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Han CY, Chan RJ, Ng HS, Sharma Y, Yaxley A, Baldwin C, Miller M. Pre-Frailty and Frailty in Hospitalized Older Adults: A Comparison Study in People with and without a History of Cancer in an Acute Medical Unit. Cancers (Basel) 2024; 16:2212. [PMID: 38927918 PMCID: PMC11201449 DOI: 10.3390/cancers16122212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/05/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
A prospective observational study was conducted in a cohort of older adults ≥65 years (n = 329), admitted to the acute medical unit (AMU) of a tertiary hospital, to describe and compare characteristics including frailty status and clinical outcomes. Multivariable models compared older adults with and without a history of cancer to determine characteristics associated with frailty and pre-frailty. An adjusted Poisson regression model was used to compare the length of hospital stay (LOS) between the two groups. About one-fifth (22%) of the cohort had a history of cancer. The most common cancer types were prostate (n = 20), breast (n = 13), lung (n = 8) and gastrointestinal (n = 8). There was no difference in the prevalence of pre-frailty/frailty among patients with or without a history of cancer (58% vs. 57%, p > 0.05). Pre-frailty/frailty was associated with polypharmacy (OR 8.26, 95% CI: 1.74 to 39.2) and malnutrition (OR 8.91, 95% CI: 2.15 to 36.9) in patients with a history of cancer. Adjusted analysis revealed that the risk of having a longer LOS was 24% higher in older adults with a history of cancer than those without (IRR 1.24, 95% CI 1.10 to 1.41, p < 0.001). Clinicians in the AMU should be aware that older adults with a history of cancer have a higher risk of a longer LOS compared to those without.
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Affiliation(s)
- Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.J.C.); (A.Y.); (C.B.); (M.M.)
| | - Raymond Javan Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.J.C.); (A.Y.); (C.B.); (M.M.)
- Faculty of Health, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Huah Shin Ng
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia; (H.S.N.); (Y.S.)
- SA Pharmacy, SA Health, Adelaide, SA 5001, Australia
| | - Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia; (H.S.N.); (Y.S.)
- Department of Acute and General Medicine, Flinders Medical Centre, Adelaide, SA 5042, Australia
| | - Alison Yaxley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.J.C.); (A.Y.); (C.B.); (M.M.)
| | - Claire Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.J.C.); (A.Y.); (C.B.); (M.M.)
| | - Michelle Miller
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.J.C.); (A.Y.); (C.B.); (M.M.)
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Källberg AS, Berg LM, Skogli S, Bjurbo C, Muntlin Å, Ehrenberg A. Prevalence of frailty and associated factors in older adults seeking care at Swedish emergency departments. BMC Geriatr 2023; 23:798. [PMID: 38049748 PMCID: PMC10694934 DOI: 10.1186/s12877-023-04545-2] [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: 06/13/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Internationally, prolonged length of stay for older adults in the emergency department (ED) is associated with increased risk of in-hospital adverse events. In Sweden patients 65 years and older account for 35% of emergency visits, and according to consensus from an international expert group, all persons over 70 should be screened for frailty. This is not routinely done in Swedish EDs, and therefore, knowledge about prevalence, characteristics and clinical outcomes associated with frailty is limited. AIM To describe the prevalence of frailty and associated factors in older adults seeking care at Swedish EDs. METHODS The study has a cross-sectional design. Data was collected at three hospital-based EDs, varying in level and size of setting, for one month. Patients age 70 and older presenting at the EDs and agreed to participate were screened for frailty using the FRail Elderly Support researcH group (FRESH) instrument. Data were analysed using descriptive statistics to assess the distribution of patient characteristics and clinical outcomes. Multivariate logistic regression was used to model the association between frailty and demographic characteristics, and Cox regression was used to model the association between frailty and clinical outcomes. RESULTS A total of 3101 patients were eligible for inclusion; of these, 984 (32%) were included and screened for frailty. Of the final sample, 57.3% were assessed as frail. Characteristics significantly associated with frailty were living in a residential care facility, age (> 80 years), being a woman and arriving with emergency medical service (EMS). There was a significant association between frailty and admittance to in-hospital care. CONCLUSION Our study shows a high prevalence of frailty in older people. Factors associated with frailty were living in a residential care facility, age ≥ 80 years, being a woman and arriving with EMS to the ED and being admitted to in-hospital care. Frailty screening should be incorporated in the triage system to identify frail patients who need tailored interventions. More studies using the FRESH instrument are needed to further confirm our findings and to develop the methods for screening for frailty in the ED.
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Affiliation(s)
- Ann-Sofie Källberg
- School of Health and Welfare, Dalarna University, Falun, SE-791 88, Sweden.
- Department of Emergency Medicine, Falun Hospital and Centre for Clinical Research Dalarna, Nissers väg 3, Falun, SE-791 82, Sweden.
| | - Lena M Berg
- School of Health and Welfare, Dalarna University, Falun, SE-791 88, Sweden
| | - Sara Skogli
- Department of Internal Medicine, Falun Hospital, Falun, SE-791 82, Sweden
| | - Charlotte Bjurbo
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, entrance 40, level 5, Uppsala, SE-751 85, Sweden
| | - Åsa Muntlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, entrance 40, level 5, Uppsala, SE-751 85, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, entrance 40, level 5, Uppsala, SE-751 85, Sweden
| | - Anna Ehrenberg
- School of Health and Welfare, Dalarna University, Falun, SE-791 88, Sweden
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Angcahan DZ, de Guzman AB. The radiology department as a sentinel in fall prevention among Filipino older adult patients. J Med Imaging Radiat Sci 2023; 54:S49-S52. [PMID: 37903708 DOI: 10.1016/j.jmir.2023.10.004] [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: 04/27/2023] [Revised: 09/22/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023]
Abstract
Accidental falls are a serious yet underreported form of adverse event in hospitals. Falls account for the leading cause of injury and mortality among older adults. The World Health Organization (WHO) in 2021 reported that an estimated 64,000 individuals die annually from falls globally. In the Philippines, about 53.6% of older Filipinos are experiencing falls from a small population-specific setting and they are more likely to experience functional declines than the younger population. The radiology departments and radiologic technologists (RTs) play a vital role in preventing accidental falls among Filipino older adult patients. Despite the existing safety standards promulgated by national health agencies, awareness of healthcare professionals such as radiologic technologists (RTs) in low- and middle-income countries (LMICs) such as the Philippines remains limited. As such, promoting a safety culture is deemed a main strategy for patient safety from adverse occurrences of falls among Filipino older adults. In doing so, there is a need to establish an incident reporting system for sentinel events, develop risk assessment tools, and define the needed competencies of RTs in preventing catastrophic falls involving Filipino older adult patients. To the authors' knowledge, this paper is the first of its kind to better understand the safety and predisposing risks for falling among older adults in the field of radiology in the Philippines.
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Affiliation(s)
- Darwin Z Angcahan
- The Graduate School, University of Santo Tomas, Manila, Philippines; Department of Diagnostic Imaging and Interventional Radiology, Rizal Medical Center, Pasig City, Philippines.
| | - Allan B de Guzman
- The Graduate School, University of Santo Tomas, Manila, Philippines; Research Center for Social Sciences and Education, University of Santo Tomas, Manila, Philippines
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Deore HS, Taranikanti M, Gaur A, Varatharajan S, John NA, Katta R, Taranikanti SS, Umesh M, Ganji V, Medala K. Comprehensive, continuous, and compulsory monitoring of frailty in elderly. J Family Med Prim Care 2023; 12:3194-3199. [PMID: 38361887 PMCID: PMC10866276 DOI: 10.4103/jfmpc.jfmpc_233_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 02/17/2024] Open
Abstract
Background The increasing elderly population makes frailty an increasing concern in society with vulnerability to stress and functional decline. Unrecognised comorbidities are common among the elderly due to lack of mention by the patients. Physicians should be equipped with effective interviewing skills along with the use of screening tools to assess any impairments in activities of daily living, cognition and signs of depression. Objectives To measure the degree of independence or dependence using scales and stratify patients based on Clinical Frailty Scale (CFS) so as to recommend it as a routinely usable tool. Materials and Methods In total, 191 elderly subjects above the age of 65 years were recruited for geriatric assessment. Tools that assess performance in daily living activities and cognition were used. The prevalidated CFS was used to score frailty to stratify patients into frail and non-frail groups, and the parameters were compared. Results Mean age of the study population was 69.54 years with 53.4% males and 46.6% females. Mean Katz index and mean Lawton score were >5. The mean Global Deterioration Scale (GDS) score was 1.5, and the mean clinical frailty score was 3.55. Significantly high number of male individuals were found in the frailty group. Hypertension was significantly higher in the frail group. The mean Katz scores were significantly lower, and mean GDS scores were significantly higher in the frailty group. Multivariable logistic regression has shown gender to be an important determinant of frailty with an odds ratio of 0.05 (CI-0.01-0.20). The higher Lawton score and GDS scores were significantly associated with frailty with an odds ratio of 0.33 (CI: 0.21-0.52) and 2.62 (CI: 1.14-6.02), respectively. Conclusion Men are more frail than women and co-morbidities like hypertension and coronary artery disease contribute to frailty with cognitive decline and decreased autonomy. A comprehensive assessment to identify frailty will provide a holistic view of well being among the elderly.
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Affiliation(s)
- Hiranya S. Deore
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Madhuri Taranikanti
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Sakthivadivel Varatharajan
- Department of General Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Nitin A. John
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Roja Katta
- Department of Physiology, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Sai Shriya Taranikanti
- Department of General Medicine, Agartala Government Medical College and GB Pant Hospital, Agartala, Tripura, India
| | - Madhusudhan Umesh
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Vidya Ganji
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Kalpana Medala
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
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Lyu H, Jiang W. Development and internal and external validation of a nomogram model for frailty risk among hospitalised older people using comprehensive geriatric assessment data. BMC Geriatr 2023; 23:712. [PMID: 37919663 PMCID: PMC10623830 DOI: 10.1186/s12877-023-04426-8] [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: 04/06/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Currently, there are few such studies about establishing the frailty prediction model on the basis of the research on the factors influencing frailty in older patients, which can better predict frailty and identify its risk factors, and then guide the formulation of intervention measures precisely, especially in the hospital setting in China. Meanwhile, comprehensive geriatric assessment (CGA) can provide measurable and substantial health improvements for frail older people. The study aimed to develop a nomogram model for frailty risk among hospitalised older people using CGA data and validated its predictive performance for providing a basis for medical staff to grasp the risk and risk factors of older inpatients' frailty conveniently and accurately, and to formulate reasonable nursing intervention plan. METHODS We used CGA data of individuals over age 64. Demographic characteristics, geriatric syndrome assessment, and frailty assessment based on the FRAIL scale were included as potential predictors. Significant variables in univariate analysis were used to construct risk models by logistic regression analysis. We used the root mean square (rms) to develop the nomogram prediction model for frailty based on independent clinical factors. Nomogram performance was internally validated with Bootstrap resampling. The final model was externally validated using an independent validation data set and was assessed for discrimination and calibration. RESULTS Data from 2226 eligible older inpatients were extracted. Five hundred sixty-two older inpatients (25.25%) suffered from frailty. The final prediction model included damaged skin, MNA-SF, GDS-15, Morse risk scores, hospital admission, ICI-Q-SF, Braden score, MMSE, BI scores, and Caprini scores. The prediction model displayed fair discrimination. The calibration curve demonstrated that the probabilities of frailty predicted by the nomogram were satisfactorily matched. CONCLUSIONS The prediction model to identify hospitalised older people at high risk for frailty using comprehensive geriatric assessment data displayed fair discrimination and good predictive calibration. Therefore, it is inexpensive, easily applied, and accessible in clinical practice, containing variables routinely collected and readily available through consultation. It will be valuable for grasp older inpatients at high risk of frailty and risk factors in hospital setting to guide the formulation of intervention measures precisely for reversing and preventing frailty.
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Affiliation(s)
- Hong Lyu
- Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, China
- Outpatient department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, China
| | - Wenhui Jiang
- Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, China.
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Luo S, Zhao H, Gan X, He Y, Wu C, Ying Y. Nomogram model for predicting frailty of patients with hematologic malignancies - A cross-sectional survey. Asia Pac J Oncol Nurs 2023; 10:100307. [PMID: 37928413 PMCID: PMC10622625 DOI: 10.1016/j.apjon.2023.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023] Open
Abstract
Objective This study aimed to develop and validate an assessment tool for predicting and mitigating the risk of frailty in patients diagnosed with hematologic malignancies. Methods A total of 342 patients with hematologic malignancies participated in this study, providing data on various demographics, disease-related information, daily activities, nutritional status, psychological well-being, frailty assessments, and laboratory indicators. The participants were randomly divided into training and validation groups at a 7:3 ratio. We employed Lasso regression analysis and cross-validation techniques to identify predictive factors. Subsequently, a nomogram prediction model was developed using multivariable logistic regression analysis. Discrimination ability, accuracy, and clinical utility were assessed through receiver operating characteristic (ROC) curves, C-index, calibration curves, and decision curve analysis (DCA). Results Seven predictors, namely disease duration of 6-12 months, disease duration exceeding 12 months, Charlson Comorbidity Index (CCI), prealbumin levels, hemoglobin levels, Generalized Anxiety Disorder-7 (GAD-7) scores, and Patient Health Questionnaire-9 (PHQ-9) scores, were identified as influential factors for frailty through Lasso regression analysis. The area under the ROC curve was 0.893 for the training set and 0.891 for the validation set. The Hosmer-Lemeshow goodness-of-fit test confirmed a good model fit. The C-index values for the training and validation sets were 0.889 and 0.811, respectively. The DCA curve illustrated a higher net benefit when using the nomogram prediction model within patients threshold probabilities ranging from 10% to 98%. Conclusions This study has successfully developed and validated an effective nomogram model for predicting frailty in patients diagnosed with hematologic malignancies. The model incorporates disease duration (6-12 months and>12 months), CCI, prealbumin and hemoglobin levels, GAD-7, and PHQ-9 scores as predictive variables.
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Affiliation(s)
- Shuangli Luo
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huihan Zhao
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao Gan
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu He
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning, China
| | - Caijiao Wu
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yanping Ying
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Mehta SP, Indramohan P, Dobariya V, Seccurro D, Goebel LJ. Validity and Accuracy of the Tilburg Frailty Indicator Part B for Identification of Frailty in Older Adults Consulting a Rural Geriatric Medicine Clinic. Can J Aging 2023; 42:466-474. [PMID: 37226297 DOI: 10.1017/s0714980823000077] [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] [Indexed: 05/26/2023] Open
Abstract
The Tilburg Frailty Indicator (TFI) is a validated tool for determining frailty in older adults. This study examined the validity and accuracy of the TFI Part B (TFI-B) in a North American context. Seventy-two individuals ≥ 65 years of age recruited from a rural geriatric medicine clinic completed a set of self-reported and performance-based measures, including TFI-B. Frailty level was determined using modified Fried's Frailty Phenotype (FFP). Pearson correlation coefficients (r) assessed the concurrent relationships between the TFI-B and other measures. Accuracy of the TFI-B in classifying frailty level was assessed using assessing area under the curve (AUC). The TFI-B scores showed low correlations (r < 0.4) with gait speed and grip, suggesting that the TFI-B did not consider frailty as merely a physical problem. The AUC of 0.82 indicated that the TFI-B scores accurately classified frail versus non-frail individuals. The score of ≥ 5 on the TFI-B scores showed satisfactory sensitivity/specificity (73%/77%) and excellent negative predictive value (91.95%). This indicates that a TFI-B score of < 5 can be used to rule out frailty.
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Affiliation(s)
- Saurabh P Mehta
- Physical Therapy Program, East Tennessee State University, Johnson City, TN, USA
- School of Physical Therapy, Marshall University, Huntington, WV, USA
| | - Pavithramohan Indramohan
- Department of Internal Medicine, Geriatrics Section, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Varun Dobariya
- Department of Internal Medicine, Geriatrics Section, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Drake Seccurro
- Department of Internal Medicine, Geriatrics Section, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Lynne J Goebel
- Department of Internal Medicine, Geriatrics Section, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
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Yuan D, Wu J, Li S, Zhang R, Zhou X, Zhang Y. Network analysis of cold cognition and depression in middle-aged and elder population: the moderation of grandparenting. Front Public Health 2023; 11:1204977. [PMID: 37674685 PMCID: PMC10479032 DOI: 10.3389/fpubh.2023.1204977] [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: 04/13/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
Background Cognitive decline and negative emotions are common in aging, especially decline in cold cognition which often co-occurred with depression in middle-aged and older adults. This study analyzed the interactions between cold cognition and depression in the middle-aged and elder populations using network analysis and explored the effects of grandparenting on the cold cognition-depression network. Methods The data of 6,900 individuals (≥ 45 years) from the China Health and Retirement Longitudinal Study (CHARLS) were used. The Minimum Mental State Examination (MMSE) and the Epidemiology Research Center Depression Scale-10 (CESD-10) were used to assess cold cognition and depressive symptoms, respectively. Centrality indices and bridge centrality indices were used to identify central nodes and bridge nodes, respectively. Results Network analysis showed that nodes "language ability" and "depressed mood" were more central nodes in the network of cold cognition and depression in all participants. Meantime, nodes "attention," "language ability" and "hopeless" were three key bridge nodes connecting cold cognition and depressive symptoms. Additionally, the global connectivity of the cold cognition and depression network was stronger in the non-grandparenting than the grandparenting. Conclusion The findings shed a light on the complex interactions between cold cognition and depression in the middle-aged and elder populations. Decline in language ability and depressed mood can serve as predictors for the emergence of cold cognitive dysfunction and depression in individuals during aging. Attention, language ability and hopelessness are potential targets for psychosocial interventions. Furthermore, grandparenting is effective in alleviating cold cognitive dysfunction and depression that occur during individual aging.
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Affiliation(s)
- Dongling Yuan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jialing Wu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shansi Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ruoyi Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Zhou
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
- Medical Psychological Institute of Central South University, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders (Xiangya), Changsha, China
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Depression and anxiety in older adults with cancer: Systematic review and meta-summary of risk, protective and exacerbating factors. Gen Hosp Psychiatry 2023; 81:32-42. [PMID: 36724695 DOI: 10.1016/j.genhosppsych.2023.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To systematically evaluate the risk factors of depression and anxiety in older adults with cancer. METHOD This PRISMA-adherent systematic review (PROSPERO CRD42022372747) involved a systematic database search for prospective and retrospective cohort studies. RESULTS We included 33 cohort studies with 31 evaluating depression and seven evaluating anxiety. Systematic synthesis yielded various protective and exacerbating factors for depression and anxiety amongst older adults with cancer. These factors span a range of domains: (1) Cancer and associated treatment-related factors; (2) Medical, physical and functional factors; (3) Demographic factors and; (4) Social and lifestyle factors. At the individual-level, the most significant factors were the presence of chronic medical comorbidities, having pre-existing psychological symptoms, and poor baseline physical and functional status. Within the social unit, the degree of social support and presence of a partner were most significant. CONCLUSION The deleterious impact comorbid psychological symptoms can have on older adults with cancer can be profound. In this review, we highlight a range of protective and exacerbating factors identified from cohort studies that may enable policymakers to tailor and individualise interventions to manage depression, anxiety and associated burden in this vulnerable population. The relative paucity of studies evaluating anxiety highlights an important research gap.
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Saunders R, Crookes K, Seaman K, Ang SGM, Bulsara C, Bulsara MK, Ewens B, Gallagher O, Graham R, Gullick K, Haydon S, Hughes J, Nguyen KH, O’Connell B, Scaini D, Etherton-Beer C. Frailty and pain in an acute private hospital: an observational point prevalence study. Sci Rep 2023; 13:3345. [PMID: 36849461 PMCID: PMC9971208 DOI: 10.1038/s41598-023-29933-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
Frailty and pain in hospitalised patients are associated with adverse clinical outcomes. However, there is limited data on the associations between frailty and pain in this group of patients. Understanding the prevalence, distribution and interaction of frailty and pain in hospitals will help to determine the magnitude of this association and assist health care professionals to target interventions and develop resources to improve patient outcomes. This study reports the point prevalence concurrence of frailty and pain in adult patients in an acute hospital. A point prevalence, observational study of frailty and pain was conducted. All adult inpatients (excluding high dependency units) at an acute, private, 860-bed metropolitan hospital were eligible to participate. Frailty was assessed using the self-report modified Reported Edmonton Frail Scale. Current pain and worst pain in the last 24 h were self-reported using the standard 0-10 numeric rating scale. Pain scores were categorised by severity (none, mild, moderate, severe). Demographic and clinical information including admitting services (medical, mental health, rehabilitation, surgical) were collected. The STROBE checklist was followed. Data were collected from 251 participants (54.9% of eligible). The prevalence of frailty was 26.7%, prevalence of current pain was 68.1% and prevalence of pain in the last 24 h was 81.3%. After adjusting for age, sex, admitting service and pain severity, admitting services medical (AOR: 13.5 95% CI 5.7-32.8), mental health (AOR: 6.3, 95% CI 1. 9-20.9) and rehabilitation (AOR: 8.1, 95% CI 2.4-37.1) and moderate pain (AOR: 3.9, 95% CI 1. 6-9.8) were associated with increased frailty. The number of older patients identified in this study who were frail has implications for managing this group in a hospital setting. This indicates a need to focus on developing strategies including frailty assessment on admission, and the development of interventions to meet the care needs of these patients. The findings also highlight the need for increased pain assessment, particularly in those who are frail, for more effective pain management.Trial registration: The study was prospectively registered (ACTRN12620000904976; 14th September 2020).
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Affiliation(s)
- Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.
| | - Kate Crookes
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Karla Seaman
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia ,grid.1004.50000 0001 2158 5405Centre for Health Systems and Safety Research, Macquarie University, Sydney, Australia
| | - Seng Giap Marcus Ang
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Caroline Bulsara
- grid.266886.40000 0004 0402 6494School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, WA Australia ,grid.266886.40000 0004 0402 6494Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA Australia
| | - Max K. Bulsara
- grid.266886.40000 0004 0402 6494Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA Australia
| | - Beverley Ewens
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Olivia Gallagher
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Renée Graham
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Karen Gullick
- grid.414296.c0000 0004 0437 5838Hollywood Private Hospital, Nedlands, WA Australia
| | - Sue Haydon
- grid.414296.c0000 0004 0437 5838Hollywood Private Hospital, Nedlands, WA Australia
| | - Jeff Hughes
- PainChek Ltd, Sydney, NSW Australia ,grid.1032.00000 0004 0375 4078Curtin Medical School, Curtin University, Bentley, WA Australia
| | - Kim-Huong Nguyen
- grid.1003.20000 0000 9320 7537Faculty of Medicine and Biomedical Sciences, The University of Queensland, Saint Lucia, QLD Australia
| | - Bev O’Connell
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Debra Scaini
- grid.414296.c0000 0004 0437 5838Hollywood Private Hospital, Nedlands, WA Australia
| | - Christopher Etherton-Beer
- grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia, Crawley, WA Australia
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Contribution of intraoperative electroencephalogram suppression to frailty-associated postoperative delirium: mediation analysis of a prospective surgical cohort. Br J Anaesth 2023; 130:e263-e271. [PMID: 36503826 DOI: 10.1016/j.bja.2022.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Frailty is a risk factor for postoperative delirium (POD), and has led to preoperative interventions that have reduced, but not eliminated, the risk. We hypothesised that EEG suppression, another risk factor for POD, mediates some of the frailty risk for POD. METHODS A prospective cohort study enrolled patients aged 65 yr or older, scheduled for noncardiac surgery under total intravenous anaesthesia. Frailty was assessed using the FRAIL scale. Cumulative duration of EEG suppression, defined as an amplitude between -5 and 5 μV for >0.5 s during anaesthesia, was measured. POD was diagnosed by either confusion assessment method (CAM), CAM-ICU, or medical records. The severity of POD was assessed using the Delirium Rating Scale - Revised-98 (DRS). Mediation analysis was used to estimate the relationships between frailty, EEG suppression, and severity of POD. RESULTS Among 252 enrolled patients, 51 were robust, 129 were prefrail, and 72 were frail. Patients classified as frail had higher duration of EEG suppression than either the robust (19 vs 0.57 s, P<0.001) or prefrail groups (19 vs 3.22 s, P<0.001). Peak delirium score was higher in the frail group than either the robust (17 vs 15, P<0.001) or prefrail groups (17 vs 16, P=0.007). EEG suppression time mediated 24.2% of the frailty-DRS scores association. CONCLUSION EEG suppression time mediated a statistically significant portion of the frailty-POD association in older noncardiac surgery patients. Trials directed at reducing EEG suppression time could result in intraoperative interventions to reduce POD in frail patients. CLINICAL TRIAL REGISTRATION ChiCTR2000041092 (Chinese Clinical Trial Registry).
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12
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Yüceler Kaçmaz H, Döner A, Kahraman H, Akin S. Prevalence and factors associated with frailty in older hospitalized patients. Rev Clin Esp 2023; 223:67-76. [PMID: 36372380 DOI: 10.1016/j.rceng.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to determine the prevalence and factors associated with frailty in older hospitalized patients. METHODS The point-prevalence study was completed on 263 patients aged 65 and over hospitalized in internal medicine and surgical clinics at a tertiary hospital in Türkiye. Data were collected between July 19th and July 22nd, 2021. A comprehensive geriatric assessment was performed on the participants. The Edmonton Frailty Scale (EFS) and FRAIL scale were used for frailty assessment. RESULTS The mean age of the individuals was 72.40 ± 6.42, 51.7% were female, and 63.9% were hospitalized in internal medicine and surgical units. The prevalence of frailty was 57.4% according to the FRAIL scale and 46.8% according to EFS. Factors affecting frailty were gender (OR 3.36, 95% CI 1.48-7.64), comorbidity (OR 1.29, 95% CI 1.01-1.64), polypharmacy (OR 0.33, 95% CI 0.13-0.80), history of falling in the last year (OR 3.54, 95% CI 1.34-9.35), incontinence (OR 5.93, 95% CI 2.47-14.27), and functional dependency (ADL, OR 0.65, 95% CI 0.46-0.92; IADL, OR 0.59, 95% CI 0.46-0.76). This model correctly predicted the participants' frailty at 70.5%. CONCLUSIONS The importance of frailty, which affects one out of every two hospitalized older persons, to the health care system should not be overlooked. Considering the increasing trend of the aging person population, national and global plans should be made to prevent and manage frailty.
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Affiliation(s)
- Hatice Yüceler Kaçmaz
- Department of Nursing, Health Sciences Faculty, Erciyes University, Kayseri, Turkey.
| | - Ayser Döner
- Department of Nursing, Health Sciences Faculty, Erciyes University, Kayseri, Turkey
| | - Hilal Kahraman
- Department of Nursing, Health Sciences Faculty, Erciyes University, Kayseri, Turkey
| | - Sibel Akin
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
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13
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Borges MM, Custódio LA, Cavalcante DDFB, Pereira AC, Carregaro RL. Direct healthcare cost of hospital admissions for chronic non-communicable diseases sensitive to primary care in the elderly. CIENCIA & SAUDE COLETIVA 2023; 28:231-242. [PMID: 36629568 DOI: 10.1590/1413-81232023281.08392022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/13/2022] [Indexed: 01/11/2023] Open
Abstract
Aging has imposed changes in the epidemiological profile and an increase in the prevalence of chronic non-communicable diseases (CNCDs). The aim was to estimate the direct cost related to hospital admissions of elderly people affected by CNCDs (hypertension, heart failure and diabetes mellitus) sensitive to primary care, in a medium-sized hospital, in the period 2015-2019. Secondly, we investigated whether clinical and demographic factors explain the costs and length of stay. The medical records of 165 elderly people were analyzed. We found a predominance of women with a mean age of 76.9 years. The most frequent cause of hospitalization was heart failure (62%), and the average length of stay was 9.5 days, and 16% of hospitalizations corresponded to rehospitalizations. Of these, 81% were caused by complications from the previous hospitalization. The estimated total cost was R$ 3 million. Male patients had a longer hospital stay compared to female patients. Hypertension and the total number of procedures were significant predictors of cost and length of stay. We found that in 5 years, the costs of hospital admissions for conditions sensitive to primary care in the elderly are considerable, indicating the relevance of investments in primary care.
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Affiliation(s)
- Marina Miranda Borges
- Universidade Federal de São Carlos. Rod. Washington Luiz s/n, Monjolinho. 13565-905 São Carlos SP Brasil.
| | - Luciana Alves Custódio
- Programa de Pós-Graduação em Ciências da Reabilitação, Núcleo de Evidências e Tecnologias em Saúde, Universidade de Brasília. Brasília DF Brasil
| | | | - Antonio Carlos Pereira
- Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Piracicaba SP Brasil
| | - Rodrigo Luiz Carregaro
- Programa de Pós-Graduação em Ciências da Reabilitação, Núcleo de Evidências e Tecnologias em Saúde, Universidade de Brasília. Brasília DF Brasil
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14
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Prevalencia y factores asociados a la fragilidad en pacientes mayores hospitalizados. Rev Clin Esp 2023. [DOI: 10.1016/j.rce.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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15
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Toh JJY, Zhang H, Soh YY, Zhang Z, Wu XV. Prevalence and health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty: A systematic review and meta-analysis. Ageing Res Rev 2023; 83:101811. [PMID: 36455791 DOI: 10.1016/j.arr.2022.101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/12/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
Polypharmacy is a prevalent issue in older adults, associated with a wide range of adverse health outcomes, amplified in those with frailty. This review aims to synthesize current literature on the prevalence and health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty. A systematic search was carried out within ten databases till December 2021. Data was extracted using a piloted data extraction form, and methodological quality was assessed using JBI critical appraisal checklists. Meta-analyses were conducted for prevalence, and narrative synthesis was conducted for the health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty. Heterogeneity was assessed using Chi2 and I2 statistics, with sensitivity and subgroup analyses performed to explore sources of heterogeneity. Sixty-six studies were included for this review. The overall pooled prevalence of polypharmacy and hyperpolypharmacy was 59% and 22% respectively. When stratifying the studies by setting, WHO regions, in eighteen frailty assessment instruments, and by its year of publication, subgroup analysis found the highest rates of prevalence in the hospital setting (71%), in the European region (68%), when Reported Edmonton Frail Scale was used (96%), and in studies published in 2015 (86%). Additionally, frail older adults with polypharmacy were less likely to experience an improvement in frailty states, had higher risks of mortality, were more likely to suffer adverse hospital-related outcomes, and required additional assistance compared to those without polypharmacy. Therefore, the high prevalence and poorer health outcomes urges the healthcare providers and health policymakers to develop and implement preventative and restorative measures targeted at the adverse outcomes associated with polypharmacy and hyperpolypharmacy in older adults with frailty.
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Affiliation(s)
- Janice Jia Yun Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, 117597, Singapore.
| | - Hui Zhang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, 117597, Singapore; St Andrew's Community Hospital, 8 Simei Street 3, 529895, Singapore.
| | - Yang Yue Soh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, 117597, Singapore.
| | - Zeyu Zhang
- Institute for Hospital Management, Tsinghua University, Beijing 100084, People's Republic of China.
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, 117597, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, 28 Medical Drive, 117456, Singapore.
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16
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Borges MM, Custódio LA, Cavalcante DDFB, Pereira AC, Carregaro RL. Direct healthcare cost of hospital admissions for chronic non-communicable diseases sensitive to primary care in the elderly. CIENCIA & SAUDE COLETIVA 2023. [DOI: 10.1590/1413-81232023281.08392022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Abstract Aging has imposed changes in the epidemiological profile and an increase in the prevalence of chronic non-communicable diseases (CNCDs). The aim was to estimate the direct cost related to hospital admissions of elderly people affected by CNCDs (hypertension, heart failure and diabetes mellitus) sensitive to primary care, in a medium-sized hospital, in the period 2015-2019. Secondly, we investigated whether clinical and demographic factors explain the costs and length of stay. The medical records of 165 elderly people were analyzed. We found a predominance of women with a mean age of 76.9 years. The most frequent cause of hospitalization was heart failure (62%), and the average length of stay was 9.5 days, and 16% of hospitalizations corresponded to rehospitalizations. Of these, 81% were caused by complications from the previous hospitalization. The estimated total cost was R$ 3 million. Male patients had a longer hospital stay compared to female patients. Hypertension and the total number of procedures were significant predictors of cost and length of stay. We found that in 5 years, the costs of hospital admissions for conditions sensitive to primary care in the elderly are considerable, indicating the relevance of investments in primary care.
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17
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Sharma Y, Avina P, Ross E, Horwood C, Hakendorf P, Thompson C. Validity of the Malnutrition Universal Screening Tool for Evaluation of Frailty Status in Older Hospitalised Patients. Gerontol Geriatr Med 2022; 8:23337214221107817. [PMID: 35832095 PMCID: PMC9272176 DOI: 10.1177/23337214221107817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
The malnutrition-universal-screening-tool (MUST) is commonly used for screening malnutrition in hospitalised patients but its utility in the detection of frailty is unknown. This study determined the utility of MUST in detection of frailty in older hospitalised patients. This prospective-study enrolled 243 patients ⩾65 years in a tertiary-teaching hospital in Australia. Patients with a MUST score of ⩾1 were classified as at-risk of malnutrition. Frailty status was determined by the Edmonton-Frail-Scale (EFS) and patients with an EFS score of >8 were classified as frail. We validated the MUST against the EFS by plotting a receiver-operating-characteristic-curve (ROC) curve and area-under-the-curve (AUC) was determined. The mean (SD) age was 83.9 (6.5) years and 126 (51.8%) were females. The EFS determined 149 (61.3%) patients as frail, while 107 (44.1%) patients were at-risk of malnutrition according to the MUST. There was a positive linear but weak association between the MUST and the EFS scores (Pearson's correlation coefficient= .22, 95% CI .12- .36, p < .001). The sensitivity, specificity, positive and negative predictive value of MUST in the detection of frailty was 51%, 67%, 78.5% and 37%, respectively and the AUC was .59 (95% CI .53-.65, p < .001). The MUST is moderately sensitive in detection of frailty in older-hospitalised patients.
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Affiliation(s)
- Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia,Flinders Medical Centre, Adelaide, SA, Australia,Yogesh Sharma, MBBS, MD, FRACP, PhD, College of Medicine and Public Health, Flinders University, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA 5002, Australia.
| | - Peter Avina
- Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Emelie Ross
- Flinders Medical Centre, Adelaide, SA, Australia
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18
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Song Y, Wu Z, Huo H, Zhao P. The Impact of Frailty on Adverse Outcomes in Geriatric Hip Fracture Patients: A Systematic Review and Meta-Analysis. Front Public Health 2022; 10:890652. [PMID: 35844855 PMCID: PMC9280195 DOI: 10.3389/fpubh.2022.890652] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/13/2022] [Indexed: 01/10/2023] Open
Abstract
ObjectiveWith an aging population and advances in medicine, more research focuses on health and longevity in geriatric adults. Recently, frailty has gradually emerged to assess physical conditions. Frailty can be generally described as a multi-dimensional situation of increased vulnerabilities to both endogenous and exogenous stressors. The objective of the review was to evaluate the predictive value of frailty on adverse outcomes in geriatric hip fracture patients.Materials and MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane library for relevant literature about the connection between frailty and poor outcomes in hip fracture elders.ResultsEleven studies involving a total of 45,979 participants were selected in our study. Our results indicated that frailty could significantly predict postoperative and in-patient complications (OR, 1.46; 95% CI, 1.13–1.90; I2 = 77.4%). Frail elders had higher risk of inpatient mortality (OR, 1.68; 95% CI, 1.26–2.25; I2 = 0.0%), 6-month mortality (OR, 1.46; 95% CI, 1.25–1.72; I2 = 0.0%) and ≥1-year mortality (OR, 2.24; 95% CI, 1.66–3.04; I2 = 91.3%). Furthermore, the risk of prolonged hospital stays was 1.15 times more likely in frail patients (95% CI, 1.03–1.28; I2 = 14.8%).ConclusionFrailty can predict adverse outcomes effectively in geriatric hip fracture patients.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails.
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Affiliation(s)
- Yanhong Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ziyi Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Huihui Huo
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ping Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Ping Zhao
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19
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Moradoghli F, Darvishpoor Kakhki A, Esmaeili R. The association between frailty and dignity in community-dwelling older people. BMC Geriatr 2022; 22:344. [PMID: 35440071 PMCID: PMC9019952 DOI: 10.1186/s12877-022-03056-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The population of people aged 60 and older is rapidly increasing in developing countries such as Iran due to declining birth rates and increased life expectancy. Old age is associated with increased risk for frailty and reduced dignity. Frailty is a clinical syndrome characterized by depletion of physical reserves and multiple system disorders, reducing the individual's ability to cope with stressful events. Dignity is an inherent characteristic of human beings and respecting dignity is an ethical principle. This study investigated the association of frailty with dignity among older people in Tehran, Iran. METHODS This correlational study was conducted on 200 individuals aged 60 years and older. Data collection relied on the Demographic Questionnaire, Frailty Index for Elders (FIFE) and the Patient Dignity Inventory (PDI). Data were analyzed with SPSS 25. RESULTS The mean age of the participants was 68 ± 5.05 years; 62% of the participants were at risk for frailty, and 69% had few dignity-related problems. The multiple regression results showed that frailty was significantly associated with dignity (ß = 0.571, p < 0.001). The association was significant across all the dimensions of dignity measured by the PDI. The highest predictors of frailty included dependency (ß = 0.584, p < 0.001), followed by existential distress (ß = 0.560, p < 0.001), symptom distress (ß = 0.400, p = 0.400), social support (ß = 0.391, p < 0.001), and peace of mind (ß = 0.338, p < 0.001) in dignity. CONCLUSIONS The results show that higher levels of frailty in older people are associated with decreases in their dignity, and frailty was the leading predictor of dignity. Providers should develop programs to prevent and reduce frailty in those at risk and to enhance the dignity of the already frail.
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Affiliation(s)
- Fereshteh Moradoghli
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Darvishpoor Kakhki
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Opposite to Rajaee Heart Hospital, Vali-Asr Avenue, Cross of Vali-Asr and Hashemi Rafsanjani Highway, 1996835119, Tehran, Iran.
| | - Roghayeh Esmaeili
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Opposite to Rajaee Heart Hospital, Vali-Asr Avenue, Cross of Vali-Asr and Hashemi Rafsanjani Highway, 1996835119, Tehran, Iran
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20
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Dementia is a surrogate for frailty in hip fracture mortality prediction. Eur J Trauma Emerg Surg 2022; 48:4157-4167. [PMID: 35355091 PMCID: PMC9532301 DOI: 10.1007/s00068-022-01960-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/13/2022] [Indexed: 12/12/2022]
Abstract
Purpose Among hip fracture patients both dementia and frailty are particularly prevalent. The aim of the current study was to determine if dementia functions as a surrogate for frailty, or if it confers additional information as a comorbidity when predicting postoperative mortality after a hip fracture. Methods All adult patients who suffered a traumatic hip fracture in Sweden between January 1, 2008 and December 31, 2017 were considered for inclusion. Pathological fractures, non-operatively treated fractures, reoperations, and patients missing data were excluded. Logistic regression (LR) models were fitted, one including and one excluding measurements of frailty, with postoperative mortality as the response variable. The primary outcome of interest was 30-day postoperative mortality. The relative importance for all variables was determined using the permutation importance. New LR models were constructed using the top ten most important variables. The area under the receiver-operating characteristic curve (AUC) was used to compare the predictive ability of these models. Results 121,305 patients were included in the study. Initially, dementia was among the top ten most important variables for predicting 30-day mortality. When measurements of frailty were included, dementia was replaced in relative importance by the ability to walk alone outdoors and institutionalization. There was no significant difference in the predictive ability of the models fitted using the top ten most important variables when comparing those that included [AUC for 30-day mortality (95% CI): 0.82 (0.81–0.82)] and excluded [AUC for 30-day mortality (95% CI): 0.81 (0.80–0.81)] measurements of frailty. Conclusion Dementia functions as a surrogate for frailty when predicting mortality up to one year after hip fracture surgery. The presence of dementia in a patient without frailty does not appreciably contribute to the prediction of postoperative mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01960-9.
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21
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Arosio B, Rossi PD, Ferri E, Cesari M, Vitale G. Characterization of Vitamin D Status in Older Persons with Cognitive Impairment. Nutrients 2022; 14:nu14061142. [PMID: 35334800 PMCID: PMC8949190 DOI: 10.3390/nu14061142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/24/2022] [Accepted: 03/03/2022] [Indexed: 01/13/2023] Open
Abstract
Vitamin D exerts a role in the maintenance of cognitive abilities and in frailty. Although several studies evaluated the interactions between vitamin D and cognitive impairment, results were conflicting. In a cohort of community-dwelling older persons, we described the association between vitamin D levels and cognitive decline and all-cause dementia evaluating frailty’s contribution. Our cohort included 509 adults, aged 64–92 years: 176 patients with mild cognitive impairment (MCI), 59 with Alzheimer’s Disease (AD), 26 with idiopathic Normal Pressure Hydrocephalus (iNPH), 133 with mixed dementia (MD) and 115 without cognitive decline. Frailty was measured by frailty index, and serum 25-hydroxyvitamin D concentrations through electrochemiluminescence immunoassays. We found a significant association between vitamin D levels and Mini Mental State Examination independently of cognitive impairment, age, sex and frailty. The patients with dementia (AD and MD) showed the lowest vitamin D levels, while MCI patients showed higher levels than the other groups. The most severe deficiency was observed in MD patients, the most aged as well as cognitively and functionally impaired. In conclusion, in our community-dwelling older persons investigated for a suspected cognitive impairment, we observed an association between vitamin D levels and cognitive decline, regardless of the frailty status.
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Affiliation(s)
- Beatrice Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Via Pace 9, 20122 Milan, Italy;
- Correspondence: ; Tel.: +39-02-55035405; Fax: +39-02-50320734
| | - Paolo Dionigi Rossi
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy; (P.D.R.); (E.F.)
| | - Evelyn Ferri
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy; (P.D.R.); (E.F.)
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Via Pace 9, 20122 Milan, Italy;
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Via Camaldoli 64, 20138 Milan, Italy
| | - Giovanni Vitale
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Via Vanvitelli 32, 20133 Milan, Italy;
- Istituto Auxologico Italiano IRCCS, Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Via Zucchi 18, 20095 Cusano Milanino, Italy
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22
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Koria LG, Sawan MJ, Redston MR, Gnjidic D. The Prevalence of Frailty Among Older Adults Living With Dementia: A Systematic Review. J Am Med Dir Assoc 2022; 23:1807-1814. [DOI: 10.1016/j.jamda.2022.01.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/11/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
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Chen S, Wang Y, Wang Z, Zhang X, Deng C, Ma B, Yang J, Lu Q, Zhao Y. Sleep Duration and Frailty Risk among Older Adults: Evidence from a Retrospective, Population-Based Cohort Study. J Nutr Health Aging 2022; 26:383-390. [PMID: 35450995 DOI: 10.1007/s12603-022-1766-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Frailty and sleep duration complaints are both prevalent and often coexist among older adults. The purpose of this study was to examine the prospective association between sleep duration and frailty risk in a nationally representative cohort study. DESIGN Prospective cohort study, ten-year follow-up. SETTING Community-based setting in 23 provinces of China. PARTICIPANTS A total of 7623 older adults age 65 and over without frailty at baseline were included in the analysis. MEASUREMENTS The participants were divided into three groups according to self-reported sleep duration: short (≤6 hours per day), middle (>6 but <10 hours per day) and long (≥10 hours per day). Frailty was measured according to the accumulation of health deficits by the construction of a frailty index of 38 items with 0.25 as the cutoff. A Cox proportional hazard model, a competing risk model and a generalized estimating equation (GEE) model with multiple adjustments were performed to evaluate the association between sleep duration and frailty risk. RESULTS During a median follow-up period of 4.4 years (IQR 2.9-9.0), 2531 (33.2%) individuals developed frailty. Compared with participants with middle sleep duration, the risk of frailty was increased among participants with long sleep duration (HR 1.26, 95% CI 1.14-1.38) in the fully adjusted Cox proportional hazard model. However, short sleep duration was insignificantly associated with frailty risk. The competing risk model and the GEE model yielded similar results. CONCLUSION Long sleep duration is significantly associated with frailty incidence among older adults even after adjustment for confounding factors. This study provides reinforcing longitudinal evidence for the need to design sleep quality improvement interventions in health care programs to prevent frailty among older adults.
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Affiliation(s)
- S Chen
- Qi Lu, MD, School of Nursing, Tianjin Medical University, Tianjin, 300070, China. Tel:86-23542855. Email address: ; Yue Zhao, PhD, Professor, School of Nursing, Tianjin Medical University, Tianjin, 300070, China. Tel:86-23542855. Email address:
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Prevalence and determinants of frailty in older adult patients with chronic coronary syndrome: a cross-sectional study. BMC Geriatr 2021; 21:519. [PMID: 34592947 PMCID: PMC8482732 DOI: 10.1186/s12877-021-02426-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/23/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Frailty is an expression of vulnerability and decline of physical, mental, and social activities, more commonly found in older adults. It is also closely related to the occurrence and poor prognosis of coronary artery disease (CAD). Little investigation has been conducted on the prevalence and determinants of frailty in older adult patients with chronic coronary syndrome (CCS). METHODS A cross-sectional study was conducted, simple random sampling was used in this study. 218 older adults (age ≥ 60 years) with CCS with an inpatient admission number ending in 6 were randomly selected who hospitalized in Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, between January and December 2018. For measurement and assessment, we used the 5-item FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight), demographic characteristics, Barthel Index(BI), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Mini Nutrition Assessment Shor-Form (MNA-SF), Morse Fall Scale (MFS), Caprini risk assessment, polypharmacy, and Numerical Rating Scale (NRS). Multivariate logistic regression analysis was used to confirme determinants. RESULTS The FRAIL scale showed 30.3% of the subjects suffered from frailty. Determinants were aging (OR1.12; 95% CI 1.04 ~ 1.62), out-of-pocket (OR18.93; 95% CI 1.11 ~ 324.07), hearing dysfunction (OR9.43; 95% CI 1.61 ~ 55.21), MNA-SF score (OR0.71; CI 0.57 ~ 0.89), GDS-15 score (OR1.35; 95% CI 1.11 ~ 1.64), and Caprini score (OR1.34; 95% CI 1.06 ~ 1.70). CONCLUSIONS The FRAIL scale confirmed that the prevalence of frailty in patients with CCS was slightly lower than CAD. Aging, malnutrition, hearing dysfunction, depression, and VTE risk were significantly associated with frail for older adult patients with CCS. A comprehensive assessment of high-risk patients can help identify determinants for frailty progression. In the context of CCS, efforts to identify frailty are needed, as are interventions to limit or reverse frailty status in older CCS patients.
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Prevalence of Hypovitaminosis C and its Relationship with Frailty in Older Hospitalised Patients: A Cross-Sectional Study. Nutrients 2021; 13:nu13062117. [PMID: 34203044 PMCID: PMC8235098 DOI: 10.3390/nu13062117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/05/2022] Open
Abstract
Frailty is common in older hospitalised patients and may be associated with micronutrient malnutrition. Only limited studies have explored the relationship between frailty and vitamin C deficiency. This study investigated the prevalence of vitamin C deficiency and its association with frailty severity in patients ≥75 years admitted under a geriatric unit. Patients (n = 160) with a mean age of 84.4 ± 6.4 years were recruited and underwent frailty assessment by use of the Edmonton Frail Scale (EFS). Patients with an EFS score <10 were classified as non-frail/vulnerable/mildly frail and those with ≥10 as moderate–severely frail. Patients with vitamin C levels between 11–28 μmol/L were classified as vitamin C depleted while those with levels <11 μmol/L were classified as vitamin C deficient. A multivariate logistic regression model determined the relationship between vitamin C deficiency and frailty severity after adjustment for various co-variates. Fifty-seven (35.6%) patients were vitamin C depleted, while 42 (26.3%) had vitamin C deficiency. Vitamin C levels were significantly lower among patients who were moderate–severely frail when compared to those who were non-frail/vulnerable/mildly frail (p < 0.05). After adjusted analysis, vitamin C deficiency was 4.3-fold more likely to be associated with moderate–severe frailty (aOR 4.30, 95% CI 1.33-13.86, p = 0.015). Vitamin C deficiency is common and is associated with a greater severity of frailty in older hospitalised patients.
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Jarman H, Crouch R, Baxter M, Wang C, Peck G, Sivapathasuntharam D, Jennings C, Cole E. Feasibility and accuracy of ED frailty identification in older trauma patients: a prospective multi-centre study. Scand J Trauma Resusc Emerg Med 2021; 29:54. [PMID: 33785031 PMCID: PMC8011126 DOI: 10.1186/s13049-021-00868-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The burden of frailty on older people is identifiable by its adverse effect on mortality, morbidity and long term functional and health outcomes. In patients suffering from a traumatic injury there is increasing evidence that it is frailty rather than age that impacts greatest on these outcomes and that early identification can guide frailty specific care. The aim of this study was to evaluate the feasibility of nurse-led assessment of frailty in older trauma patients in the ED in patients admitted to major trauma centres. METHODS Patients age 65 years and over attending the Emergency Departments (ED) of five Major Trauma Centres following traumatic injury were enrolled between June 2019 and March 2020. Patients were assessed for frailty whilst in the ED using three different screening tools (Clinical Frailty Scale [CFS], Program of Research to Integrate Services for the Maintenance of Autonomy 7 [PRIMSA7], and the Trauma Specific Frailty Index [TSFI]) to compare feasibility and accuracy. Accuracy was determined by agreement with geriatrician assessment of frailty. The primary outcome was identification of frailty in the ED using three different assessment tools. RESULTS We included 372 patients whose median age was 80, 53.8% of whom were female. The most common mechanism of injury was fall from less than 2 m followed by falls greater than 2 m. Completion rates for the tools were variable, 31.9% for TSFI, compared to 93% with PRISMA7 and 98.9% with the CFS. There was substantial agreement when using CFS between nurse defined frailty and geriatrician defined frailty. Agreement was moderate using PRISMA7 and slight using TSFI. CONCLUSIONS This prospective study has demonstrated that screening for frailty in older major trauma patients within the Emergency Department is feasible and accurate using CFS. TRIAL REGISTRATION ISRCTN, ISRCTN10671514 . Registered 22 October 2019.
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Affiliation(s)
- Heather Jarman
- Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
| | - Robert Crouch
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Baxter
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Chao Wang
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - George Peck
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Cara Jennings
- King's College Hospital NHS Foundation Trust, London, UK
| | - Elaine Cole
- Blizard Institute, Queen Mary's, University of London, London, UK
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Saunders R, Crookes K, Atee M, Bulsara C, Bulsara MK, Etherton-Beer C, Ewens B, Gallagher O, Graham RM, Gullick K, Haydon S, Nguyen KH, O'Connell B, Seaman K, Hughes J. Prevalence of frailty and pain in hospitalised adult patients in an acute hospital: a protocol for a point prevalence observational study. BMJ Open 2021; 11:e046138. [PMID: 33757956 PMCID: PMC7993156 DOI: 10.1136/bmjopen-2020-046138] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Frailty and pain are associated with adverse patient clinical outcomes and healthcare system costs. Frailty and pain can interact, such that symptoms of frailty can make pain assessment difficult and pain can exacerbate the progression of frailty. The prevalence of frailty and pain and their concurrence in hospital settings are not well understood, and patients with cognitive impairment are often excluded from pain prevalence studies due to difficulties assessing their pain. The aim of this study is to determine the prevalence of frailty and pain in adult inpatients, including those with cognitive impairment, in an acute care private metropolitan hospital in Western Australia. METHODS AND ANALYSIS A prospective, observational, single-day point prevalence, cross-sectional study of frailty and pain intensity of all inpatients (excluding day surgery and critical care units) will be undertaken. Frailty will be assessed using the modified Reported Edmonton Frail Scale. Current pain intensity will be assessed using the PainChek smart-device application enabling pain assessment in people unable to report pain due to cognitive impairment. Participants will also provide a numerical rating of the intensity of current pain and the worst pain experienced in the previous 24 hours. Demographic and clinical information will be collected from patient files. The overall response rate of the survey will be reported, as well as the percentage prevalence of frailty and of pain in the sample (separately for PainChek scores and numerical ratings). Additional statistical modelling will be conducted comparing frailty scores with pain scores, adjusting for covariates including age, gender, ward type and reason for admission. ETHICS AND DISSEMINATION Ethical approval has been granted by Ramsay Health Care Human Research Ethics Committee WA/SA (reference: 2038) and Edith Cowan University Human Research Ethics Committee (reference: 2020-02008-SAUNDERS). Findings will be widely disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER ACTRN12620000904976.
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Affiliation(s)
- Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kate Crookes
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Mustafa Atee
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
- The Dementia Centre, St Leonards, New South Wales, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Christopher Etherton-Beer
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- WA Centre for Health & Ageing, University of Western Australia, Crawley, Western Australia, Australia
| | - Beverley Ewens
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Olivia Gallagher
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Renee M Graham
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karen Gullick
- Clinical Services, Hollywood Private Hospital, Nedlands, Western Australia, Australia
| | - Sue Haydon
- Clinical Services, Hollywood Private Hospital, Nedlands 6009, Western Australia, Australia
| | - Kim-Huong Nguyen
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Bev O'Connell
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karla Seaman
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Jeff Hughes
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
- PainChek Ltd, Bentley, Western Australia, Australia
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Evaluation of pro-inflammatory cytokines in frail Tunisian older adults. PLoS One 2020; 15:e0242152. [PMID: 33166358 PMCID: PMC7652286 DOI: 10.1371/journal.pone.0242152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022] Open
Abstract
The present study was undertaken to evaluate serum levels of pro-inflammatory cytokines in Tunisian older adults and to examine the relationships between inflammatory marker levels, geriatric, and biochemical parameters. A cross-sectional study was conducted in a population of Tunisian older adults (N = 141, aged 65 and over). Patients were recruited from the Department of Internal Medicine, Fattouma Bourguiba University Hospital (Monastir, Tunisia) and from a nursing home (Sousse, Tunisia). Comprehensive geriatric assessment, history taking and examination including functional and nutritional assessment were done for each participant. Enzyme-linked immunosorbent assay (ELISA) test was used to measure serum cytokine (TNF-α, IL-8, IL-6) levels. The modified Short Emergency Geriatric Assessment score (SEGAm) were used to classify patients as 51 very-frail, 40 frail, and 50 non-frail. The age of the participants (80 men, 61 women) ranged from 65 to 97 years. Serum levels of TNF-α, IL-8 and C-reactive protein (CRP) were significantly higher in very-frail participants compared to frail and non-frail ones. However, no significant differences in IL-6 levels were detected among frailty groups. After adjustment for age, CRP and IL-8 levels remained significantly associated with frailty. Analysis of the receiver operating characteristic (ROC) curve corresponding to IL-8 showed an area under the curve of 0.7 (p = 0.003; 95% CI [0.58-0.81]) and a predictive threshold of 5.27 pg/ml. Positive correlations were found between frailty score, IL-6, and IL-8 levels. In addition, a significant positive correlation was observed between IL-8 levels and Timed Up and Go test results. However, a negative correlation was observed between Mini Nutritional Assessment Short-Form score, IL-6 and CRP levels, as well as between Activities of Daily Living score and serum levels of TNF-α, IL-6, and CRP. In conclusion, the key findings of this study collectively support a role of pro-inflammatory cytokines, TNF-α, CRP, and especially IL-8 in the development of frailty in older adults.
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