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Atala-Acevedo C, McGrath R, Capurro D, Glenister K, Bourke L, Morgan M, Simmons D, Mariño R. Identifying Frailty in Older Adults in Rural Victoria, Australia: A Secondary Analysis of Population Health Data. J Aging Health 2024; 36:170-181. [PMID: 37260112 DOI: 10.1177/08982643231180045] [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: 06/02/2023]
Abstract
Objectives: To determine the prevalence of frailty among community-dwelling older adults in regional Victoria, Australia. Methods: Frailty status of 376 participants from the Crossroads II cross-sectional study was assessed by selected markers of frailty. The selected variables were psychometrically tested. Associations between frailty and socio-demographic, environmental and health factors were analysed using chi-square, ANOVA and binary logistic regression (BLR). Results: Estimated prevalence of frailty was 39.4%. BLR indicated that frailty decreased with higher educational attainment, (OR = .23; 95% CI: .10-.51) increased for divorced/separated participants (OR = 2.68; 95% CI: 1.29-5.56) and when having three (OR = 3.27; 95% CI: 1.07-9.98), four (OR = 7.20; 95% CI: 2.22-23.31) or five or more chronic conditions (OR = 9.18; 95% CI: 2.83-29.72). Discussion: Frailty in this Australian regional community-dwelling sample was higher than other studies conducted in urban areas of Australia. Present results highlight the importance of exploring the multidimensionality of the frailty construct to have a better understanding which factors are associated with the development of this syndrome.
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Affiliation(s)
- Claudia Atala-Acevedo
- Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - Roisin McGrath
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - Daniel Capurro
- School of Computing and Information Systems, Centre for the Digital Transformation of Health, The University of Melbourne, Melbourne, VIC Australia
| | - Kristen Glenister
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
| | - Mike Morgan
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - David Simmons
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
- Macarthur Clinical School, Western Sydney University, Sydney, Australia
| | - Rodrigo Mariño
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
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Van Deutekom C, Geelhoed B, Van Munster BC, Bakker SJL, Gansevoort RT, Van Gelder IC, Rienstra M. Cardiovascular and renal multimorbidity increase risk of atrial fibrillation in the PREVEND cohort. Open Heart 2023; 10:e002315. [PMID: 37460268 DOI: 10.1136/openhrt-2023-002315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) is a condition that occurs in the presence of comorbidities. With the accumulation of comorbidities (multimorbidity), some combinations may more often occur together than others. Information on the impact of clustering of these on incident AF is sparse. We aimed to investigate clustering of cardiovascular and renal comorbidities and study the association between comorbidity clusters and incident AF. METHODS We used the community-based Prevention of Renal and Vascular ENd-stage Disease (PREVEND) cohort in which 8592 individuals participated. Latent class analysis was performed to assess clustering of 10 cardiovascular and renal comorbidities. RESULTS We excluded individuals with prior AF or missing ECG data, leaving 8265 individuals for analysis (mean age 48.9±12.6 years, 50.2% women). During 9.2±2.1 years of follow-up, 251 individuals (3.0%) developed AF. A model with three clusters was the optimal model, with one cluster being young (44.5±10.8 years) and healthy, carrying a low (1.0%) risk of incident AF; one cluster being older (63.0±8.4 years) and multimorbid, carrying a high (16.2%) risk of incident AF and a third middle-aged (57.0±11.3 years), obese and hypertensive cluster carrying an intermediate risk (5.9%) of incident AF. While the prevalence of the comorbidities differed between classes, no clear combination(s) of comorbidities was observed within the classes. CONCLUSIONS We identified three clusters of comorbidities in individuals in the community-based PREVEND cohort. The three clusters contained different amount of comorbidities carrying different risks of incident AF. However, there were no differences between the clusters regarding specific combination(s) of comorbidities.
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Affiliation(s)
- Colinda Van Deutekom
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bastiaan Geelhoed
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara C Van Munster
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Proietti M, Romiti GF, Corica B, Mei DA, Bonini N, Vitolo M, Imberti JF, Boriani G, Lip GYH. Features of Clinical Complexity in European Patients with Atrial Fibrillation: A Report from a European Observational Prospective AF Registry. Curr Probl Cardiol 2023; 48:101752. [PMID: 37087078 DOI: 10.1016/j.cpcardiol.2023.101752] [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: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
There is increasing concern regarding impact of clinical complexity in patients with atrial fibrillation (AF). We explored the impact of different clinical complexity features in AF patients. We analyzed patients from a prospective, observational, multicentre Europe-wide AF registry. Features of clinical complexity among patients with CHA2DS2-VASc ≥2 were: i) history of bleeding; ii) frailty; iii) chronic kidney disease (CKD); iv) ≥2 features. A total of 10,169 patients were analysed. Of these, 141 (1.4%) had history of bleeding, 954 (9.4%) were frail, 1,767 (17.4%) had CKD and 1,253 (12.3%) had ≥2 features. All features of clinical complexity were less treated with OAC. History of bleeding (HR 1.94, 95% CI 1.32-2.85), frailty (HR 1.38, 95% CI 1.11-1.71), CKD (HR 1.50, 95% 1.28-1.75) and ≥2 features (HR 2.08, 95% CI 1.73-2.51) were associated with outcomes. Presence of features of clinical complexity is associated with lower use of OAC and higher risk of outcomes.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Bernadette Corica
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Davide Antonio Mei
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Niccolò Bonini
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo Francesco Imberti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark..
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Bevilacqua G, Westbury LD, Bloom I, Zhang J, Ward KA, Cooper C, Dennison EM. Investigating the relationship between self-perception of fracture risk and prior fracture: findings from the Hertfordshire Cohort Study. Aging Clin Exp Res 2023; 35:599-606. [PMID: 36529804 PMCID: PMC9760539 DOI: 10.1007/s40520-022-02322-6] [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: 09/30/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Self-perceived risk of fracture (SPR) is associated with fracture independent of FRAX calculated risk. To understand this better we considered whether lifestyle factors not included in the FRAX algorithm and psychosocial factors (social isolation, self-efficacy, or mental health status) explain the relationship between SPR and fracture. METHODS We studied 146 UK community-dwelling older adults from the Hertfordshire Cohort Study. SPR ranked as 'lower', 'similar' and 'higher' relative to others of the same age, was assessed by questionnaire. Social isolation was assessed using the six-item Lubben Social Network Scale; self-efficacy was assessed using a shortened General Self-Efficacy Scale (GSE); mental health status was assessed using the anxiety/depression item from the EuroQoL questionnaire. SPR in relation to previous self-reported fracture was examined using logistic regression. RESULTS Among participants of median age 83.4 (IQR 81.5-85.5) years, SPR was lower for 54.1% of participants, similar for 30.8%, and higher for 15.1%; 74.7% reported no previous fractures. Greater SPR was associated with increased odds of previous fractures when adjusting for sex and age only (OR 1.72, 95% CI 1.03-2.87, per higher band of SPR). While further individual adjustment for social isolation (1.73, 1.04-2.89), self-efficacy (1.71, 1.02-2.85), or mental health (1.77, 1.06-2.97) did not attenuate the relationship, individual adjustment for diet quality and number of comorbidities did. CONCLUSIONS Adjustment for social isolation, self-efficacy or mental health status did not attenuate the relationship between SPR and fracture. By contrast, lifestyle factors not included in FRAX, such as diet quality, did attenuate relationships, suggesting a possible future area of investigation.
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Affiliation(s)
- Gregorio Bevilacqua
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Leo D Westbury
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Ilse Bloom
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Jean Zhang
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Kate A Ward
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Cyrus Cooper
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
- National Institute for Health and Care Research (NIHR), Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Elaine M Dennison
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK.
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK.
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand.
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Tan V, Chen C, Merchant RA. Association of social determinants of health with frailty, cognitive impairment, and self-rated health among older adults. PLoS One 2022; 17:e0277290. [PMID: 36367863 PMCID: PMC9651553 DOI: 10.1371/journal.pone.0277290] [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: 10/12/2021] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectives Recently, the role of social determinants of health on frailty and dementia has received increased attention. The aim of the present study is to explore the association of social determinants on cognitive impairment, frailty, and self-rated health. As health is influenced by many factors, we also examine other health determinants including lifestyle, health seeking behaviour, socio-demographics, and multimorbidity in the analysis. Research design and methods Cross-sectional analysis of the Healthy Older People Everyday (HOPE) study in Singapore was carried out on 998 older adults above the age of 65. We used forward stepwise multivariable logistic and linear regression analyses to assess the association of five health determinants (social determinants, lifestyle, health seeking behaviour, socio-demographics and multimorbidity) on frailty, cognitive impairment, and self-rated health. Results Mean age of participants was 71.1 ± 0.2 years; 154 (15.4%) were cognitively impaired; 430 (43.1%) were pre-frail or frail; mean self-rated health was 80.4 ± 15.6. Social determinants contributed between 29% to 57% of the overall variation found in the full model with all five health determinants adjusted for. Participants with higher education had significantly lower odds of cognitive impairment and frailty. Leisure physical activity was significantly associated with lower odds of frailty and cognitive impairment, and better self-rated health. Discussion and implications Understanding the dynamics of different health determinants is crucial to protect the vulnerable in an ageing population. Our study highlights the need for a multidimensional, multidisciplinary and multisectoral approach in the prevention of frailty, cognitive impairment, and associated disability.
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Affiliation(s)
- Vanessa Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
- Department of Non-Communicable Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Muhammad T, Saravanakumar P, Sharma A, Srivastava S, Irshad CV. Association of food insecurity with physical frailty among older adults: study based on LASI, 2017-18. Arch Gerontol Geriatr 2022; 103:104762. [PMID: 35841798 DOI: 10.1016/j.archger.2022.104762] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Food security can be directly linked to nutritional status and either directly or indirectly, it has an impact on health status and well-being of the population. Physical frailty is one of the most important phenotypes used to understand the vulnerable nature of older adults. This paper examined the association between food security and physical frailty in older adults. METHODS We used data from the Longitudinal Ageing Study in India (LASI, 2017-18), wave-1. The sample size was 31,464 older adults aged 60 years and above. Physical frailty was assessed using the modified version of frailty phenotype proposed by Fried and colleagues. Multivariable logistic regression was used to establish the association between food insecurity with physical frailty. RESULTS A proportion of 30.65% of older adults were frail in this study. Older adults with food insecurity had higher prevalence of exhaustion (12.1% vs 6.5%), unintentional weight loss (65.5% vs 5.1%), and weak grip strength (8.6% vs 7.9%) in comparison to their food secure counterparts. After adjusting for a large number of confounders, older adults who reported food insecurity had significantly higher odds of being frail [AOR: 2.68; CI: 2.26-3.19] in comparison to older adults with no food insecurity. CONCLUSION The study showed that food insecurity is associated with physical frailty among older adults in India. It is suggested that food security programs in the country may be considered as an effective strategy to prevent physical frailty among older adults.
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Affiliation(s)
- T Muhammad
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, Maharashtra 400088, India
| | - Priya Saravanakumar
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Building 10, Level 7, 235 Jones St, Ultimo, Sydney, NSW 2007, Australia
| | - Abhishek Sharma
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra 400088, India
| | - Shobhit Srivastava
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra 400088, India
| | - C V Irshad
- Department of Humanities and Social Sciences, Indian Institute of Technology, Madras, 600036 India.
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Impact of Multimorbidity and Polypharmacy on Clinical Outcomes of Elderly Chinese Patients with Atrial Fibrillation. J Clin Med 2022; 11:jcm11051370. [PMID: 35268461 PMCID: PMC8910929 DOI: 10.3390/jcm11051370] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 12/20/2022] Open
Abstract
Background: The co-incidence of multiple morbidities and polypharmacy is common amongst patients with atrial fibrillation (AF); however, data on their impact on clinical outcomes are scarce in Asian cohorts. Objective: To evaluate the impact of multimorbidity and polypharmacy on clinical outcomes and AF management among elderly Chinese patients. Methods: The ChiOTEAF registry is a prospective, multicenter nationwide study conducted from October 2014 to December 2018. Endpoints of interest were the composite outcome of all-cause death/any thromboembolism (TE), all-cause death, cardiovascular death, TE events, major bleeding, as well as AF management. Results: The eligible cohort included 6341 individuals (mean age 74.7 ± 10.7; 39.1% female), of whom 4644 (73.2%) had multimorbidity (defined as two or more chronic diseases), and 2262 (35.7%) were treated with five or more medications. There were 2775 (43.8%) patients on anticoagulant (OAC) use. On multivariate analysis, (i) multimorbidity was associated with a higher odds ratio of the composite outcome (OR: 2.04; 95% CI: 1.49–2.79), all-cause death (OR: 1.82; 95% CI: 1.31–2.54), cardiovascular death (OR: 2.05; 95% CI: 1.13–3.69), any TE (OR: 2.69; 95% CI: 1.29–5.62), and major bleeding (OR: 2.61; 95% CI: 1.25–5.45); (ii) polypharmacy was associated with a lower odds ratio of all-cause death (OR: 0.78; 95% CI: 0.63–0.96). The use of OAC was safe and was associated with a lower odds ratio of the composite outcome and all-cause death in all subgroups of patients. Conclusions: Multimorbidity and polypharmacy were common among elderly AF Chinese patients. Multimorbidity was an independent predictor of adverse clinical outcomes. The use of OAC was safe and significantly improved survival amongst AF patients with multimorbidity and polypharmacy.
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Bhardwaj PV, Rastegar V, Meka R, Sawalha K, Brennan M, Stefan MS. The Association Between Body Mass Index, Frailty and Long-Term Clinical Outcomes in Hospitalized Older Adults. Am J Med Sci 2021; 362:268-275. [PMID: 33894183 DOI: 10.1016/j.amjms.2021.04.004] [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: 06/30/2020] [Revised: 12/14/2020] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND While frailty is thought to be a wasting disorder, there is scarce data regarding the association between frailty and body mass index (BMI). The aim of this study was to determine the relationship between BMI, frailty, and mortality among hospitalized older adults. METHODS This is a secondary analysis of a prospective cohort study of patients aged ≥65 years admitted to a tertiary center between 2014 and 2016. Frailty was assessed by Reported Edmonton Frailty Scale (REFS) and categorized as: not frail, vulnerable/mild frail, and moderate/severe frail. BMI (kg/m2) was categorized as: underweight (<18.5), normal (18.5-24.9), overweight (25.0- 29.9), or obese (≥ 30.0). Primary outcome was all-cause one-year mortality. RESULTS Among 769 patients included in the study, 55.4% were frail. There was no statistically significant association between frailty categories and levels of BMI. Frail patients had a higher risk of death than non-frail after adjusting for confounders [HR: 1.98, 95% CI (1.46, 2.70) for mild frail and HR 2.03, 95% CI (1.43, 2.87) for moderate/severe frail]. Compared with normal weight patients, those who were overweight had a survival advantage if they were non-frail [HR 0.55, 95% CI (0.31, 0.96)] or vulnerable/mild frail [HR 0.65, 95% CI (0.43, 0.97)] but not if they were moderate/severe frail. There were no other statistically significant differences in survival by BMI and frailty categories. CONCLUSIONS We did not find a relationship between BMI and frailty among hospitalized older adults. Overweight patients had a survival advantage if they were non-frail or vulnerable. There is need for further longitudinal studies assessing the interaction between frailty and BMI in older adults.
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Affiliation(s)
- Prarthna V Bhardwaj
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
| | - Vida Rastegar
- Institute for Healthcare Delivery and Population Science, Springfield, MA, USA.
| | - Rohini Meka
- Department of Hospital Medicine, Baystate Medical Center, Springfield, MA, USA.
| | - Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
| | - Maura Brennan
- Division of Geriatrics, University of Massachusetts Medical School - Baystate, Springfield MA, USA.
| | - Mihaela S Stefan
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA; Institute for Healthcare Delivery and Population Science, Springfield, MA, USA.
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9
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Gao K, Li BL, Yang L, Zhou D, Ding KX, Yan J, Gao YJ, Huang XR, Zheng XP. Cardiometabolic diseases, frailty, and healthcare utilization and expenditure in community-dwelling Chinese older adults. Sci Rep 2021; 11:7776. [PMID: 33833338 PMCID: PMC8032763 DOI: 10.1038/s41598-021-87444-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/24/2021] [Indexed: 11/09/2022] Open
Abstract
This study investigated associations between cardiometabolic diseases, frailty, and healthcare utilization and expenditure among Chinese older adults. The participants were 5204 community-dwelling adults aged at least 60 years from the China Health and Retirement Longitudinal Study. Five cardiometabolic diseases were assessed including hypertension, dyslipidemia, diabetes, cardiac diseases and stroke. Frailty status was based on five criteria: slowness, weakness, exhaustion, inactivity, and shrinking. Participants were deemed frailty if they met at least three criteria. As the number of cardiometabolic diseases increased, so did the prevalence of frailty, and the proportion of healthcare utilization, including outpatient visit and inpatient visit. Moreover, the total healthcare expenditure and the odds of catastrophic health expenditure were increased with the number of cardiometabolic disorders. After adjusting for covariates, cardiometabolic diseases were positively associated with higher odds of frailty, incurring outpatient and inpatient visit. And individuals with 2 or more cardiometabolic diseases had a higher odds of catastrophic health expenditure than persons with non-cardiometabolic disease. Participants who were frailty were more likely to report higher odds of healthcare utilization. These findings suggest that both cardiometabolic diseases and frailty assessment may improve identification of older adults likely to require costly, extensive healthcare.
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Affiliation(s)
- Ke Gao
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
| | - Bo-Lin Li
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Lei Yang
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
| | - Dan Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kang-Xi Ding
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Ju Yan
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Wulumuqi, Xinjiang, China
| | - Ya-Jie Gao
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Xiao-Rui Huang
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Xiao-Pu Zheng
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China. .,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China.
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