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Vijenthira A, Calzavara A, Nagamuthu C, Kaliwal Y, Liu N, Blunt D, Alibhai S, Prica A, Cheung MC, Mozessohn L. Health care utilization and costs for frail vs nonfrail patients with diffuse large B-cell lymphoma. Blood Adv 2024; 8:4625-4632. [PMID: 39024541 PMCID: PMC11401182 DOI: 10.1182/bloodadvances.2024013158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/17/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024] Open
Abstract
ABSTRACT Half of older patients with diffuse large B-cell lymphoma (DLBCL) receiving curative-intent treatment are frail. Understanding the differences in health care utilization including costs between frail and nonfrail patients can inform appropriate models of care. A retrospective cohort study was conducted using population-based data in Ontario, Canada. Patients aged ≥66 years with DLBCL who received frontline curative-intent chemoimmunotherapy between 2006 and 2017 were included. Frailty was defined using a cumulative deficit-based frailty index. Health care utilization and costs were grouped into 5 phases: (1) 90 days preceding first treatment; (2) early treatment (0 to +90 days after starting treatment); (3) late treatment (+91 to +180 days); (4) follow-up (+181 to -181 days before death); and (5) end of life (last 180 days before death). Costs were standardized to 30-day intervals (2019 Canadian dollars). A total of 5527 patients were included (median age, 75 years; 48% female). A total of 2699 patients (49%) were classified as frail. The median costs for frail vs nonfrail patients per 30 days based on phase of care were (1) $5683 vs $2586 ; (2) $13 090 vs $11 256; (3) $5734 vs $4883; (4) $1138 vs $686; and (5) $11 413 vs $9089; statistically significant in all phases. In multivariable modeling, frail patients had higher rates of emergency department visits and hospitalizations and increased costs than nonfrail patients through all phases except end-of-life phase. During end-of-life phase, a substantial portion of patients (n = 2569 [84%]) required admission to hospital; 684 (27%) required intensive care unit admission. Future work could assess whether certain hospitalizations are preventable, particularly for patients identified as frail.
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Affiliation(s)
- Abi Vijenthira
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Ning Liu
- Cancer Research Program, ICES, Toronto, ON, Canada
| | - Danielle Blunt
- Division of Hematology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Shabbir Alibhai
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine and Geriatrics, University Health Network, Toronto, ON, Canada
| | - Anca Prica
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew C Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Cancer Research Program, ICES, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Lee Mozessohn
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Cancer Research Program, ICES, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
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Melchiorre MG, Socci M, Lamura G, Quattrini S. Perceived Loneliness, Social Isolation, and Social Support Resources of Frail Older People Ageing in Place Alone in Italy. Healthcare (Basel) 2024; 12:875. [PMID: 38727432 PMCID: PMC11083615 DOI: 10.3390/healthcare12090875] [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: 03/06/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
This paper presents some findings from the IN-AGE ("Inclusive ageing in place") study, which the authors carried out in 2019 in Italy. It explores the available social support resources for frail older people with functional limitations ageing in place alone, and possible links between their social isolation and perceived loneliness. The authors conducted qualitative/semi-structured interviews involving 120 participants aged 65 years and over, and used a mixed-methods analysis (quantitative/qualitative). The main results show the family as the main help resource for daily activities, but also for intimate confidences against social isolation, especially when said relatives live close. Family confidants are less present when seniors are supported by friends/neighbours or/and public services. Moreover, the family is valuable for decreasing loneliness, although not always. However, some older people feel particularly alone when they are supported by public services. Such a complex context draws attention on the need of support for frail seniors living alone and could provide insights for policymakers on adequate policies for preventing and managing loneliness and social isolation in later life. This is especially relevant when family (and other) resources are not available or scarce, also considering the opportunities offered by technology, which can help seniors remain socially connected to relatives, friends and their overall community.
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Affiliation(s)
| | - Marco Socci
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, Via Santa Margherita 5, 60124 Ancona, Italy; (M.G.M.); (G.L.); (S.Q.)
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Lo YT, Chen MH, Lu TH, Yang YP, Chang CM, Yang YC. Effects of an integrated ambulatory care program on healthcare utilization and costs in older patients with multimorbidity: a propensity score-matched cohort study. BMC Geriatr 2024; 24:109. [PMID: 38287245 PMCID: PMC10826123 DOI: 10.1186/s12877-023-04654-y] [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: 08/12/2023] [Accepted: 12/31/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Population aging has increased the prevalence of multimorbidity, jeopardizing the sustainability and efficiency of healthcare systems. This study aimed to evaluate the effects of an integrated ambulatory care program (IACP) on healthcare utilization and costs among older patients with multimorbidity while accounting for the confounding effects of frailty. METHODS A retrospective cohort study using propensity matching including patients aged 65 or older with two or more chronic conditions attending the outpatient clinic at our hospital between June 1 and December 31, 2019, was conducted. Exposure was defined as receipt of IACP care. Patients not undergoing the IACP comprised the unexposed group and were matched at a ratio of 1:4 to patients undergoing the IACP group according to sex, age, Charlson Comorbidity Index score, multimorbidity frailty index score, and number of outpatient visits within 6 months before the index date. Outcomes were changes in healthcare utilization and related costs between 6 months before and after receiving IACP care. Multivariate regression analyses were used for data analysis and the Generalized Estimation Equation method was used to fit the regression models. RESULTS A total of 166 (IACP) and 664 (non-exposed) patients were analyzed. The mean participant baseline ages were 77.15 ± 7.77 (IACP) and 77.28 ± 7.90 years (unexposed). In univariate analyses, the IACP group demonstrated greater reductions than the unexposed group in the frequency of outpatient visits (-3.16 vs. -1.36, p < 0.001), number of physicians visited (-0.99 vs. -0.17, p < 0.001), diagnostic fees (-1300 New Taiwan Dollar [NTD] vs. -520 NTD, p < 0.001), drug prescription fees (-250 NTD vs. -70 NTD, p < 0.001), and examination fees (-1620 NTD vs. -700 NTD, p = 0.014). Multivariate analyses demonstrated that patients in the IACP group experienced significant reduction in the frequency of outpatient visits (95% CI: -0.357 to -0.181, p < 0.001), number of physicians visited (95% CI: -0.334 to -0.199, p < 0.001), and overall outpatient costs (95% CI: -0.082 to -0.011, p = 0.01). However, emergency department utilization, hospitalization, and costs did not differ significantly. CONCLUSIONS Expanding IACPs may help patients with multimorbidity reduce their use of outpatient clinics at the 6-month follow-up, reduce care fragmentation, and promote sustainability of the healthcare system.
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Affiliation(s)
- Yu-Tai Lo
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mei-Hua Chen
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Ping Yang
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Chia-Ming Chang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Geriatrics and Gerontology, School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Family Medicine,School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Socci M, Di Rosa M, D’Amen B, Melchiorre MG. Functional and Psychosocial Profile of Older People Living in Nursing Homes: Findings from the European Survey of Health, Ageing and Retirement in Europe (SHARE). Healthcare (Basel) 2023; 11:2702. [PMID: 37830739 PMCID: PMC10572757 DOI: 10.3390/healthcare11192702] [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: 09/01/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND This paper is based on results from the Survey of Health, Ageing and Retirement in Europe (SHARE), exploring many aspects (health, economic situation and welfare) of the European population aged 50+. Differently from many other international studies, SHARE includes persons living in nursing homes or residential care facilities as part of its sample. The aim of this paper is to provide a socio-demographic, functional and psychosocial snapshot of older residents in nursing homes in Europe. METHODS This paper uses data from SHARE Wave 8/2020, carried out in 27 European countries. A quantitative/descriptive approach explores the prevalence of older people aged 65+ living in residential facilities as mapped by the SHARE survey across Europe, with regard to associated dimensions, i.e., socio-demographic, family relationship, perceived health/main diseases, functional and psychological status. RESULTS These show that older residents live mainly in Central and Northern Europe, are aged 80+, female and widowed. A small social network (SN) size is often reported. Health is perceived, above all, as being fair-poor, and the presence of long-term illness is high, with several chronic health conditions and functional limitations. The reported quality of life (QoL) is low for most respondents, with moderate-low satisfaction with life. CONCLUSION The analysis depicts a profile of seniors needing residential care in Europe, and provides useful insights for policymakers, to better sustain this frail population group, and to allow and improve access to high-quality long-term care (LTC) in Europe. Our findings could also be of help to train health professionals, and potentially drive the research towards the exploration of new housing solutions for seniors. This would in turn contribute to the effective implementation of European initiatives to strengthen LTC systems.
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Affiliation(s)
- Marco Socci
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, Via Santa Margherita 5, 60124 Ancona, Italy; (M.S.); (M.G.M.)
| | - Mirko Di Rosa
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, IRCCS INRCA—National Institute of Health and Science on Ageing, Via Santa Margherita 5, 60124 Ancona, Italy
| | - Barbara D’Amen
- Italian National Institute of Statistics—ISTAT, Via Cesare Balbo 39, 00184 Roma, Italy;
| | - Maria Gabriella Melchiorre
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, Via Santa Margherita 5, 60124 Ancona, Italy; (M.S.); (M.G.M.)
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Su H, Luo Q, Wang X, Yan W. Frailty combined with nutritional risk score in predicting postoperative complications of elderly patients with gastrointestinal malignancies. Asian J Surg 2023; 46:4240-4244. [PMID: 36653293 DOI: 10.1016/j.asjsur.2023.01.003] [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: 09/06/2022] [Revised: 11/28/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Exploring the predictive power of frailty combined with nutritional risk on postoperative complications in elderly gastrointestinal malignancies patients. METHODS Elderly patients who underwent gastrointestinal cancer surgery at Gastrointestinal Surgery Department of the Affiliated Hospital of Binzhou Medical University from August 2021 to June 2022 were selected as the research subjects. The patients' frailty and nutritional status were assessed using the Fried Frailty Scale and the NRS2002 Nutritional Risk Scale within 24 h of admission. Observing and recording the diagnosis and treatment of postoperative complications during the hospitalization. RESULTS 202 patients were enrolled, including 119 patients (58.91%) with nutritional risk and 89 patients (44.06%) with frailty. Frailty was an independent risk factor for postoperative complications [OR = 5.904, 95%CI (3.103, 11.233)]. The AUC value of frailty assessment was 0.780, which was greater than the AUC value of NRS2002 score of 0.705 (P < 0.01). The AUC value of frailty assessment combined with NRS-2002 score was 0.844, which was significantly higher than that alone (P < 0.01). CONCLUSIONS The ability of frailty to predict postoperative complications is better than the NRS-2002 score. Frailty combined with nutritional risk assessment can increase the predictive power of postoperative complications in elderly gastrointestinal malignancies patients.
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Affiliation(s)
- Hongxia Su
- Binzhou Medical University, 256603, Binzhou, China
| | - Qianqian Luo
- Binzhou Medical University, 256603, Binzhou, China
| | - Xiuzhen Wang
- Department of Gastrointestinal Surgery, Binzhou Medical University Hospital, 256603, Binzhou, China
| | - Wanhua Yan
- Binzhou Medical University, 256603, Binzhou, China.
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Ahn SS, Park YB, Lee SW. Association between computed tomography-assessed sarcopenia and mortality in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis. Int J Rheum Dis 2023; 26:1704-1713. [PMID: 37350277 DOI: 10.1111/1756-185x.14795] [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: 12/14/2022] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
AIM Sarcopenia is frequently observed in patients with autoimmune rheumatic diseases; however, its relationship with patient outcomes has not been well understood. This study evaluated the influence of sarcopenia, especially muscle quality, on outcomes of antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS Records of patients with AAV at the Severance Hospital with computed tomography (CT) images taken at initial disease diagnosis were retrospectively reviewed. For measures of sarcopenia, normal attenuation muscle area (NAMA), low attenuation muscle area (LAMA), intramuscular adipose tissue (IMAT), and total abdominal muscle area (TAMA) in the axial muscles of the middle third lumbar vertebra level were calculated. Correlations between NAMA, LAMA, IMAT, and baseline patient characteristics, as well as the association between the NAMA/TAMA ratio and clinical outcomes were assessed. RESULTS A total of 136 patients with CT images at AAV diagnosis were identified. Correlation analyses revealed that age, female sex, total cholesterol, and alanine aminotransferase were significantly associated with NAMA. LAMA was associated with age, body mass index (BMI), five-factor score (FFS), and C-reactive protein, and a relationship between IMAT and age and BMI was observed. During the follow up of 31.2 months, 23 (16.9%) patients died, and Cox-proportional hazard analysis demonstrated that a NAMA/TAMA ≤0.46 (odds ratio [OR] 10.247, p < .001), female sex (OR 0.206, p = .006), dyslipidemia (OR 3.143, p = .027), creatinine (OR 1.342, p = .012), and FFS (OR 1.775, p = .046), were independently associated with patient mortality. CONCLUSION A higher rate of mortality was observed in patients with AAV with NAMA/TAMA ≤0.46, indicating that careful monitoring is required in these patients.
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Affiliation(s)
- Sung Soo Ahn
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
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Kim MJ, Lee S, Cheong HK, Jang SY, Kim HS, Oh IH. Healthcare Utilization and Costs According to Frailty Transitions After Two Years: A Korean Frailty and Aging Cohort Study. J Korean Med Sci 2023; 38:e191. [PMID: 37337810 DOI: 10.3346/jkms.2023.38.e191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/03/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Korea's aging population has raised several challenges, especially concerning healthcare costs. Consequently, this study evaluated the association of frailty transitions with healthcare utilization and costs for older adults aged 70 to 84. METHODS This study linked the frailty status data of the Korean Frailty and Aging Cohort Study to the National Health Insurance Database. We included 2,291 participants who had frailty measured by Fried Frailty phenotype at baseline in 2016-2017 and follow-up in 2018-2019. We conducted a multivariate regression analysis to determine the association between their healthcare utilization and costs by frailty transition groups. RESULTS After 2 years, changes from "pre-frail" to "frail" (Group 6) and "frail" to "pre-frail" (Group 8) were significantly associated with increased inpatient days (P < 0.001), inpatient frequency (P < 0.001), inpatient cost (P < 0.001 and P < 0.01, respectively), and total healthcare cost (P < 0.001) than "robust" to "robust" (Group 1) older adults. A transition to frailty from "pre-frail" to "frail" (Group 6) resulted in a $2,339 total healthcare cost increase, and from "frail" to "pre-frail" (Group 8), a $1,605, compared to "robust" to "robust" older adults. CONCLUSION Frailty among community-dwelling older adults is economically relevant. Therefore, it is crucial to study the burden of medical expenses and countermeasures for older adults to not only provide appropriate medical services but also to prevent the decline in their living standards due to medical expenses.
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Affiliation(s)
- Moon Jung Kim
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seoyoon Lee
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul, Korea
| | - Hyeon-Kyoung Cheong
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Su Yeon Jang
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Hee-Sun Kim
- Department of Health Policy Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.
| | - In-Hwan Oh
- Department of Medicine (AgeTech-Service Convergence Major), Kyung Hee University, Seoul, Korea.
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To TL, Kuo CP, Yeh CJ, Liao WC, Lee MC. Transitions of self-management behaviors and frailty status among community-dwelling older adults: a national longitudinal population-based cohort study. BMC Geriatr 2022; 22:874. [DOI: 10.1186/s12877-022-03578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 10/17/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Frailty in older adults is a common geriatric syndrome that could be prevented; thus, coping strategies for the aging population are essential. Self-management behaviors may represent cost-effective strategies to prevent physical frailty in community-dwelling older adults. This study aimed to describe the changes in frailty status among community-dwelling older adults in Taiwan and investigate the association between transitions of self-management behaviors and frailty status over 4 years of follow-up (2007 to 2011).
Methods
Data were retrieved from the Taiwan Longitudinal Study of Aging (TLSA), years 2007 and 2011. In this prospective cohort study, 1283 community-dwelling older adults aged 65 years and older without cognitive impairment were recruited. Frailty was defined based on Fried’s frailty phenotype. Self-management behaviors (maintaining body weight, quitting smoking or no smoking, drinking less or no drinking, exercising, keeping diet control, and maintaining a regular lifestyle) were assessed using a questionnaire. Multinomial logistic regression analyses were used to investigate the associations between changes in self-management behaviors and in frailty status. The age group was further stratified to examine the moderation effect in the relationship between changes in self-management behaviors and in frailty status among older adults.
Results
The prevalence of frailty was 8.7% at baseline and 14.9% after 4 years of follow-up, with 196 (15.3%) deaths. Overall, 514 (40.1%) participants maintained their frailty status, 424 (33.0%) worsened, and only 149 (11.6%) improved. Being aged ≥75 years old, having chronic diseases, and an absence of self-management behaviors were associated with frailty at baseline and after follow-up. Among individuals aged 65–74, compared to those who maintained no self-management behaviors, those who decreased the exercise behaviors (yes-to-no) had a higher risk of worsening (RRR = 2.518), while increasing (no-to-yes) and maintaining (yes-to-yes) frequent physical exercise were associated with a lower risk of worsening (RRR = 0.466 and 0.572, respectively) than stable frailty; those who maintained body weight (yes-to-yes) were associated with a lower risk of worsening (RRR = 0.327) than stable frailty after controlling for individual covariates and chronic diseases. Among individuals over 75 years old, compared to no exerciser, older old who decreased their physical exercise had a higher risk of frailty worsening (RRR = 3.255), and increasing frequent physical exercise (no-to-yes) was associated with an improvement in frailty status (RRR = 3.684). Age was a moderator between the effects of maintaining body weight on frailty worsening. There were no associations between the behavioral transitions of smoking, drinking, diet control, or regular lifestyle on the frailty status changes.
Conclusions
Maintaining body weight and frequent physical exercise increased the ratio of frailty stability among individuals 65–74 years old. Increasing exercise behavior is the only factor to improve their frailty status among older adults aged 75 years and over. Older adults should be encouraged to perform adequate physical exercise and maintain a healthy body weight to maintain the frailty status in younger old aged 65–74 years, and especially perform more frequent exercise to improve frailty status in older old over 75 years.
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Melchiorre MG, D’Amen B, Quattrini S, Lamura G, Socci M. Health Emergencies, Falls, and Use of Communication Technologies by Older People with Functional and Social Frailty: Ageing in Place in Deprived Areas of Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14775. [PMID: 36429499 PMCID: PMC9691100 DOI: 10.3390/ijerph192214775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Frail older people ageing alone in place need help to perform daily living activities, especially when functional limitations are increasing and formal/informal supports are lacking. This context represents a risk of experiencing health emergencies, in particular falls. It is thus important to understand how seniors manage these potential difficulties and who helps them. The present study aimed to explore these dimensions in Italy, where 120 qualitative interviews were carried out in 2019 within the "Inclusive ageing in place" (IN-AGE) research project, involving frail older people living alone at home. A content analysis was conducted. Results showed that seniors need to manage health emergencies regarding heart and breathing problems but mainly episodes of falls are reported, with consequent fractures and fear of falling again. In several cases, the use of a mobile phone was crucial in order to seek for help, and the first to intervene were children, in addition to some neighbors. Some seniors also referred their ability to call independently the General Practitioner (GP) or the emergency room, in order to not disturb family members. These findings highlight new useful insights for policy makers, regarding health emergencies prevention and management measures to put in place, especially concerning falls, and the support provided by communication technologies.
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Welch C, Greig C, Majid Z, Masud T, Moorey H, Pinkney T, Jackson T. Induced frailty and acute sarcopenia are overlapping consequences of hospitalisation in older adults. J Frailty Sarcopenia Falls 2022; 7:103-116. [PMID: 36119557 PMCID: PMC9433945 DOI: 10.22540/jfsf-07-103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives To determine the effects of hospitalisation upon frailty and sarcopenia. Methods Prospective cohort study at single UK hospital including adults ≥70 years-old admitted for elective colorectal surgery, emergency abdominal surgery, or acute infections. Serial assessments for frailty (Fried, Frailty Index, Clinical Frailty Scale [CFS]), and sarcopenia (handgrip strength, ultrasound quadriceps and/or bioelectrical impedance analysis, and gait speed and/or Short Physical Performance Battery) were conducted at baseline, 7 days post-admission/post-operatively, and 13 weeks post-admission/post-operatively. Results Eighty participants were included (mean age 79.2, 38.8% females). Frailty prevalence by all criteria at baseline was higher among medical compared to surgical participants. Median and estimated marginal CFS values and Fried frailty prevalence increased after 7 days, with rates returning towards baseline at 13 weeks. Sarcopenia incidence amongst those who did not have sarcopenia at baseline was 20.0%. However, some participants demonstrated improvements in sarcopenia status, and overall sarcopenia prevalence did not change. There was significant overlap between diagnoses with 37.3% meeting criteria for all four diagnoses at 7 days. Conclusions Induced frailty and acute sarcopenia are overlapping conditions affecting older adults during hospitalisation. Rates of frailty returned towards baseline at 13 weeks, suggesting that induced frailty is reversible.
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Affiliation(s)
- Carly Welch
- Medical Research Council (MRC) – Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Corresponding author: Dr Carly Welch, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, B152TT, UK E-mail:
| | - Carolyn Greig
- Medical Research Council (MRC) – Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Zeinab Majid
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tahir Masud
- Medical Research Council (MRC) – Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Hannah Moorey
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Thomas Pinkney
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Thomas Jackson
- Medical Research Council (MRC) – Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Frail Older People Ageing in Place in Italy: Use of Health Services and Relationship with General Practitioner. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159063. [PMID: 35897424 PMCID: PMC9332283 DOI: 10.3390/ijerph19159063] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 02/04/2023]
Abstract
Functional limitations, chronic diseases and frailty often occur in later life. These aspects become very challenging when older people age alone in place, thus needing support in the activities of daily living, and in this context, it is important they can access and use health services. The present study aimed to explore these issues in Italy. In 2019, 120 qualitative interviews were carried out within the “Inclusive Ageing in Place” (IN-AGE) project, involving frail older people living at home in three Italian regions (Lombardy, Marche, and Calabria). A content analysis and some quantifications of main statements are presented. Results showed that the majority of seniors report poor self-rated health (SRH), suffer from many chronic diseases, and mainly use the General Practitioner (GP) and Medical Specialists (MSs), even though long waiting list in the public sector and high costs in the private one act as barriers to access health services. Complaints regarding GPs mainly refer to the almost exclusive provision of prescriptions and the lack of home visits. Some regional peculiarities highlighted a better overall context in the north than in the south, especially with regards to the public health sector. These results can provide useful insights for policy makers, in order to deliver health services assuring frail, older people the continuity of assistance needed at home.
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Melchiorre MG, D’Amen B, Quattrini S, Lamura G, Socci M. Caring for Frail Older People Living Alone in Italy: Future Housing Solutions and Responsibilities of Family and Public Services, a Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127413. [PMID: 35742664 PMCID: PMC9223601 DOI: 10.3390/ijerph19127413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/20/2022]
Abstract
When frail older people age alone in place, with increasing functional limitations, they require support in performing daily living activities. In this respect, it is important to assess their preferences in terms of future housing solutions, and their opinions/orientations on the care responsibilities of both family and public services. The present study aimed to explore these aspects in Italy. Qualitative interviews were carried out in 2019 within the “Inclusive ageing in place” (IN-AGE) research project, involving 120 frail older people who lived at home in three Italian regions (Lombardy, Marche, and Calabria). A content analysis was conducted, and some quantifications of interviewees’ statements were provided. The results revealed that the majority of seniors prefer ageing at home, at least with a personal care assistant (PCA), whereas moving to a nursing home is typically deemed as a last option. Moreover, they considered the family to be primarily responsible for taking care of them, even with the support of public services. In addition, some territorial differences emerged. Strengthening an integrated model of long-term care (LTC) for older people, where both formal and informal supports allow frail older people to age at home, seems thus a good overall policy solution to pursue, with interventions based also on the needs and preferences of both seniors and their respective families.
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Pansini A, Lombardi A, Morgante M, Frullone S, Marro A, Rizzo M, Martinelli G, Boccalone E, De Luca A, Santulli G, Mone P. Hyperglycemia and Physical Impairment in Frail Hypertensive Older Adults. Front Endocrinol (Lausanne) 2022; 13:831556. [PMID: 35498439 PMCID: PMC9048203 DOI: 10.3389/fendo.2022.831556] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/23/2022] [Indexed: 01/08/2023] Open
Abstract
Background Frailty is a multidimensional condition typical of elders. Frail older adults have a high risk of functional decline, hospitalization, and mortality. Hypertension is one of the most common comorbidities in elders. Hyperglycemia (HG) is frequently observed in frail older adults, and represents an independent predictor of worst outcomes, with or without diabetes mellitus (DM). We aimed at investigating the impact of HG on physical impairment in frailty. Methods We studied consecutive older adults with frailty and hypertension at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, from March 2021 to September 2021. Exclusion criteria were: age <65 years, no frailty, no hypertension, left ventricular ejection fraction <25%, previous myocardial infarction, previous primary percutaneous coronary intervention and/or coronary artery bypass grafting. Blood glucose, Hb1Ac, and creatinine were measured in all patients. Physical frailty was assessed applying the Fried Criteria; we performed a 5-meter gait speed (5mGS) test in all patients. Results 149 frail hypertensive older adults were enrolled in the study, of which 82 had normoglycemia (NG), and 67 had HG. We observed a significantly slower 5mGS in the HG group compared to the NG group (0.52 ± 0.1 vs. 0.69 ± 0.06; p<0.001). Moreover, we found a strong and significant correlation between 5mGS and glycemia (r: 0.833; p<0.001). A multivariable linear regression analysis using 5mGS as a dependent variable revealed a significant independent association with glycemia (p<0.001) after adjusting for likely confounders. Conclusions HG drives physical impairment in frail hypertensive older adults independently of DM.
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Affiliation(s)
| | - Angela Lombardi
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, United States
| | | | | | | | - Mario Rizzo
- ASL Avellino, Avellino, Italy
- Campania University, Caserta, Italy
| | | | | | | | - Gaetano Santulli
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, United States
| | - Pasquale Mone
- ASL Avellino, Avellino, Italy
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, United States
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O'Halloran AM, Hartley P, Moloney D, McGarrigle C, Kenny RA, Romero-Ortuno R. Informing patterns of health and social care utilisation in Irish older people according to the Clinical Frailty Scale. HRB Open Res 2021; 4:54. [PMID: 34240005 PMCID: PMC8220351 DOI: 10.12688/hrbopenres.13301.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/20/2022] Open
Abstract
Background: There is increasing policy interest in the consideration of frailty measures (rather than chronological age alone) to inform more equitable allocation of health and social care resources. In this study the Clinical Frailty Scale (CFS) classification tree was applied to data from The Irish Longitudinal Study on Ageing (TILDA) and correlated with health and social care utilisation. CFS transitions over time were also explored. Methods: Applying the CFS classification tree algorithm, secondary analyses of TILDA data were performed to examine distributions of health and social care by CFS categories using descriptive statistics weighted to the population of Ireland aged ≥65 years at Wave 5 (n=3,441; mean age 74.5 (SD ±7.0) years, 54.7% female). CFS transitions over 8 years and (Waves 1-5) were investigated using multi-state Markov models and alluvial charts. Results: The prevalence of CFS categories at Wave 5 were: 6% 'very fit', 36% 'fit', 31% 'managing well', 16% 'vulnerable', 6% 'mildly frail', 4% 'moderately frail' and 1% 'severely frail'. No participants were 'very severely frail' or 'terminally ill'. Increasing CFS categories were associated with increasing hospital and community health services use and increasing hours of formal and informal social care provision. The transitions analyses suggested CFS transitions are dynamic, with 2-year probability of transitioning from 'fit' (CFS1-3) to 'vulnerable' (CFS4), and 'fit' to 'frail' (CFS5+) at 34% and 6%, respectively. 'Vulnerable' and 'frail' had a 22% and 17% probability of reversal to 'fit' and 'vulnerable', respectively. Conclusions: Our results suggest that the CFS classification tree stratified the TILDA population aged ≥65 years into subgroups with increasing health and social care needs. The CFS could be used to aid the allocation of health and social care resources in older people in Ireland. We recommend that CFS status in individuals is reviewed at least every 2 years.
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Affiliation(s)
- Aisling M. O'Halloran
- TILDA, Trinity College Dublin, Dublin, Ireland
- Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Peter Hartley
- TILDA, Trinity College Dublin, Dublin, Ireland
- Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - David Moloney
- TILDA, Trinity College Dublin, Dublin, Ireland
- Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St James's hospital, Dublin, Ireland
| | - Christine McGarrigle
- TILDA, Trinity College Dublin, Dublin, Ireland
- Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- TILDA, Trinity College Dublin, Dublin, Ireland
- Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St James's hospital, Dublin, Ireland
| | - Roman Romero-Ortuno
- TILDA, Trinity College Dublin, Dublin, Ireland
- Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St James's hospital, Dublin, Ireland
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