiliation(s)
- Andrew D. Brown
- Division of Interventional Radiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ben Li
- Division of Vascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Gabriel
- Division of Vascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert J. Cusimano
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Chung
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eric Horlick
- Division of Cardiology, Peter Munk Cardiac Centre, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mark D. Osten
- Division of Cardiology, Peter Munk Cardiac Centre, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Graham Roche-Nagle
- Division of Vascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Dr Graham Roche-Nagle, Division of Vascular Surgery, University Health Network, 6E-218, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada. Tel.: +1-416-340-5332; fax: +1-416-340-5029.
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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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25
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Beard JR, Si Y, Liu Z, Chenoweth L, Hanewald K. Intrinsic Capacity: Validation of a New WHO Concept for Healthy Ageing in a Longitudinal Chinese Study. J Gerontol A Biol Sci Med Sci 2021; 77:94-100. [PMID: 34343305 DOI: 10.1093/gerona/glab226] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The World Health Organization has proposed a model of healthy aging built around the concept of functional ability, comprising an individual's intrinsic capacity, the physical and social environment they occupy, and interactions between the two. However, these constructs have been poorly defined. We examined the structure of intrinsic capacity in a representative sample of the Chinese population aged 60 years and over and assessed its value in predicting declining performance in instrumental activities of daily living (IADLs) and activities of daily living (ADLs) using similar methods to a construct validation previously undertaken in an English cohort. METHODS De-identified data were accessed on 7643 participants of the China Health and Retirement Longitudinal Study (CHARLS) 2011 and 2013 waves. Incrementally related structural equation modelling was applied, including exploratory and confirmatory factor analysis, and path analysis. Multiple linear regression tested construct validity, and simple and serial mediation models assessed predictive validity. RESULTS Factor loadings for the models showed a clear structure for intrinsic capacity: one general factor with five subfactors - locomotor, cognitive, psychological and sensory capacities, and vitality (reflecting underlying physiologic changes). Intrinsic capacity predicted declining performance in both IADLs (Standardized Coefficient (SE) -0.324 (0.02), p<0.001) and ADLs (-0.227 (0.03), p<0.001), after accounting for age, sex, education, wealth and number of chronic diseases. Each characteristic was associated with intrinsic capacity, providing strong construct validity. CONCLUSIONS Assessment of intrinsic capacity provides valuable information on an individual's subsequent functioning beyond that afforded by age, other personal factors and multimorbidity.
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Affiliation(s)
- John R Beard
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia
| | - Yafei Si
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia.,School of Risk & Actuarial Studies, University of New South Wales, Sydney, Australia
| | - Zhixin Liu
- Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - Lynn Chenoweth
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Katja Hanewald
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia.,School of Risk & Actuarial Studies, University of New South Wales, Sydney, Australia
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Van Damme JK, Lemmon K, Oremus M, Neiterman E, Stolee P. Understanding Frailty Screening: a Domain Mapping Exercise. Can Geriatr J 2021; 24:154-161. [PMID: 34079610 PMCID: PMC8137461 DOI: 10.5770/cgj.24.401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Many definitions and operationalisations of frailty exclude psychosocial factors, such as social isolation and mental health, despite considerable evidence of the links between frailty and these factors. This study aimed to investigate the health domains covered by frailty screening tools. Methods A systematic search of the literature was conducted in accordance with PRISMA guidelines. MEDLINE, CINAHL, EMBASE, and PsycInfo were searched from inception to December 31, 2018. Data related to the domains of each screening tool were extracted and mapped onto a framework based on the biopsychosocial model of Lehmans et al. (2009) and Wade & Halligans (2017). Results Sixty-seven frailty screening tools were captured in 79 articles. All screening tools assessed biological factors, 73% assessed psychological factors, 52% assessed social factors, and 78% assessed contextual factors. Under half (43%) of the tools evaluated all four domains, 33% evaluated three of four domains, 12% reported two of four domains, and 13% reported one domain (biological). Conclusion This review found considerable variation in the assessment domains covered by frailty screening tools. Frailty is a broad construct, and frailty screening tools need to cover a wide variety of domains to enhance screening and outcomes assessment.
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Affiliation(s)
- Jill K Van Damme
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1
| | - Kassandra Lemmon
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1
| | - Mark Oremus
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1
| | - Elena Neiterman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1
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Abey-Nesbit R, Peel NM, Matthews H, Hubbard RE, Nishtala PS, Bergler U, Deely JM, Pickering JW, Schluter PJ, Jamieson HA. Frailty of Māori, Pasifika, and Non-Māori/Non-Pasifika Older People in New Zealand: A National Population Study of Older People Referred for Home Care Services. J Gerontol A Biol Sci Med Sci 2021; 76:1101-1107. [PMID: 33075128 DOI: 10.1093/gerona/glaa265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of frailty in indigenous populations. We developed a frailty index (FI) for older New Zealand Māori and Pasifika who require publicly funded support services. METHODS An FI was developed for New Zealand adults aged 65 and older who had an interRAI Home Care assessment between June 1, 2012 and October 30, 2015. A frailty score for each participant was calculated by summing the number of deficits recorded and dividing by the total number of possible deficits. This created a FI with a potential range from 0 to 1. Linear regression models for FIs with ethnicity were adjusted for age and sex. Cox proportional hazards models were used to assess the association between the FI and mortality for Māori, Pasifika, and non-Māori/non-Pasifika. RESULTS Of 54 345 participants, 3096 (5.7%) identified as Māori, 1846 (3.4%) were Pasifika, and 49 415 (86.7%) identified as neither Māori nor Pasifika. New Zealand Europeans (48 178, 97.5%) constituted most of the latter group. Within each sex, the mean FIs for Māori and Pasifika were greater than the mean FIs for non-Māori and non-Pasifika, with the difference being more pronounced in women. The FI was associated with mortality (Māori subhazard ratio [SHR] 2.53, 95% CI 1.63-3.95; Pasifika SHR 6.03, 95% CI 3.06-11.90; non-Māori and non-Pasifika SHR 2.86, 95% CI 2.53-3.25). CONCLUSIONS This study demonstrated differences in FI between the ethnicities in this select cohort. After adjustment for age and sex, increases in FI were associated with increased mortality. This suggests that FI is predictive of poor outcomes in these ethnic groups.
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Affiliation(s)
| | - Nancye M Peel
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Hector Matthews
- Māori and Pacific Health, Canterbury District Health Board, Christchurch, New Zealand
| | - Ruth E Hubbard
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Ulrich Bergler
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanne M Deely
- Canterbury District Health Board, Christchurch, New Zealand
| | - John W Pickering
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Philip J Schluter
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,School of Health Sciences and Child Wellbeing Research Institute, University of Canterbury, Christchurch, New Zealand
| | - Hamish A Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Dwyer JT, Gahche JJ, Weiler M, Arensberg MB. Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps. J Community Health 2021; 45:640-660. [PMID: 31571022 PMCID: PMC7188699 DOI: 10.1007/s10900-019-00739-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.
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Affiliation(s)
- Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, 02111, USA
- Department of Medicine and Community Health, School of Medicine and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
| | - Jaime J Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
| | - Mary Weiler
- Abbott Nutrition Division of Abbott, Columbus, OH, 43219, USA
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Wæhler IS, Saltvedt I, Lydersen S, Fure B, Askim T, Einstad MS, Thingstad P. Association between in-hospital frailty and health-related quality of life after stroke: the Nor-COAST study. BMC Neurol 2021; 21:100. [PMID: 33663430 PMCID: PMC7931593 DOI: 10.1186/s12883-021-02128-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/17/2021] [Indexed: 12/31/2022] Open
Abstract
Background Stroke survivors are known to have poorer health-related quality of life (HRQoL) than the general population, but less is known about characteristics associated with HRQoL decreasing through time following a stroke. This study aims to examine how in-hospital frailty is related to HRQoL from 3 to 18 months post stroke. Method Six hundred twenty-five participants hospitalised with stroke were included and followed up at 3 and/or 18 months post stroke. Stroke severity was assessed the day after admission with the National Institutes of Health Stroke Scale (NIHSS). A modified Fried phenotype was used to assess in-hospital frailty; measures of exhaustion, physical activity, and weight loss were based on pre-stroke status, while gait speed and grip strength were measured during hospital stay. HRQoL at 3- and 18-months follow-up were assessed using the five-level version of the EuroQol five-dimensional descriptive system (EQ-5D-5L) and the EuroQol visual analogue scale (EQ-5D VAS). We conducted linear mixed effect regression analyses unadjusted and adjusted for sex, age, and stroke severity to investigate the association between in-hospital frailty and post-stroke HRQoL. Results Mean (SD) age was 71.7 years (11.6); mean NIHSS score was 2.8 (4.0), and 263 (42.1%) were female. Frailty prevalence was 10.4%, while 58.6% were pre-frail. The robust group had EQ-5D-5L index and EQ-5D VAS scores at 3 and 18 months comparable to the general population. Also at 3 and 18 months, the pre-frail and frail groups had significantly lower EQ-5D-5L indices than the robust group (p < 0.001), and the frail group showed a larger decrease from 3 to 18 months in the EQ-5D-5L index score compared to the robust group (− 0.056; 95% CI − 0.104 to − 0.009; p = 0.021). There were no significant differences in change in EQ-5D VAS scores between the groups. Conclusion This study on participants mainly diagnosed with mild strokes suggests that robust stroke patients have fairly good and stable post-stroke HRQoL, while post-stroke HRQoL is impaired and continues to deteriorate among patients with in-hospital frailty. This emphasises the importance of a greater focus on frailty in stroke units. Trial registration ClinicalTrials.gov (NCT02650531).
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Affiliation(s)
- Idunn Snorresdatter Wæhler
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Brynjar Fure
- Department of Internal Medicine and Department of Neurology, Central Hospital Karlstad and School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Marte Stine Einstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
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Comprehensive geriatric assessment among elderly people in a convalescence unit: a best practice implementation project. JBI Evid Implement 2021; 19:357-366. [PMID: 34810407 DOI: 10.1097/xeb.0000000000000274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aim of this project was to audit the usual assessment practices employed when admitting patients to a convalescence unit on the outskirts of Barcelona, Spain. The project implemented strategies to improve evidence-based practice using the Joanna Briggs Institute methodology. The specific objectives of this project were (1) to improve completion of the comprehensive geriatric assessment (CGA) record, (2) to improve professionals' CGA knowledge, (3) to promote interdisciplinary work, (4) to improve tailored therapeutic plan generation by implementing evidence-based practice criteria within the instrument, and (5) to evaluate the records and action plans derived from the CGA. METHODS Pre-/post-implementation audit methodology was used the Practical Application of Clinical Evidence System and Getting Research into Practice, and was developed in multiple phases. The implementation phase took 6 months. A sample of 34 consecutive admissions had their CGA patient records evaluated. Descriptive statistics were calculated. RESULTS A total of 64 records (34 pre/30 post) were reviewed to assess CGA completion. The baseline audit results showed that only two audit criteria were higher than 50%, indicating poor knowledge about the concept of CGA and poor compliance with the current program. Following the implementation of the strategies, which included education and the development of a checklist, there was an improvement in all the criteria audited: the record was correctly completed in 67% of cases, and 80% of team members were knowledgeable and competent in CGA. CONCLUSION Several barriers were identified at baseline, and various strategies were implemented to improve CGA compliance. The results show that the project increased awareness of the importance of a comprehensive assessment of the care that patients receive, resulting in better CGA completion.
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Zupo R, Castellana F, Bortone I, Griseta C, Sardone R, Lampignano L, Lozupone M, Solfrizzi V, Castellana M, Giannelli G, De Pergola G, Boeing H, Panza F. Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty. Ageing Res Rev 2020; 64:101148. [PMID: 32827687 DOI: 10.1016/j.arr.2020.101148] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
Abstract
Different methods have been proposed for the assessment of the nutritional status in frailty phenotypes. In the present narrative review article, we have summarized the number and specifications of nutritional items in existing frailty tools, in order to develop a possible means of assessment and operational definition of the nutritional frailty phenotype. In six different databases until December 2019, we searched for original articles regarding frailty tools (i.e., scales, indexes, scores, questionnaires, instruments, evaluations, screening, indicators), analyzing each tool regarding nutritional items. We identified 160 articles describing 71 frailty tools. Among the selected frailty tools, 54 were community-based (70 %), 17 hospital-based (22 %), 4 validated in long-term care institutions for older adults (LTCIOA) (5.1 %) and 2 validated in both community- and hospital-based settings, including LTCIOA (2.5 %). Fifty-two of these tools (73 %) included at least one nutritional item. Twenty-two (42 %) reported two or more nutritional items. The items were grouped in the following categories: A) anthropometric measurements, B) laboratory measurements, and C) other nutritional-related measurements. Anthropometric measurements stood out compared to all other items. Nutritional items are included in the majority of frailty tools, strengthening the concept that they may have a direct implication on an increased risk of adverse health-related outcomes in frail subjects. This supports the development of the concept of nutritional frailty as an independent frailty phenotype. Subsequent steps will be to assess the contribution of each nutritional item to a possible operational definition of nutritional frailty and define the items that may best identify this new frailty phenotype.
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Bloomfield K, Wu Z, Tatton A, Calvert C, Peel N, Hubbard R, Jamieson H, Hikaka J, Boyd M, Bramley D, Connolly MJ. An interRAI-derived frailty index is associated with prior hospitalisations in older adults residing in retirement villages. Australas J Ageing 2020; 40:66-71. [PMID: 33118304 DOI: 10.1111/ajag.12863] [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: 07/16/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To develop and validate a frailty index (FI) from interRAI-Community Health Assessments (CHA) on older adults in retirement villages (RVs). METHODS This is a cross-sectional analysis of a current RV research study. A FI was generated using the cumulative deficit model. Health-care utilisation measures were acute, and all, hospitalisations 12 months before baseline assessment. Associations between FI and hospitalisations were explored using multivariable logistic regression to estimate odds ratio (OR). RESULTS Of 577 included residents, mean (SD) age was 81 (7) and 419 (73%) were female. Mean (SD) FI was 0.16 (0.09); 260 (45%) were mildly frail, and 108 (19%) moderate-severely frail. In multivariate-adjusted analysis, odds of acute hospitalisation for mild (OR = 3.3, P < .001) and moderate-severely frail (OR = 6.4, P < .001) were significantly higher than fit residents. Higher odds were also observed for all hospitalisations. CONCLUSION A considerable proportion of RV residents were moderately-severely frail. FI was associated with acute and all hospitalisations.
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Affiliation(s)
- Katherine Bloomfield
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Waitematā District Health Board, Auckland, New Zealand
| | | | - Nancye Peel
- University of Queensland, Brisbane, Queensland, Australia
| | - Ruth Hubbard
- University of Queensland, Brisbane, Queensland, Australia
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
| | - Martin J Connolly
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
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Sinn CLJ, Heckman G, Poss JW, Onder G, Vetrano DL, Hirdes J. A comparison of 3 frailty measures and adverse outcomes in the intake home care population: a retrospective cohort study. CMAJ Open 2020; 8:E796-E809. [PMID: 33262118 PMCID: PMC7721251 DOI: 10.9778/cmajo.20200083] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In Ontario, Canada, nearly all home care patients are assessed with a brief clinical assessment (interRAI Contact Assessment [interRAI CA]) on admission. Our objective was to compare 3 frailty measures that can be operationalized using the interRAI CA. METHODS We conducted a retrospective cohort study using linked patient-level assessment and administrative data for all Ontario adult (≥ 18 yr) home care patients assessed with the interRAI CA in 2014. We employed multivariable logistic models to compare the Changes in Health, End-stage disease and Signs and Symptoms Scale for the Contact Assessment (CHESS-CA), Assessment Urgency Algorithm (AUA) and the Frailty Index for the Contact Assessment (FI-CA) that was created for this study. Our outcomes of interest were death, hospital admission and emergency department visits within 90 days, and assessor-rated need for comprehensive geriatric assessment (CGA). RESULTS In 2014, there were 228 679 unique adult home care patients in Ontario assessed with the interRAI CA. Controlling for age, sex and health region, being in a higher frailty level defined by any measure increased the likelihood of experiencing adverse outcomes. Among all assessments, CHESS-CA was best suited for predicting death and hospital admission, and either AUA or FI-CA for predicting perceived need for CGA. Previous emergency department visits were more predictive of future visits than frailty. Model fit was independent of whether the assessment was completed over the phone or in person. INTERPRETATION Frailty measures from the interRAI CA identified patients at higher risk for death, hospital admission and perceived need for CGA. In jurisdictions where the CHESS-CA and AUA are already built into the electronic home care platform, such as Ontario, patients identified as high risk should be prioritized for proactive referral and care planning, and may benefit from greater involvement of primary care and other health professionals in the circle of care.
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Affiliation(s)
- Chi-Ling Joanna Sinn
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - George Heckman
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Jeffrey W Poss
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Graziano Onder
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Davide Liborio Vetrano
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - John Hirdes
- School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Gordon EH, Hubbard RE. Frailty in older adults: moving from measurement to management. Med J Aust 2020; 213:314-315. [PMID: 32924157 DOI: 10.5694/mja2.50778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Emily H Gordon
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
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Kim KJ, Lee SB, Kim CO. How to Assess Frailty: Role of Comprehensive Geriatric Assessment. J Korean Med Sci 2020; 35:e34. [PMID: 31950780 PMCID: PMC6970077 DOI: 10.3346/jkms.2020.35.e34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kwang Joon Kim
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Severance Executive Healthcare Clinic, Severance Hospital, Seoul, Korea
| | - Sang Bae Lee
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Severance Executive Healthcare Clinic, Severance Hospital, Seoul, Korea
| | - Chang Oh Kim
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Ludwig C, Busnel C. Protocol of a case-control longitudinal study (fraXity) assessing frailty and complexity among Swiss home service recipients using interRAI-HC assessments. BMC Geriatr 2019; 19:207. [PMID: 31382880 PMCID: PMC6683486 DOI: 10.1186/s12877-019-1230-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The early screening of frail individuals and of patients with complex care needs are challenges that countries witnessing population aging face. Homecare nurses are actors of choice in meeting these challenges, yet they need means of identifying frail and complex patients in their routine practice. The fraXity study's aim is to fill this gap by (1) proposing frailty and complexity computation algorithms derived from the interRAI-HC; (2) assessing the predictive validity of the proposed indices with respect to adverse health outcomes; and (3) identifying subgroups of the aged population for whom the early screening of frailty and complexity appears to be most relevant. METHODS The study will rely on a prospective observational case-control longitudinal study. Three samples of individuals aged 65 or older living in the community will be considered: recipients of formal home care (case 1), of formal home assistance (case 2) and individuals free of formal home services (controls). All participants will receive interRAI-HC assessments at three measurement occasions, separated by six-month intervals. Baseline assessments will serve to derive frailty and complexity scores. Follow-ups will serve to assess the predictive validity of the proposed indices and to estimate the intra-individual change in frailty and complexity. Group comparisons will serve to identify subgroups of the population for whom the screening of frailty and complexity appears to be the most relevant. DISCUSSION The expected results of the fraXity study are a) reliable computation algorithms for frailty and complexity scores derived from the interRAI-HC and b) clinical assessment protocols for use by homecare nurses. These outcomes should contribute to outfitting key actors of the health system with means of enhancing their part in a collective endeavor targeting the best care and quality of life for aged citizens. TRIAL REGISTRATION ClinicalTrials.gov, NCT03883425 , registered on March 20, 2019.
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Affiliation(s)
- Catherine Ludwig
- Geneva School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, Avenue de Champel 47, 1206 Geneva, Switzerland
| | - Catherine Busnel
- Geneva Institution for Homecare and Assistance (imad), Avenue du Cardinal Mermillod 36, 1227 Carouge, Switzerland
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Wang Y, Zhang R, Shen Y, Su L, Dong B, Hao Q. Prediction of chemotherapy adverse reactions and mortality in older patients with primary lung cancer through frailty index based on routine laboratory data. Clin Interv Aging 2019; 14:1187-1197. [PMID: 31308642 PMCID: PMC6616135 DOI: 10.2147/cia.s201873] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/09/2019] [Indexed: 02/05/2023] Open
Abstract
Objectives To assess the role of a pre-chemotherapy frailty index based on routine laboratory data in predicting mortality and chemotherapy adverse reactions among older patients with primary lung cancer. Design Retrospective cohort study. Setting West China Hospital, Chengdu, China. Participants We included patients aged ≥60 years with primary lung cancer receiving the first course of chemotherapy. Measurements Data were collected from medical records, local government death databases or telephone interviews. Outcomes included chemotherapy adverse reactions and all-cause mortality. We constructed a frailty index based on 44 laboratory variables (FI-LAB) before chemotherapy, and chose the following cutoff points: robust (0.0-0.2), pre-frail (0.2-0.35) and frail (≥0.35). Results We included 1,020 patients (71.4% male; median age: 65 years old). Both pre-frailty and frailty was associated with any chemotherapy adverse reactions and infections during chemotherapy (OR=3.48, 95%CI: 1.77-6.87; OR=3.58, 95%CI: 1.55-8.26, respectively). Frail patients had a shorter median overall survival rate compared to robust patients (18.05 months vs 38.89 months, log-rank p<0.001). After adjusting for some potential confounding variables, the risk of all-cause mortality was dramatically increased in frail patients (HR:2.13, 95% CI:1.51-3.00) with an average follow-up of 3.9 years. Each 0.01 or per standard deviation (SD) increase in the FI-LAB value significantly increased the HR of death by 2.0% (HR:1.02, 95% CI: 1.01-1.03) and 23.0% (HR: 1.23, 95% CI: 1.13-1.34), respectively. Conclusions Frailty assessed by routine laboratory data indicates increased risks of chemotherapy adverse reactions and death in older patients with primary lung cancer receiving the first course of chemotherapy.
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Affiliation(s)
- Yuting Wang
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Rui Zhang
- Health Informatics Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yanjiao Shen
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Lin Su
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Birong Dong
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qiukui Hao
- The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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