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Verstraeten LMG, van Wijngaarden JP, Meskers CGM, Maier AB. High Sarcopenia Awareness Contrasts a Lack of Clinical Implementation Among Geriatric Rehabilitation Health Care Professionals in the Netherlands: EMPOWER-GR. J Geriatr Phys Ther 2024; 47:67-76. [PMID: 36827678 DOI: 10.1519/jpt.0000000000000379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND PURPOSE Despite being associated with serious adverse outcomes, such as mortality, sarcopenia remains largely undiagnosed in older individuals. This study aimed to assess the awareness, practices, and barriers and enablers to clinical implementation of sarcopenia diagnosis and treatment among geriatric rehabilitation health care professionals in the Netherlands. METHODS As part of EMPOWER-GR, a cross-sectional survey among geriatric rehabilitation health care professionals working in the Netherlands was undertaken between September 23, 2020, and January 28, 2021. Professionals were recruited via a geriatric rehabilitation care provider, health care professional associations, professional networks of the research team, and social media. Descriptive statistics were used to assess the study outcomes. RESULTS AND DISCUSSION Of the 501 geriatric rehabilitation health care professionals, 12.2% were physicians, 23.0% physical therapist/occupational therapists, 30.3% dietitians, 19.6% nurses, and 11.0% health care assistants. The concept of sarcopenia was known by 83.8% of the participants, 92.5% correctly identified sarcopenia as low muscle mass and strength (and low physical performance), and 73.8% identified sarcopenia as very important in the management of older adults admitted for rehabilitation. Although 26.2% and 18.9% of the participants reported screening and diagnosing sarcopenia, respectively, in their current practice, only 3.0% adequately used the (revised) definition of the European Working Group on Sarcopenia in Older People. When sarcopenia has been diagnosed, 65.0% reported initiating treatment consisting of resistance exercise training (78.7%), food fortification/high-energy or protein diet (85.4%), and oral nutritional supplements (70.4%). Most important barriers to screening and diagnosis were lack of knowledge, access to tools, and equipment and time, while enablers were protocol implementation, access to training, and clear responsibilities. CONCLUSIONS Sarcopenia awareness is high among geriatric rehabilitation health care professionals in the Netherlands, but adequate screening and diagnosis is almost nonexistent in current clinical practice, which hampers interventions. Better knowledge, clear responsibilities, and access to tools and protocols, as well as prioritization, are needed for sarcopenia to be diagnosed and treated in geriatric rehabilitation in the Netherlands.
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Affiliation(s)
- Laure M G Verstraeten
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | | | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Center for Healthy Longevity, @AgeSingapore, National University Health System, Singapore
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Deng Y, Sato N. Global frailty screening tools: Review and application of frailty screening tools from 2001 to 2023. Intractable Rare Dis Res 2024; 13:1-11. [PMID: 38404737 PMCID: PMC10883846 DOI: 10.5582/irdr.2023.01113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024] Open
Abstract
As the aging population increases globally, health-related issues caused by frailty are gradually coming to light and have become a global health priority. Frailty leads to a significantly increased risk of falls, incapacitation, and death. Early screening leads to better prevention and management of frailty, increasing the possibility of reversing it. Developing assessment tools by incorporating disease states of older adults using effective interventions has become the most effective approach for preventing and controlling frailty. The most direct and effective tool for evaluating debilitating conditions is a frailty screening tool, but because there is no globally recognized gold standard, every country has its own scale for national use. The diversity and usefulness of the frailty screening tool has become a hot topic worldwide. In this article, we reviewed the frailty screening tool published worldwide from January 2001 to June 2023. We focused on several commonly used frailty screening tools. A systematic search was conducted using PubMed database, and the commonly used frailty screening tools were found to be translated and validated in many countries. Disease-specific scales were also selected to fit the disease. Each of the current frailty screening tools are used in different clinical situations, and therefore, the clinical practice applications of these frailty screening tools are summarized graphically to provide the most intuitive screening and reference for clinical practitioners. The frailty screening tools were categorized as (ⅰ) Global Frailty Screening Tools in Common; (ⅱ) Frailty Screening Tools in various countries; (ⅲ) Frailty Screening Tools for various diseases. As science and technology continue to advance, electronic frailty assessment tools have been developed and utilized. In the context of Coronavirus disease 2019 (COVID-19), electronic frailty assessment tools played an important role. This review compares the currently used frailty screenings tools, with a view to enable quick selection of the appropriate scale. However, further improvement and justification of each tool is needed to guide clinical practitioners to make better decisions.
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Affiliation(s)
- Yi Deng
- Graduate School of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naomi Sato
- Department of Clinical Nursing, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Araya AX, Iriarte E, De Oliveira G, Baeza MJ, Jankowski C. Factors Related to the Need for Informal Care Among Community-Dwelling Older Adults in Chile. J Gerontol Nurs 2024; 50:43-52. [PMID: 38290095 DOI: 10.3928/00989134-20240111-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE To identify factors contributing to the need for informal care among community-dwelling older adults with functional impairment in Chile. METHOD A secondary data analysis was conducted using cross-sectional data from 540 Chilean older adults aged ≥60 years (mean age = 72.2 years, SD = 6.22 years). RESULTS Informal care need was reported by 24.3% (n = 131) of participants. Among the variables that most influenced the need for informal care among older adults were hospitalization in the past 1 year, functionality, comorbidities, and multidimensional frailty (all p < 0.05). CONCLUSION This study identified factors that clinicians and nurses should be aware of when caring for this population to prevent or manage the need for informal care. [Journal of Gerontological Nursing, 50(2), 43-52.].
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Van Hollebeke M, Chohan K, Adams CJ, Fisher JH, Shapera S, Fidler L, Goligher EC, Martinu T, Wickerson L, Mathur S, Singer LG, Reid WD, Rozenberg D. Clinical implications of frailty assessed in hospitalized patients with acute-exacerbation of interstitial lung disease. Chron Respir Dis 2024; 21:14799731241240786. [PMID: 38515270 PMCID: PMC10958799 DOI: 10.1177/14799731241240786] [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: 11/14/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Approximately 50% of patients with interstitial lung disease (ILD) experience frailty, which remains unexplored in acute exacerbations of ILD (AE-ILD). A better understanding may help with prognostication and resource planning. We evaluated the association of frailty with clinical characteristics, physical function, hospital outcomes, and post-AE-ILD recovery. METHODS Retrospective cohort study of AE-ILD patients (01/2015-10/2019) with frailty (proportion ≥0.25) on a 30-item cumulative-deficits index. Frail and non-frail patients were compared for pre- and post-hospitalization clinical characteristics, adjusted for age, sex, and ILD diagnosis. One-year mortality, considering transplantation as a competing risk, was analysed adjusting for age, frailty, and Charlson Comorbidity Index (CCI). RESULTS 89 AE-ILD patients were admitted (median: 67 years, 63% idiopathic pulmonary fibrosis). 31 were frail, which was associated with older age, greater CCI, lower 6-min walk distance, and decreased independence pre-hospitalization. Frail patients had more major complications (32% vs 10%, p = .01) and required more multidisciplinary support during hospitalization. Frailty was not associated with 1-year mortality (HR: 0.97, 95%CI: [0.45-2.10]) factoring transplantation as a competing risk. CONCLUSIONS Frailty was associated with reduced exercise capacity, increased comorbidities and hospital complications. Identifying frailty may highlight those requiring additional multidisciplinary support, but further study is needed to explore whether frailty is modifiable with AE-ILD.
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Affiliation(s)
- Marine Van Hollebeke
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Karan Chohan
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Colin J. Adams
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jolene H. Fisher
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Shane Shapera
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lee Fidler
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Sunnybrook Health Science Center, Toronto, ON, Canada
| | - Ewan C. Goligher
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Tereza Martinu
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa Wickerson
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Sunita Mathur
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Lianne G. Singer
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - W. Darlene Reid
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Ji M, Hang L, Wang T, Luo H, Wu X, Gu D. A survey of nurses' knowledge, attitudes, and practice of sarcopenia: A cross-sectional study. Nurse Educ Pract 2024; 74:103869. [PMID: 38183908 DOI: 10.1016/j.nepr.2023.103869] [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: 08/29/2023] [Revised: 10/20/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024]
Abstract
AIM This paper aims to assess the current knowledge, attitudes, and behaviors of nursing staff regarding sarcopenia and explore associating factors that influence them. BACKGROUND Sarcopenia has an insidious onset and is easily overlooked. However, it is has become very common in older people, seriously jeopardizing the quality of life in patients. The present situation of nurses in China is inadequate, even though they are the primary professionals tasked with screening for sarcopenia, the ability to recognize and effectively manage the disease, and the critical role they play in preventing and controlling sarcopenia in patients. DESIGN We conducted a cross-sectional design of nurses. METHODS Facilitated sampling was used in seven hospitals in Jiangsu Province, China. A total of 409 hospital nursing staff participated in the survey from December 2022 to March 2023. The main survey instruments were the nursing staff about the knowledge of sarcopenia, beliefs, a behavior questionnaire, and a self-designed general information questionnaire. Descriptive of general data, t-test, and ANOVA for influencing factors of three dimensions, whereas multiple linear regression analyses were performed using SPSS23.0 software. RESULTS Questionnaires were distributed to 460 nurses, and of the 426 (92.6%) questionnaires returned, 409 (96.0%) were valid. The total mean score of nurses' knowledge, beliefs, and behavior about sarcopenia was 125.42 (SD 18.97), the mean score of knowledge latitude was 29.09 (SD 7.80), the mean score of attitude dimension was 57.53 (SD 7.63), and the mean score of behavior latitude was 38.80 (SD 10.71). Multiple linear regression analysis revealed that the nurse's position, Knowledge of sarcopenia, whether or not they were specialist nurses and years of experience in the workplace were the most significant factors correlated with the level of knowledge, belief, and practice (P < 0.05). CONCLUSIONS In China, nurses have little knowledge about sarcopenia, but their attitude towards sarcopenia care is positive. However, there is potential for improvement in nursing behavior toward sarcopenia management. RELEVANCE TO CLINICAL PRACTICE Managers are advised to develop targeted training programs for nurses. Further, it improves their screening and diagnosing abilities, allowing them to prevent and control sarcopenia more effectively.
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Affiliation(s)
- Mengchen Ji
- Affiliated Jiangnan University, Wuxi, China.
| | - Ling Hang
- Affiliated Hospital of Jiangnan University, Wuxi, China.
| | - Tian Wang
- Affiliated Jiangnan University, Wuxi, China.
| | - Huamin Luo
- Affiliated Hospital of Jiangnan University, Wuxi, China.
| | - Xinyan Wu
- Affiliated Jiangnan University, Wuxi, China.
| | - Danfeng Gu
- Affiliated Hospital of Jiangnan University, Wuxi, China.
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Chen K, Yang D, Li F, Gao L, Tian Y, Xu B, Xu X, Xu Q, Cao J. Changes in the symptom clusters of elderly patients with lung cancer over the course of postoperative rehabilitation and their correlation with frailty and quality of life: A longitudinal study. Eur J Oncol Nurs 2023; 67:102388. [PMID: 37948789 DOI: 10.1016/j.ejon.2023.102388] [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: 03/15/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To explore changes in the symptom clusters of perioperatively elderly patients with lung cancer at different time points (i.e., the day of admission [T0]), 2-4 days after surgery [T1], 1 month after discharge [T2] and 3 months after discharge [T3]) and to analyze correlations between cluster severity, frailty and quality of life (QOL). METHODS A longitudinal study was conducted from August 2020 to June 2021 among elderly lung cancer patients undergoing surgery at hospitals in Jiangsu Province. Data were collected using the Chinese Tilburg Frailty Indicator, the MD Anderson Symptom Inventory and the Quality of Life-Core scale. RESULTS According to exploratory factor analysis, a total of 5 symptom clusters were found and three of them (the global mental function symptom cluster, the special mental function symptom cluster and the respiratory function symptom cluster) were persistent. The incidence of the top four symptoms varied at different time points. The severity of symptom clusters at different time points was positively correlated with frailty and negatively correlated with QOL. CONCLUSIONS The findings may serve as a reference for medical staff to implement symptom management in elderly lung cancer patients after surgery. Frailty may be an important variable affecting the severity of symptom clusters and the QOL of patients.
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Doucet J, Gourdy P, Meyer L, Benabdelmoumene N, Bourdel-Marchasson I. Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities. Clin Interv Aging 2023; 18:1687-1703. [PMID: 37841649 PMCID: PMC10573466 DOI: 10.2147/cia.s423122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
The population of older adults (≥65 years) with type 2 diabetes mellitus (T2DM) is diverse, encompassing individuals with varying functional capabilities, living arrangements, concomitant medical conditions, and life expectancies. Hence, their categorization into different patient profiles (ie, good health, intermediate health, poor health) may aid in clinical decision-making when establishing glycemic goals and pharmacological treatment strategies. Further granularity in assessing each patient profile through interdisciplinary collaboration may also add precision to therapeutic and monitoring decisions. In this review, we discuss with a multidisciplinary approach how to deliver the best benefit from advanced diabetes therapies and technologies to older adults with T2DM according to each patient profile. There remain however several areas that deserve further research in older adults with T2DM, including the efficacy and safety of continuous glucose monitoring and automated insulin delivery systems, the switch to once-weekly insulin, the effectiveness of multidisciplinary care models, and the use of supported telemedicine and remote blood glucose monitoring in the oldest-old (≥85 years) who particularly require the assistance of others.
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Affiliation(s)
- Jean Doucet
- Department of Polyvalent Internal Medicine, Saint Julien Hospital, Rouen University Hospital, Rouen, France
| | - Pierre Gourdy
- Department of Diabetology, Toulouse University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UT3, Toulouse University, Toulouse, France
| | - Laurent Meyer
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Benabdelmoumene
- Department of Internal Medicine and Geriatrics, University Hospital of Marseille, Marseille, France
| | - Isabelle Bourdel-Marchasson
- CNRS, CRMSB, UMR 5536, University of Bordeaux, Bordeaux, France
- University Hospital of Bordeaux, Bordeaux, France
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Lound A, Bruton J, Jones K, Shah N, Williams B, Gross J, Post B, Day S, Brett SJ, Ward H. "I'd rather wait and see what's around the corner": A multi-perspective qualitative study of treatment escalation planning in frailty. PLoS One 2023; 18:e0291984. [PMID: 37733669 PMCID: PMC10513333 DOI: 10.1371/journal.pone.0291984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION People living with frailty risk adverse outcomes following even minor illnesses. Admission to hospital or the intensive care unit is associated with potentially burdensome interventions and poor outcomes. Decision-making during an emergency is fraught with complexity and potential for conflict between patients, carers and clinicians. Advance care planning is a process of shared decision-making which aims to ensure patients are treated in line with their wishes. However, planning for future care is challenging and those living with frailty are rarely given the opportunity to discuss their preferences. The aim of the ProsPECT (Prospective Planning for Escalation of Care and Treatment) study was to explore perspectives on planning for treatment escalation in the context of frailty. We spoke to people living with frailty, their carers and clinicians across primary and secondary care. METHODS In-depth online or telephone interviews and online focus groups. The topic guide explored frailty, acute decision-making and planning for the future. Data were thematically analysed using the Framework Method. Preliminary findings were presented to a sample of study participants for feedback in two online workshops. RESULTS We spoke to 44 participants (9 patients, 11 carers and 24 clinicians). Four main themes were identified: frailty is absent from treatment escalation discussions, planning for an uncertain future, escalation in an acute crisis is 'the path of least resistance', and approaches to facilitating treatment escalation planning in frailty. CONCLUSION Barriers to treatment escalation planning include a lack of shared understanding of frailty and uncertainty about the future. Emergency decision-making is focussed on survival or risk aversion and patient preferences are rarely considered. To improve planning discussions, we recommend frailty training for non-specialist clinicians, multi-disciplinary support, collaborative working between patients, carers and clinicians as well as broader public engagement.
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Affiliation(s)
- Adam Lound
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Jane Bruton
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Kathryn Jones
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Nira Shah
- ProsPECT Study Public Advisor, Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Barry Williams
- ProsPECT Study Public Advisor, Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Jamie Gross
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Benjamin Post
- Department of Bioengineering and Department of Computing, Imperial College London, London, United Kingdom
- UKRI Centre in AI for Healthcare, Imperial College London, London, United Kingdom
| | - Sophie Day
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Stephen J. Brett
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Helen Ward
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- National Institute for Health Research Imperial Biomedical Research Centre, London, United Kingdom
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Melvin RL, Ruple A, Pearson EB, Olby NJ, Fitzpatrick AL, Creevy KE. A review of frailty instruments in human medicine and proposal of a frailty instrument for dogs. Front Vet Sci 2023; 10:1139308. [PMID: 37441560 PMCID: PMC10333704 DOI: 10.3389/fvets.2023.1139308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Over the last few decades, frailty has become a pillar of research and clinical assessment in human gerontology. This complex syndrome, characterized by loss of physiologic reserves leading to decreased resilience to stressors, is of critical importance because it predicts higher risks of poor health outcomes, including mortality. Thus, identifying frailty among the elderly human population has become a key focus of gerontology. This narrative review presents current scientific literature on frailty in both humans and animals. The authors discuss the need for an accessible frailty instrument for companion dogs suitable for general use in veterinary medicine and the advances that would be facilitated by this instrument. A phenotypic frailty instrument for companion dogs, utilizing components that are easily collected by owners, or in the general practice setting, is proposed. The authors elaborate on the domains (physical condition, physical activity, mobility, strength, cognitive task performance, and social behavior), factors that will be included, and the data from the Dog Aging Project that inform each domain.
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Affiliation(s)
- Rachel L. Melvin
- Department of Small Animal Clinical Sciences, Texas A&M University School of Veterinary Medicine & Biomedical Sciences, College Station, TX, United States
| | - Audrey Ruple
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Elizabeth B. Pearson
- Department of Small Animal Clinical Sciences, Texas A&M University School of Veterinary Medicine & Biomedical Sciences, College Station, TX, United States
| | - Natasha J. Olby
- Department of Clinical Sciences, NC State University College of Veterinary Medicine, Raleigh, NC, United States
| | | | - Kate E. Creevy
- Department of Small Animal Clinical Sciences, Texas A&M University School of Veterinary Medicine & Biomedical Sciences, College Station, TX, United States
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Fanaki C, Fortin J, Sirois MJ, Kröger E, Elliott J, Stolee P, Gregg S, Sims-Gould J, Giguere A. Potential Factors Influencing Adoption of a Primary Care Pathway to Prevent Functional Decline in Older Adults. Can Geriatr J 2023; 26:227-238. [PMID: 37265986 PMCID: PMC10198677 DOI: 10.5770/cgj.26.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Introduction To help recognize and care for community-dwelling older adults living with frailty, we plan to implement a primary care pathway consisting of frailty screening, shared decision-making to select a preventive intervention, and facilitated referral to community-based services. In this study, we examined the potential factors influencing adoption of this pathway. Methods In this qualitative, descriptive study, we conducted semi-structured interviews and focus groups with patients aged 70 years and older, health professionals (HPs), and managers from four primary care practices in the province of Quebec, representatives of community-based services and geriatric clinics located near the practices. Two researchers conducted an inductive/deductive thematic analysis, by first drawing on the Consolidated Framework for Implementation Research and then adding emergent subthemes. Results We recruited 28 patients, 29 HPs, and 8 managers from four primary care practices, 16 representatives from community-based services, and 10 representatives from geriatric clinics. Participants identified several factors that could influence adoption of the pathway: the availability of electronic and printed versions of the decision aids; the complexity of including a screening form in the electronic health record; public policies that limit the capacity of community-based services; HPs' positive attitudes toward shared decision-making and their work overload; and lack of funding. Conclusions These findings will inform the implementation of the care pathway, so that it meets the needs of key stakeholders and can be scaled up.
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Affiliation(s)
- Chaimaa Fanaki
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
| | - Julie Fortin
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
| | - Marie-Josée Sirois
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Research Centre of the CHU de Québec, Quebec, QC
- Department of Readaptation, Université Laval, Quebec, QC
| | - Edeltraut Kröger
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Faculty of Pharmacy, Université Laval, Quebec, QC
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Susie Gregg
- Canadian Mental Health Association Waterloo Wellington Dufferin, Waterloo, ON
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Anik Giguere
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
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Prognostic significance of frailty status in patients with primary lung cancer. BMC Geriatr 2023; 23:46. [PMID: 36698160 PMCID: PMC9878966 DOI: 10.1186/s12877-023-03765-w] [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: 10/10/2022] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
Lung cancer has one of the highest morbidity and mortality rates in the world. Frailty is common in many countries and is a major cause of premature functional decline and premature death in older adults, and may affect the treatment and prognosis of lung cancer patients. To investigate the predictive value of frailty at diagnosis on all-cause mortality in lung cancer patients, this study retrospectively collected and analysed clinical information on lung cancer patients from 2015-2018. A total of 1667 patients with primary lung cancer were finally included in this study. The median follow-up time of patients was 650 (493, 1001.5) days. A total of 297(17.8%) patients had FI-LAB(the frailty index based on laboratory test) status of frail at the moment of diagnosis and the all-cause mortality rate for all patients was 61.1% (1018/1667). In a univariate model, we found a higher total all-cause mortality risk in frail patients (frail vs. robust, HR(hazard ratio) = 1.616, 95% CI(confidence interval) = 1.349,1.936), after balancing other variables combined into model 1 to model 6. The results were analyzed visually using ROC(Receiver operating characteristic) curves with nomogram and the AUC values ranged from 0.866-0.874. The final inclusion of age, TNM stage, CCI(Charlson comorbidity index) score, surgery history and chemotherapy into a multifactorial model balanced the predictive power of frailty grading on all-cause mortality. The study showed that for lung cancer patients, the higher the level of frailty at diagnosis, the higher the risk of all-cause mortality. In the context of widespread electronic medical records in hospitals, it is convenient and feasible to use FI-LAB to assess the prognosis of lung cancer patients.
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Sunkersing D, Martin FC, Sullivan P, Bell D. Care and support networks of community-dwelling frail individuals in North West London: a comparison of patient and healthcare workers' perceptions. BMC Geriatr 2022; 22:953. [PMID: 36494627 PMCID: PMC9737751 DOI: 10.1186/s12877-022-03561-y] [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: 02/06/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Evidence suggests that successful assessment and care for frail individuals requires integrated and collaborative care and support across and within settings. Understanding the care and support networks of a frail individual could therefore prove useful in understanding need and designing support. This study explored the care and support networks of community-dwelling older people accessing a falls prevention service as a marker of likely frailty, by describing and comparing the individuals' networks as perceived by themselves and as perceived by healthcare providers involved in their care. METHODS A convenience sample of 16 patients and 16 associated healthcare professionals were recruited from a community-based NHS 'Falls Group' programme within North-West London. Individual (i.e., one on one) semi-structured interviews were conducted to establish an individual's perceived network. Principles of quantitative social network analysis (SNA) helped identify the structural characteristics of the networks; qualitative SNA and a thematic analysis aided data interpretation. RESULTS All reported care and support networks showed a high contribution level from family and friends and healthcare professionals. In patient-reported networks, 'contribution level' was often related to the 'frequency' and 'helpfulness' of interaction. In healthcare professional reported networks, the reported frequency of interaction as detailed in patient records was used to ascertain 'contribution level'. CONCLUSION This study emphasises the importance of the role of informal carers and friends along with healthcare professionals in the care of individuals living with frailty. There was congruence in the makeup of 'patient' and 'provider' reported networks, but more prominence of helper/carers in patients' reports. These findings also highlight the multidisciplinary makeup of a care and support network, which could be targeted by healthcare professionals to support the care of frail individuals.
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Affiliation(s)
- David Sunkersing
- grid.7445.20000 0001 2113 8111Department of Primary Care and Public Health, Imperial College London, London, W6 8RP UK
| | - Finbarr C. Martin
- grid.13097.3c0000 0001 2322 6764King’s College London (Population Health Sciences), London, UK
| | - Paul Sullivan
- grid.7445.20000 0001 2113 8111Department of Primary Care and Public Health, Imperial College London, London, W6 8RP UK
| | - Derek Bell
- grid.7445.20000 0001 2113 8111Department of Primary Care and Public Health, Imperial College London, London, W6 8RP UK
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