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Yang Y, Lv W, Zeng Y, Chen Y, Yuan H. Bioelectrical impedance phase angle combined with physical function predicts pre-frailty in maintenance hemodialysis patients: a prospective study. BMC Nephrol 2024; 25:243. [PMID: 39075445 PMCID: PMC11288012 DOI: 10.1186/s12882-024-03684-x] [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: 02/25/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The prevalence of pre-frailty is notably high among maintenance hemodialysis (MHD) patients. Pre-frailty, an early and reversible condition between non-frailty and frailty, can lead to adverse outcomes such as increased unplanned hospital admissions and a higher risk of other chronic diseases. Early identification and intervention of pre-frailty in MHD patients are crucial. This study aimed to establish a simple and effective model for screening and identifying MHD patients at high risk of pre-frailty by using 50 kHz-Whole Body Phase Angle (PhA) measured by bioelectrical impedance analysis (BIA), hand grip strength (HGS), the Five-Times-Sit-to-Stand Test (FTSST), and laboratory parameters, with a specific focus on gender differences. METHODS This prospective cross-sectional study was conducted from September to December 2023 at the Wenjiang Hemodialysis Center in the Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China. A total of 244 MHD patients, including 130 males and 114 females, were enrolled, comprising 128 non-frail and 116 pre-frail individuals. Data were collected prospectively, including demographic information, physical measurements, and laboratory test results. All participants provided informed consent before enrollment. The FRAIL scale (FS) was used to assess pre-frailty in MHD patients. Grip strength was measured using an electronic grip strength tester, physical function was assessed using the Five-Times-Sit-to-Stand Test, and whole-body phase angle was measured using the InBody S10 device. RESULTS A total of 244 MHD patients with a mean age of 53.75 ± 0.90 years were enrolled, including 130 males with a mean age of 54.12 ± 1.26 years and 114 females with a mean age of 53.32 ± 1.29 years. ROC curve analysis showed that in male patients, the AUC of PhA for predicting pre-frailty was 0.919, with a sensitivity of 94.5% and specificity of 91.3%, and a cutoff value of 6.05°; in female patients, the AUC of PhA was 0.870, with a sensitivity of 70.5% and specificity of 90.6%, and a cutoff value of 5.25°. The AUC of FTSST for screening pre-frailty in male patients was 0.827, with a sensitivity of 62.3% and specificity of 96.2%, and a cutoff value of 12.95 s; in female patients, the AUC of FTSST was 0.784, with a sensitivity of 67.3% and specificity of 84.0%, and a cutoff value of 12.95 s. Additionally, in male patients, the combination of PhA and FTSST resulted in an AUC of 0.930, with a sensitivity of 96.4% and specificity of 81.3%; in female patients, the AUC was 0.911, with a sensitivity of 78.7% and specificity of 92.5%. CONCLUSION PhA measured by BIA, in combination with the Five-Times-Sit-to-Stand Test, serves as an effective screening tool and predictor of pre-frailty in MHD patients. The combination of PhA and FTSST shows enhanced diagnostic value in female patients, while PhA alone is sufficient for predicting pre-frailty in male patients. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100051111), registered on 2021-09-13.
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Affiliation(s)
- Yujie Yang
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, NO.37, Guoxue Alley, Chengdu, Sichuan province, 610041, China
- School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Wenmei Lv
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, NO.37, Guoxue Alley, Chengdu, Sichuan province, 610041, China
- School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Ying Zeng
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, NO.37, Guoxue Alley, Chengdu, Sichuan province, 610041, China
- School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Yang Chen
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, NO.37, Guoxue Alley, Chengdu, Sichuan province, 610041, China
- School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Huaihong Yuan
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, NO.37, Guoxue Alley, Chengdu, Sichuan province, 610041, China.
- School of Nursing, Sichuan University, Chengdu, 610041, China.
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Taylor JK, Peek N, Greenstein AS, Sammut-Powell C, Martin GP, Ahmed FZ. Remotely monitored physical activity from older people with cardiac devices associates with physical functioning. BMC Geriatr 2024; 24:526. [PMID: 38886679 PMCID: PMC11184810 DOI: 10.1186/s12877-024-05083-1] [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: 02/27/2024] [Accepted: 05/16/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Accelerometer-derived physical activity (PA) from cardiac devices are available via remote monitoring platforms yet rarely reviewed in clinical practice. We aimed to investigate the association between PA and clinical measures of frailty and physical functioning. METHODS The PATTErn study (A study of Physical Activity paTTerns and major health Events in older people with implantable cardiac devices) enrolled participants aged 60 + undergoing remote cardiac monitoring. Frailty was measured using the Fried criteria and gait speed (m/s), and physical functioning by NYHA class and SF-36 physical functioning score. Activity was reported as mean time active/day across 30-days prior to enrolment (30-day PA). Multivariable regression methods were utilised to estimate associations between PA and frailty/functioning (OR = odds ratio, β = beta coefficient, CI = confidence intervals). RESULTS Data were available for 140 participants (median age 73, 70.7% male). Median 30-day PA across the analysis cohort was 134.9 min/day (IQR 60.8-195.9). PA was not significantly associated with Fried frailty status on multivariate analysis, however was associated with gait speed (β = 0.04, 95% CI 0.01-0.07, p = 0.01) and measures of physical functioning (NYHA class: OR 0.73, 95% CI 0.57-0.92, p = 0.01, SF-36 physical functioning: β = 4.60, 95% CI 1.38-7.83, p = 0.005). CONCLUSIONS PA from cardiac devices was associated with physical functioning and gait speed. This highlights the importance of reviewing remote monitoring PA data to identify patients who could benefit from existing interventions. Further research should investigate how to embed this into clinical pathways.
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Affiliation(s)
- J K Taylor
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Oxford Road, Manchester, M13 9P, UK.
- Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Oxford Rd, Manchester, UK.
| | - N Peek
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Oxford Road, Manchester, M13 9P, UK
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - A S Greenstein
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - C Sammut-Powell
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Oxford Road, Manchester, M13 9P, UK
| | - G P Martin
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Oxford Road, Manchester, M13 9P, UK
| | - F Z Ahmed
- Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Oxford Rd, Manchester, UK
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Chau A, Kim DH, Sison SDM, Shi SM. Mobility Device Use and Frailty Progression in Community-Dwelling Older Adults With Mobility Limitations. J Aging Health 2024:8982643241242927. [PMID: 38565230 DOI: 10.1177/08982643241242927] [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] [Indexed: 04/04/2024]
Abstract
Objective: Examine the association between mobility device use and changes in a frailty index (FI) over one year in community-dwelling older adults with mobility limitations. Methods: Analyses utilized 2015-2016 data from the National Health and Aging Trends Study community-dwelling older adults (n = 3934). We calculated a validated 40-item deficit accumulation frailty index (FI) in 2015 and 2016 and compared one year change in FI in older adults with/without canes or walkers using multivariable logistic regression. Analyses were repeated with stratification by baseline frailty. Results: Device use was not associated with worsening frailty in the overall cohort, but was associated with worsening frailty in non-frail individuals when stratified by baseline frailty. Discussion: Device use does not worsen frailty in individuals who are frail at baseline. Device users who were not frail at baseline experienced worsening frailty suggesting additional contributing factors to their frailty aside from mobility limitations.
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Affiliation(s)
- Amanda Chau
- University of Hawaii John A Burns School of Medicine, Honolulu, HI, USA
| | - Dae H Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephanie Denise M Sison
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sandra M Shi
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Guseva OV, Zhukova NG. [Criteria of syndrome frailty in Parkinson´s disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:52-56. [PMID: 38529863 DOI: 10.17116/jnevro202412403152] [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: 03/27/2024]
Abstract
OBJECTIVE To evaluate syndrome frailty by the Fried phenotype in patients with Parkinson's disease (PD). MATERIAL AND METHODS Seventy-three patients over 65 years of age with Hoehn and Yahr stage 2-4 PD were tested for the presence of subjective criteria of the Fried phenotype of syndrome frailty: fatigue, difficulty in performing habitual activities, weight loss and objective criteria: grip strength and walking speed. The relationships of the objective criteria of Fried with indicators of age, sex, sports history, prescription of PD, the number of medications, blood pressure and MDS UPDRS part III scores, the severity of depression on the Beck scale and cognitive disorders on the MOCA were evaluated. RESULTS All patients complained of fatigue, difficulties in performing habitual activities. Four people noted a decrease in body weight of more than 5 kg per year. Objective criteria of Fried were absent in 38 (51%) patients, 23 (32%) people had one objective criterion: reduced walking speed (less than 0.8 m/s) or hand strength (less than 16 kg for women and 26 kg for men), in 12 (17%) people both objective criteria were reduced. The values of objective criteria of weakness were correlated with age, sex and MDS UPDRS part III total scores. CONCLUSION Frailty syndrome is difficult to diagnose in patients with PD due to the coincidence of complaints of the underlying disease and the syndrome. Objective criteria of the Fried phenotype suggest the presence of syndrome frailty in patients. The increase in the age of the patient, the female sex and the severity of PD are interrelated with the presence of objective criteria for the frailty of an elderly person.
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Affiliation(s)
- O V Guseva
- Siberian State Medical University, Tomsk, Russia
| | - N G Zhukova
- Siberian State Medical University, Tomsk, Russia
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5
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Camerlingo N, Kabiri NS, Psaltos DJ, Kelly M, Wicker MK, Messina I, Auerbach SH, Zhang H, Messere A, Karahanoğlu FI, Santamaria M, Demanuele C, Caouette D, Thomas KC. Monitoring Gait and Physical Activity of Elderly Frail Individuals in Free-Living Environment: A Feasibility Study. Gerontology 2023; 70:439-454. [PMID: 37984340 PMCID: PMC11014463 DOI: 10.1159/000535283] [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: 03/17/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Frailty is conventionally diagnosed using clinical tests and self-reported assessments. However, digital health technologies (DHTs), such as wearable accelerometers, can capture physical activity and gait during daily life, enabling more objective assessments. In this study, we assess the feasibility of deploying DHTs in community-dwelling older individuals, and investigate the relationship between digital measurements of physical activity and gait in naturalistic environments and participants' frailty status, as measured by conventional assessments. METHODS Fried Frailty Score (FFS) was used to classify fifty healthy individuals as non-frail (FFS = 0, n/female = 21/11, mean ± SD age: 71.10 ± 3.59 years), pre-frail (FFS = 1-2, n/female = 23/9, age: 73.74 ± 5.52 years), or frail (FFS = 3+, n/female = 6/6, age: 70.70 ± 6.53 years). Participants wore wrist-worn and lumbar-worn GENEActiv accelerometers (Activinsights Ltd., Kimbolton, UK) during three in-laboratory visits, and at-home for 2 weeks, to measure physical activity and gait. After this period, they completed a comfort and usability questionnaire. Compliant days at-home were defined as follows: those with ≥18 h of wear time, for the wrist-worn accelerometer, and those with ≥1 detected walking bout, for the lumbar-worn accelerometer. For each at-home measurement, a group analysis was performed using a linear regression model followed by ANOVA, to investigate the effect of frailty on physical activity and gait. Correlation between at-home digital measurements and conventional in-laboratory assessments was also investigated. RESULTS Participants were highly compliant in wearing the accelerometers, as 94% indicated willingness to wear the wrist device, and 66% the lumbar device, for at least 1 week. Time spent in sedentary activity and time spent in moderate activity as measured from the wrist device, as well as average gait speed and its 95th percentile from the lumbar device were significantly different between frailty groups. Moderate correlations between digital measurements and self-reported physical activity were found. CONCLUSIONS This work highlights the feasibility of deploying DHTs in studies involving older individuals. The potential of digital measurements in distinguishing frailty phenotypes, while unobtrusively collecting unbiased data, thus minimizing participants' travels to sites, will be further assessed in a follow-up study.
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Affiliation(s)
| | - Nina Shaafi Kabiri
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, USA
| | | | - Meredith Kelly
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Madisen K. Wicker
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Isabelle Messina
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Sanford H. Auerbach
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Hao Zhang
- Early Clinical Development, Pfizer, Inc., Cambridge, MA, USA
| | - Andrew Messere
- Early Clinical Development, Pfizer, Inc., Cambridge, MA, USA
| | | | - Mar Santamaria
- Early Clinical Development, Pfizer, Inc., Cambridge, MA, USA
| | | | - David Caouette
- Early Clinical Development, Pfizer, Inc., Cambridge, MA, USA
| | - Kevin C. Thomas
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, USA
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Elabbas E, Sharma A, Thu K, Tan A, Alim M, Zhang Y. Functional outcome and frailty in colorectal surgery patients. ANZ J Surg 2023; 93:2664-2668. [PMID: 37485796 DOI: 10.1111/ans.18602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Frailty is a recognized risk and predictor of poor health outcomes in older patients undergoing surgery. A significant proportion of elderly patients undergoing colorectal cancer-related surgery are nevertheless not routinely assessed for frailty in current clinical practice in Australia. We examined the preoperative use of the Clinical Frailty Scale (CFS) to predict post-operative functional outcomes in geriatric patients undergoing colorectal cancer surgery. METHODS This retrospective observational cohort study included elderly colorectal cancer patients (n = 227) who underwent elective major colorectal surgery from 2016 to 2020 at Nepean Hospital, Australia. CFS was calculated retrospectively from medical records and the relationship between CFS and functional outcome factors was analysed. RESULTS Frail patients (n = 111) had a significant postoperative functional decline as demonstrated by discharge to supported care (57% vs. 0.9%), Barthel Index change (P<0.05) and inability to self-manage stoma (P<0.05) compared to non-frail patients (n = 116). Multivariate analysis with adjustment for age, comorbidities as measured by Charlson Comorbidities Index (CCI), and cognitive impairment, demonstrated frailty was the most significant independent predictor of discharge to supported care (OR 109.3). Cognitive impairment and an increased CCI were also found to be important predictors. CONCLUSION Preoperative frailty is significantly associated with postoperative functional decline and postoperative adverse outcomes, highlighting the potential utility of CFS in preoperative frailty assessment.
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Affiliation(s)
- Elhassan Elabbas
- Geriatric Medicine Department, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Anita Sharma
- Geriatric Medicine Department, Nepean Hospital, Kingswood, New South Wales, Australia
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Kingswood, New South Wales, Australia
| | - Khin Thu
- Geriatric Medicine Department, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Azriel Tan
- Geriatric Medicine Department, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Melissa Alim
- Geriatric Medicine Department, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Yan Zhang
- Rehabilitation Medicine Department, Nepean Hospital, Kingswood, New South Wales, Australia
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Lluva-Plaza S, Jiménez-Martín A, Gualda-Gómez D, Villadangos-Carrizo JM, García-Domínguez JJ. Multisensory System for Long-Term Activity Monitoring to Facilitate Aging-in-Place. SENSORS (BASEL, SWITZERLAND) 2023; 23:8646. [PMID: 37896739 PMCID: PMC10611293 DOI: 10.3390/s23208646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023]
Abstract
Demographic changes and an ageing population require more effective methods to confront the increased prevalence of chronic diseases which generate dependence in older adults as well as an important rise in social expenditure. The challenge is not only to increase life expectancy, but also to ensure that the older adults can fully enjoy that moment in their lives, living where they wish to (private home, nursing home, …). Physical activity (PA) is a representative parameter of a person's state of health, especially when we are getting older, because it plays an important role in the prevention of diseases, and that is the reason why it is promoted in older adults. One of the goals of this work is to assess the feasibility of objectively measuring the PA levels of older adults wherever they live. In addition, this work proposes long-term monitoring that helps to gather daily activity patterns. We fuse inertial measurements with other technologies (WiFi- and ultrasonic-based location) in order to provide not only PA, but also information about the place where the activities are carried out, including both room-level location and precise positioning (depending on the technology used). With this information, we would be able to generate information about the person's daily routines which can be very useful for the early detection of physical or cognitive impairment.
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Affiliation(s)
- Sergio Lluva-Plaza
- Department of Electronics, University of Alcalá, 28801 Madrid, Spain; (S.L.-P.); (A.J.-M.); (J.M.V.-C.)
| | - Ana Jiménez-Martín
- Department of Electronics, University of Alcalá, 28801 Madrid, Spain; (S.L.-P.); (A.J.-M.); (J.M.V.-C.)
| | - David Gualda-Gómez
- Department of Signal Theory and Communications, University Rey Juan Carlos, 28943 Fuenlabrada, Spain;
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Bai A, Zhao M, Zhang T, Yang C, Yan J, Wang G, Zhang P, Xu W, Hu Y. Development and validation of a nomogram-assisted tool to predict potentially reversible cognitive frailty in Chinese community-living older adults. Aging Clin Exp Res 2023; 35:2145-2155. [PMID: 37477792 DOI: 10.1007/s40520-023-02494-9] [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: 03/28/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Cognitive frailty (CF) is a complex and heterogeneous clinical syndrome that indicates the onset of neurodegenerative processes and poor prognosis. In order to prevent the occurrence and development of CF in real world, we intended to develop and validate a simple and timely diagnostic instrument based on comprehensive geriatric assessment that will identify patients with potentially reversible CF (PRCF). METHODS 750 community-dwelling individuals aged over 60 years were randomly allocated to either a training or validation set at a 4:1 ratio. We used the operator regression model offering the least absolute data dimension shrinkage and feature selection among candidate predictors. PRCF was defined as the presence of physical pre-frailty, frailty, and mild cognitive impairment (MCI) occurring simultaneously. Multivariate logistic regression was conducted to build a diagnostic tool to present data as a nomogram. The performance of the tool was assessed with respect to its calibration, discrimination, and clinical usefulness. RESULTS PRCF was observed in 326 patients (43%). Predictors in the tool were educational background, coronary heart disease, handgrip strength, gait speed, instrumental activity of daily living (IADL) disability, subjective cognitive decline (SCD) and five-times-sit-to-stand test. The diagnostic nomogram-assisted tool exhibited good calibration and discrimination with a C-index of 0.805 and a higher C-index of 0.845 in internal validation. The calibration plots demonstrated strong agreement in both the training and validation sets, while decision curve analysis confirmed the nomogram's efficacy in clinical practice. CONCLUSIONS This tool can effectively identify older adults at high risk for PRCF, enabling physicians to make informed clinical decisions and implement proper patient-centered individual interventions.
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Affiliation(s)
- Anying Bai
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Geriatric Health Care Department 4th of The Second Medical Center & National, Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ming Zhao
- The outpatient Department of the Fourth Comprehensive Service Guarantee Center of the Veteran Cadre Service Administration of the Beijing Garrison District, Beijing, China
| | - Tianyi Zhang
- Institution of Hospital Management, Department of Medical Innovation and Research, Chinese PLA General Hospital, Beijing, 100853, China
| | - Cunmei Yang
- Geriatric Health Care Department 4th of The Second Medical Center & National, Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jin Yan
- Graduate School of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Guan Wang
- Department of Cardiovascular Medicine, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China
| | - Peicheng Zhang
- Haidian No.51 Outpatient Department, Beijing, 100142, China
| | - Weihao Xu
- Haikou Cadre's Sanitarium of Hainan Military Region, Haikou, 570203, China
| | - Yixin Hu
- Geriatric Health Care Department 4th of The Second Medical Center & National, Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
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Liu XT, Nikkhoo M, Wang L, Chen CP, Chen HB, Chen CJ, Cheng CH. Feasibility of a kinect-based system in assessing physical function of the elderly for home-based care. BMC Geriatr 2023; 23:495. [PMID: 37587451 PMCID: PMC10429079 DOI: 10.1186/s12877-023-04179-4] [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: 12/08/2022] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND With concerns about accurate diagnosis through telehealth, the Kinect sensor offers a reliable solution for movement analysis. However, there is a lack of practical research investigating the suitability of a Kinect-based system as a functional fitness assessment tool in homecare settings. Hence, the objective of this study was to evaluate the feasibility of using a Kinect-based system to assess physical function changes in the elderly. METHODS The study consisted of two phases. Phase one involved 35 young healthy adults, evaluating the reliability and validity of a Kinect-based fitness evaluation compared to traditional physical examination using the intraclass correlation coefficient (ICC). Phase two involved 665 elderly subjects, examining the correlation between the Kinect-based fitness evaluation and physical examination through Pearson's correlation coefficients. A Kinect sensor (Microsoft Xbox One Kinect V2) with customized software was employed to capture and compute the movement of joint centers. Both groups performed seven functional assessments simultaneously monitored by a physical therapist and the Kinect system. System usability and user satisfaction were assessed using the System Usability Scale (SUS) and Questionnaire for User Interface Satisfaction (QUIS), respectively. RESULTS Kinect-based system showed overall moderate to excellent within-day reliability (ICC = 0.633-1.0) and between-day reliability (ICC = 0.686-1.0). The overall agreement between the two devices was highly correlated (r ≧ 0.7) for all functional assessment tests in young healthy adults. The Kinect-based system also showed a high correlation with physical examination for the functional assessments (r = 0.858-0.988) except functional reach (r = 0.484) and walking speed(r = 0.493). The users' satisfaction with the system was excellent (SUS score = 84.4 ± 18.5; QUIS score = 6.5-6.7). CONCLUSIONS The reliability and validity of Kinect for assessing functional performance are generally favorable. Nonetheless, caution is advised when employing Kinect for tasks involving depth changes, such as functional reach and walking speed tests for their moderate validity. However, Kinect's fundamental motion detection capabilities demonstrate its potential for future applications in telerehabilitation in different healthcare settings.
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Affiliation(s)
- Xin-Ting Liu
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, No.259, Wen-Hwa 1st Rd, Kweishan, Taoyuan, Taiwan, R.O.C
| | - Mohammad Nikkhoo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, No.259, Wen-Hwa 1st Rd, Kweishan, Taoyuan, Taiwan, R.O.C
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan, R.O.C
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Lizhen Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Carl Pc Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Hung-Bin Chen
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, No.259, Wen-Hwa 1st Rd, Kweishan, Taoyuan, Taiwan, R.O.C
| | | | - Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, No.259, Wen-Hwa 1st Rd, Kweishan, Taoyuan, Taiwan, R.O.C..
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan, R.O.C..
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van Cappellen-van Maldegem SJM, Hoedjes M, Seidell JC, van de Poll-Franse LV, Buffart LM, Mols F, Beijer S. Self-performed Five Times Sit-To-Stand test at home as (pre-)screening tool for frailty in cancer survivors: Reliability and agreement assessment. J Clin Nurs 2023; 32:1370-1380. [PMID: 35332600 DOI: 10.1111/jocn.16299] [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: 12/09/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The self-performance of a Five-Times-Sit-To-Stand (FTSTS)-test, without the usual supervision by a medical professional, provides valuable opportunities for clinical practice and research. This study aimed: (1) to determine the validity of the self-performed FTSTS test in comparison to a supervised reference test and (2) to determine the reliability of a self-performed FTSTS test by cancer survivors. BACKGROUND Early detection of frailty in cancer survivors may enable prehabilitation interventions before surgery or intensive treatment, improving cancer outcomes. DESIGN A repeated measures reliability and agreement study, with one week in between measures, was performed. METHODS Cancer survivors (n = 151) performed two FTSTS tests themselves. One additional reference FTSTS test was supervised by a physical therapist. The intraclass correlation coefficient (ICC), structural error of measurement (SEM) and minimally important clinical difference (MID) were calculated comparing a self-performed FTSTS test to the reference test, and comparing two self-performed FTSTS tests. The Guidelines for Reporting Reliability and Agreement Studies (GRASS) have been used. RESULTS Mean age of cancer survivors was 65.6 years (SD = 9.3), 54.6% were female, median time since diagnosis was 2 years [IQR = 1], and tumour type varied (e.g., breast cancer (31.8%), prostate cancer (17.2%), gastrointestinal cancer (11.9%) and haematological cancer (11.9%)). Validity of the self-performed FTSTS test at home was acceptable in comparison with the reference test (ICC = .74; SEM = 3.2; MID = 3.6) as was the reliability of the self-performed FTSTS test (ICC = .70; SEM = 2.2; MID = 3.8). CONCLUSIONS The self-performed FTSTS test is a valid and reliable measure to assess lower body function and has potential to be used as objective (pre-)screening tool for frailty in cancer survivors. RELEVANCE TO CLINICAL PRACTICE The self-performed FTSTS test at home may indicate the cancer survivors in need of prehabilitation in advance of surgery or intensive treatment. The feasibility, short amount of time needed and potential cost-effectiveness of the self-performed FTSTS test can make it a valuable contribution to personalised care and precision medicine.
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Affiliation(s)
- Sandra J M van Cappellen-van Maldegem
- Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Meeke Hoedjes
- Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, The EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Physiology, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Floortje Mols
- Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Sandra Beijer
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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11
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Khan S, Kumar S, Acharya S, Wanjari A. Impact of Vitamin D Level on Sarcopenia in Elderly People: A Critical Review. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2023. [DOI: 10.1055/s-0042-1760090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AbstractVitamin D insufficiency is a widespread health issue globally, particularly among the elderly. Vitamin D controls and affects the metabolism and functionality of several human systems, including muscle tissue. The action of vitamin D on muscles has been extensively studied, with evidence indicating that this vitamin can increase the osteogenic differentiation of muscle fibers, hence preserving and enhancing muscular strength and athletic performance. Low hormone levels are more common in older people as a result of poor food intake and decreased skin ultraviolet irradiation. As a result, elderly persons who are deficient in vitamin D may be at risk of developing sarcopenia, a geriatric condition defined by gradual loss of skeletal muscle mass and strength that is frequently accompanied by adverse events such as falls, incapacity hospitalization, and mortality. As a result, these activities are seen to be crucial in illuminating the underlying functional condition of the aged, and functional mobility is employed as a technique for assessing fall risk and frailty. Several randomized controlled studies have been done to explore the efficacy of oral treatment in elderly people to prevent or cure sarcopenia; however, the results are still debatable. We describe the biochemical, clinical, and epidemiological data supporting the idea of a causal relationship between vitamin D insufficiency and a higher likelihood of sarcopenia in elderly adults in this narrative review. The muscular system, the biggest organ in the body, contributing to around 40% of body composition, is vital in exercising and glycogen depletion. Sarcopenia, a steady deterioration in muscle mass and strength, and function in the aged can result in prolonged circumstances, wheelchair confinement, and a reduction in quality of life. Diagnosis and control of muscle wasting are vital for improving health and quality of life in industrialized nations with aging populations. Vitamin D, a fat-soluble vitamin, has gained popularity in recent years because of its relevance in sarcopenia. The role of vitamin D deficiency and fortification on muscle wasting will be the focus of this review.
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Affiliation(s)
- Saniya Khan
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (deemed to be university), Wardha, Maharashtra, India
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (deemed to be university), Wardha, Maharashtra, India
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (deemed to be university), Wardha, Maharashtra, India
| | - Anil Wanjari
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (deemed to be university), Wardha, Maharashtra, India
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12
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Abbas M, Le Bouquin Jeannès R. A review of frailty analysis in older adults: from clinical tools towards fully automated preventive systems. Ing Rech Biomed 2022. [DOI: 10.1016/j.irbm.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Random forest algorithms to classify frailty and falling history in seniors using plantar pressure measurement insoles: a large-scale feasibility study. BMC Geriatr 2022; 22:746. [PMID: 36096722 PMCID: PMC9469527 DOI: 10.1186/s12877-022-03425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Background Frailty and falls are two adverse characteristics of aging that impair the quality of life of senior people and increase the burden on the healthcare system. Various methods exist to evaluate frailty, but none of them are considered the gold standard. Technological methods have also been proposed to assess the risk of falling in seniors. This study aims to propose an objective method for complementing existing methods used to identify the frail state and risk of falling in older adults. Method A total of 712 subjects (age: 71.3 ± 8.2 years, including 505 women and 207 men) were recruited from two Japanese cities. Two hundred and three people were classified as frail according to the Kihon Checklist. One hundred and forty-two people presented with a history of falling during the previous 12 months. The subjects performed a 45 s standing balance test and a 20 m round walking trial. The plantar pressure data were collected using a 7-sensor insole. One hundred and eighty-four data features were extracted. Automatic learning random forest algorithms were used to build the frailty and faller classifiers. The discrimination capabilities of the features in the classification models were explored. Results The overall balanced accuracy for the recognition of frail subjects was 0.75 ± 0.04 (F1-score: 0.77 ± 0.03). One sub-analysis using data collected for men aged > 65 years only revealed accuracies as high as 0.78 ± 0.07 (F1-score: 0.79 ± 0.05). The overall balanced accuracy for classifying subjects with a recent history of falling was 0.57 ± 0.05 (F1-score: 0.62 ± 0.04). The classification of subjects relative to their frailty state primarily relied on features extracted from the plantar pressure series collected during the walking test. Conclusion In the future, plantar pressures measured with smart insoles inserted in the shoes of senior people may be used to evaluate aspects of frailty related to the physical dimension (e.g., gait and balance alterations), thus allowing assisting clinicians in the early identification of frail individuals. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03425-5.
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14
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Li H, Han D, Wang H, Shu D, Xu L, Hou L, Xu Y, Lai X. The Relationship Between Vitamin D and Activity of Daily Living in the Elderly. Int J Gen Med 2022; 15:6357-6364. [PMID: 35935099 PMCID: PMC9355018 DOI: 10.2147/ijgm.s366203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/13/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To analyze the association between vitamin D and the performance of activity of daily living in the elderly. Methods A total of 94 patients over the age of 65 were eligible to participate if they had undergone a bone mineral density test and if they were in a stable health condition. Subjects were further divided into two groups according to activity of daily living (ADL): the score over 40 of the patients as the high ADL group and the below as the low ADL group. Results According to univariate analysis, the mean of total hip T score, serum creatinine/cystatin C ratio (CCR), and vitamin D were significantly different between the two groups (P=0.024, 0.008, 0.010). Multivariate ORs showed that the CCR (OR: 0.948; 95%CI: 0.910–0.989; P=0.013) and vitamin D (OR: 865; 95%CI: 0.752–0.994; P=0.047) were inversely associated with having low ADL. Furthermore, on multiple linear regression analysis, the Barthel ADL index was related to geriatric nutritional risk index (GNRI), CCR and vitamin D but independent of patients’ age with the slope of 0.732, 0.539, and 0.689 separately, reflected the stronger relative within the variables. Conclusion We demonstrated that there is a negative correlation of CCR and vitamin D with having low ADL in elderly population. Monitoring the trend of serum vitamin D and CCR, may have a role in the early detection of low ADL with loss of muscle mass and strength in the population of the elderly.
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Affiliation(s)
- Han Li
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, People’s Republic of China
| | - Dongmei Han
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, People’s Republic of China
| | - Haiyan Wang
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
| | - Dan Shu
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, People’s Republic of China
| | - Lei Xu
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, People’s Republic of China
| | - Liufang Hou
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, People’s Republic of China
| | - Ying Xu
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
- Correspondence: Ying Xu; Xueli Lai, Department of Nephrology, Shanghai Changhai Hospital, Shanghai, 200433, People’s Republic of China, Email ;
| | - Xueli Lai
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
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15
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Butkuviene M, Tamuleviciute-Prasciene E, Beigiene A, Barasaite V, Sokas D, Kubilius R, Petrenas A. Wearable-Based Assessment of Frailty Trajectories During Cardiac Rehabilitation After Open-Heart Surgery. IEEE J Biomed Health Inform 2022; 26:4426-4435. [PMID: 35700246 DOI: 10.1109/jbhi.2022.3181738] [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: 11/10/2022]
Abstract
Frailty in patients after open-heart surgery influences the type and intensity of a cardiac rehabilitation program. The response to tailored exercise training can be different, requiring convenient tools to assess the effectiveness of a training program routinely. The study aims to investigate whether kinematic measures extracted from the acceleration signals can provide information about frailty trajectories during rehabilitation. One hundred patients after open-heart surgery, assigned to the equal-sized intervention and control groups, participated in exercise training during inpatient rehabilitation. After rehabilitation, the intervention group continued exercise training at home, whereas the control group was asked to maintain the usual physical activity regimen. Stride time, cadence, movement vigor, gait asymmetry, Lissajous index, and postural sway were estimated during the clinical walk and stair-climbing tests before and after inpatient rehabilitation as well as after home-based exercise training. Frailty was assessed using the Edmonton frail scale. Most kinematic measures estimated during walking improved after rehabilitation along with the improvement in frailty status, i.e., stride time, cadence, postural sway, and movement vigor improved in 71%, 77%, 81%, and 83% of patients, respectively. Meanwhile, kinematic measures during stair-climbing improved to a lesser extent compared to walking. Home-based exercise training did not result in a notable change in kinematic measures which agrees well with only a negligible deterioration in frailty status. The study demonstrates the feasibility to follow frailty trajectories during inpatient rehabilitation after open-heart surgery based on kinematic measures extracted using a single wearable sensor.
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16
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Li Q, Legault V, Girard VD, Ferrucci L, Fried LP, Cohen AA. An objective metric of individual health and aging for population surveys. Popul Health Metr 2022; 20:11. [PMID: 35361249 PMCID: PMC8974028 DOI: 10.1186/s12963-022-00289-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/21/2022] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND We have previously developed and validated a biomarker-based metric of overall health status using Mahalanobis distance (DM) to measure how far from the norm of a reference population (RP) an individual's biomarker profile is. DM is not particularly sensitive to the choice of biomarkers; however, this makes comparison across studies difficult. Here we aimed to identify and validate a standard, optimized version of DM that would be highly stable across populations, while using fewer and more commonly measured biomarkers. METHODS Using three datasets (the Baltimore Longitudinal Study of Aging, Invecchiare in Chianti and the National Health and Nutrition Examination Survey), we selected the most stable sets of biomarkers in all three populations, notably when interchanging RPs across populations. We performed regression models, using a fourth dataset (the Women's Health and Aging Study), to compare the new DM sets to other well-known metrics [allostatic load (AL) and self-assessed health (SAH)] in their association with diverse health outcomes: mortality, frailty, cardiovascular disease (CVD), diabetes, and comorbidity number. RESULTS A nine- (DM9) and a seventeen-biomarker set (DM17) were identified as highly stable regardless of the chosen RP (e.g.: mean correlation among versions generated by interchanging RPs across dataset of r = 0.94 for both DM9 and DM17). In general, DM17 and DM9 were both competitive compared with AL and SAH in predicting aging correlates, with some exceptions for DM9. For example, DM9, DM17, AL, and SAH all predicted mortality to a similar extent (ranges of hazard ratios of 1.15-1.30, 1.21-1.36, 1.17-1.38, and 1.17-1.49, respectively). On the other hand, DM9 predicted CVD less well than DM17 (ranges of odds ratios of 0.97-1.08, 1.07-1.85, respectively). CONCLUSIONS The metrics we propose here are easy to measure with data that are already available in a wide array of panel, cohort, and clinical studies. The standardized versions here lose a small amount of predictive power compared to more complete versions, but are nonetheless competitive with existing metrics of overall health. DM17 performs slightly better than DM9 and should be preferred in most cases, but DM9 may still be used when a more limited number of biomarkers is available.
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Affiliation(s)
- Qing Li
- School of Economics and Management, Xinjiang University, 666 Shengli Road, Urumqi, 830046, China
| | - Véronique Legault
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - Vincent-Daniel Girard
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - Luigi Ferrucci
- Translational Gerontology Branch, Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, MedStar Harbor Hospital, 3001 S. Hanover Street, Baltimore, MD, 21225, USA
| | - Linda P Fried
- Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, R140810032, USA
| | - Alan A Cohen
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada.
- Research Center on Aging, 1036 Belvédère S, Sherbrooke, QC, J1H 4C4, Canada.
- Research Center of Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada.
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Schmidle S, Gulde P, Herdegen S, Böhme GE, Hermsdörfer J. Kinematic analysis of activities of daily living performance in frail elderly. BMC Geriatr 2022; 22:244. [PMID: 35321645 PMCID: PMC8943928 DOI: 10.1186/s12877-022-02902-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/04/2022] [Indexed: 11/20/2022] Open
Abstract
Background Frailty is accompanied by limitations of activities of daily living (ADL) and frequently associated with reduced quality of life, institutionalization, and higher health care costs. Despite the importance of ADL performance for the consequence of frailty, movement analyses based on kinematic markers during the performance of complex upper extremity-based manual ADL tasks in frail elderly is still pending. The main objective of this study was to evaluate if ADL task performance of two different tasks in frail elderlies can be assessed by an activity measurement based on an acceleration sensor integrated into a smartwatch, and further to what degree kinematic parameters would be task independent. Methods ADL data was obtained from twenty-seven elderly participants (mean age 81.6 ± 7.0 years) who performed two ADL tasks. Acceleration data of the dominant hand was collected using a smartwatch. Participants were split up in three groups, F (frail, n = 6), P (pre-frail, n = 13) and R (robust, n = 8) according to a frailty screening. A variety of kinematic measures were calculated from the vector product reflecting activity, agility, smoothness, energy, and intensity. Results Measures of agility, smoothness, and intensity revealed significant differences between the groups (effect sizes combined over tasks η2p = 0.18 – 0.26). Smoothness was particularly affected by frailty in the tea making task, while activity, agility, a different smoothness parameter and two intensity measures were related to frailty in the gardening task. Four of nine parameters revealed good reliability over both tasks (r = 0.44 – 0.69). Multiple linear regression for the data combined across tasks showed that only the variability of the magnitude of acceleration peaks (agility) contributed to the prediction of the frailty score (R2 = 0.25). Conclusion The results demonstrate that ADL task performance can be assessed by smartwatch-based measures and further shows task-independent differences between the three levels of frailty. From the pattern of impaired and preserved performance parameters across the tested tasks, we concluded that in persons with frailty ADL performance was more impaired by physiological deficiencies, i.e., physical power and endurance, than by cognitive functioning or sensorimotor control.
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Affiliation(s)
- Stephanie Schmidle
- Human Movement Science, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.
| | - Philipp Gulde
- Human Movement Science, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.,Center for Clinical Neuroplasticity Medical Park Loipl, Bischofswiesen, Germany
| | - Sophie Herdegen
- Human Movement Science, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Georg-Eike Böhme
- Lehelmed GmbH General Practitioners Lehel and Medical Center Motorworld, Munich, Germany
| | - Joachim Hermsdörfer
- Human Movement Science, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Rahman M, Mim SA, Islam R, Parvez A, Islam F, Uddin MB, Rahaman S, Shuvo PA, Ahmed M, Greig NH, Kamal MA. Exploring the Recent Trends in Management of Dementia and Frailty: Focus on Diagnosis and Treatment. Curr Med Chem 2022; 29:5289-5314. [PMID: 35400321 PMCID: PMC10477961 DOI: 10.2174/0929867329666220408102051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/19/2021] [Accepted: 09/19/2021] [Indexed: 02/08/2023]
Abstract
Dementia and frailty increase health adversities in older adults, which are topics of growing research interest. Frailty is considered to correspond to a biological syndrome associated with age. Frail patients may ultimately develop multiple dysfunctions across several systems, including stroke, transient ischemic attack, vascular dementia, Parkinson's disease, Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, cortico-basal degeneration, multiple system atrophy, amyotrophic lateral sclerosis, and Creutzfeldt-Jakob disease. Patients with dementia and frailty often develop malnutrition and weight loss. Rigorous nutritional, pharmacological, and non-pharmacological interventions generally are required for these patients, which is a challenging issue for healthcare providers. A healthy diet and lifestyle instigated at an early age can reduce the risk of frailty and dementia. For optimal treatment, accurate diagnosis involving clinical evaluation, cognitive screening, essential laboratory evaluation, structural imaging, functional neuroimaging, and neuropsychological testing is necessary. Diagnosis procedures best apply the clinical diagnosis, identifying the cause(s) and the condition(s) appropriate for treatment. The patient's history, caregiver's interview, physical examination, cognitive evaluation, laboratory tests, and structural imaging should best be involved in the diagnostic process. Varying types of physical exercise can aid the treatment of these disorders. Nutrition maintenance is a particularly significant factor, such as exceptionally high-calorie dietary supplements and a Mediterranean diet to support weight gain. The core purpose of this article is to investigate trends in the management of dementia and frailty, focusing on improving diagnosis and treatment. Substantial evidence builds the consensus that a combination of balanced nutrition and good physical activity is an integral part of treatment. Notably, more evidence-based medicine knowledge is required.
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Affiliation(s)
- Mominur Rahman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Sadia Afsana Mim
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Rezaul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Anwar Parvez
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Fahadul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Mohammad Borhan Uddin
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Saidur Rahaman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Pollob Ahmed Shuvo
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Muniruddin Ahmed
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Nigel H. Greig
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Mohammad Amjad Kamal
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- King Fahd Medical Research Center, King Abdulaziz University, Saudi Arabia
- Enzymoics, NSW; Novel Global Community Educational Foundation, Peterlee Place, Hebersham, NSW 2770, Australia
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Akbari G, Nikkhoo M, Wang L, Chen CPC, Han DS, Lin YH, Chen HB, Cheng CH. Frailty Level Classification of the Community Elderly Using Microsoft Kinect-Based Skeleton Pose: A Machine Learning Approach. SENSORS 2021; 21:s21124017. [PMID: 34200838 PMCID: PMC8230520 DOI: 10.3390/s21124017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
Frailty is one of the most important geriatric syndromes, which can be associated with increased risk for incident disability and hospitalization. Developing a real-time classification model of elderly frailty level could be beneficial for designing a clinical predictive assessment tool. Hence, the objective of this study was to predict the elderly frailty level utilizing the machine learning approach on skeleton data acquired from a Kinect sensor. Seven hundred and eighty-seven community elderly were recruited in this study. The Kinect data were acquired from the elderly performing different functional assessment exercises including: (1) 30-s arm curl; (2) 30-s chair sit-to-stand; (3) 2-min step; and (4) gait analysis tests. The proposed methodology was successfully validated by gender classification with accuracies up to 84 percent. Regarding frailty level evaluation and prediction, the results indicated that support vector classifier (SVC) and multi-layer perceptron (MLP) are the most successful estimators in prediction of the Fried’s frailty level with median accuracies up to 97.5 percent. The high level of accuracy achieved with the proposed methodology indicates that ML modeling can identify the risk of frailty in elderly individuals based on evaluating the real-time skeletal movements using the Kinect sensor.
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Affiliation(s)
- Ghasem Akbari
- Department of Mechanical Engineering, Qazvin Branch, Islamic Azad University, Qazvin 341851416, Iran;
| | - Mohammad Nikkhoo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran 1477893855, Iran;
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan
| | - Lizhen Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China;
| | - Carl P. C. Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, Bei-Hu Branch, National Taiwan University Hospital, Taipei 10845, Taiwan;
| | - Yang-Hua Lin
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.L.); (H.-B.C.)
| | - Hung-Bin Chen
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.L.); (H.-B.C.)
| | - Chih-Hsiu Cheng
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.L.); (H.-B.C.)
- Correspondence: ; Tel.: +886-3211-8800-3714
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20
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Association between gait speed and the SHARE Frailty Instrument in a Falls and Syncope Clinic. Eur Geriatr Med 2021; 12:1101-1105. [PMID: 33991324 DOI: 10.1007/s41999-021-00509-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Identifying physical frailty is useful in the context of falls and syncope assessment. The phenotype-based SHARE Frailty Instrument for Primary Care (SHARE-FI) does not measure gait speed. We evaluated the association between SHARE-FI and gait speed in a Falls' and Syncope Unit (FASU). METHODS We recruited a pilot sample of patients aged 50 and over attending FASU between November 2019 and March 2020. The association between gait speed and SHARE-FI was assessed with the Spearman's co-efficient (rs). Logistic regression was conducted to investigate the association controlling for age, sex, body mass index, comorbidities and polypharmacy. RESULTS 104 participants were included (34 frail) median (IQR) age 74 (68-79) years. 68 were female. There was a significant negative correlation between frailty and gait speed (rs - 0.54, P < 0.001). In the multivariable model, gait speed remained independently associated with frailty (OR 0.09, 95% CI 0.02-0.52, P = 0.007). CONCLUSIONS SHARE-FI significantly captured gait speed in this clinical sample, adding to its validity.
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Cybularz M, Wydra S, Berndt K, Poitz DM, Barthel P, Alkouri A, Heidrich FM, Ibrahim K, Jellinghaus S, Speiser U, Linke A, Christoph M, Pfluecke C. Frailty is associated with chronic inflammation and pro-inflammatory monocyte subpopulations. Exp Gerontol 2021; 149:111317. [PMID: 33744391 DOI: 10.1016/j.exger.2021.111317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 01/19/2023]
Abstract
AIM OF THE STUDY Frail patients with high grade aortic valve stenosis (AS) undergoing Transcatheter Aortic Valve Implantation (TAVI) have an increased mortality. A connection between frailty and inflammation has been suggested. Monocyte subpopulations are associated with both cardiovascular diseases and chronic inflammatory diseases. This study investigates the association of frailty with monocyte subpopulations and systemic inflammatory parameters in elderly patients undergoing TAVI. METHODS A total of 120 patients with symptomatic AS was examined. Before TAVI implantation, frailty was assessed by a bedside evaluation (eyeball test). In all patients a flow cytometry analysis has been performed. Monocyte subpopulations were defined as follows: classical (CD14++CD16-), intermediate (CD14++CD16+) and non-classical (CD14+CD16++). Expression of CD11b was measured as a marker for monocyte activation. Pro-inflammatory cytokines such as interleukin IL-8, as well as CRP were measured with Cytometric Bead Array or standard laboratory methods. RESULTS 28 out of 120 patients were frail. These patients showed both, signs of elevated chronic systemic inflammation reflected by elevated CRP (3.7 (1.4-5.4) vs. 5.9 (3.7-29.1), p = 0.001) and an elevated level of intermediate monocytes (37 (24-54) vs. 53 (47-63), p = 0.001). At 6 months after TAVI, 19 of 120 patients died, primarily without relevant dysfunction of the implanted aortic valve. Mortality was significantly higher in the frail as compared with non-frail patients (9 of 28 frail patients vs. 10 of 92 non frail patients, p < 0.001). A binary logistic regression analysis validated frailty and intermediate monocytes as independent predictors for early mortality after TAVI. CONCLUSION Chronic systemic inflammation and increased levels of intermediate monocytes are associated with frailty in old patients with severe aortic valve stenosis. Both the syndrome of frailty and elevated intermediate monocytes showed an association with early mortality after TAVI.
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Affiliation(s)
- Maria Cybularz
- Internal medicine, cardiology and intensive care medicine, Heart Center Dresden, Technical University Dresden, Dresden, Germany
| | - Sandy Wydra
- Internal medicine, cardiology and intensive care medicine, Heart Center Dresden, Technical University Dresden, Dresden, Germany
| | - Katharina Berndt
- Department of Cardiology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - David M Poitz
- Institute for Clinical Chemistry and Laboratory Medicine, Technical University Dresden, Dresden, Germany
| | - Peggy Barthel
- Internal medicine, cardiology and intensive care medicine, Heart Center Dresden, Technical University Dresden, Dresden, Germany
| | - Ahmad Alkouri
- Internal medicine, cardiology and intensive care medicine, Heart Center Dresden, Technical University Dresden, Dresden, Germany
| | - Felix M Heidrich
- Internal medicine, cardiology and intensive care medicine, Heart Center Dresden, Technical University Dresden, Dresden, Germany
| | - Karim Ibrahim
- Department of Cardiology, Technische Universität Dresden, Klinikum Chemnitz, Germany
| | - Stefanie Jellinghaus
- Internal medicine, cardiology and intensive care medicine, Heart Center Dresden, Technical University Dresden, Dresden, Germany
| | - Uwe Speiser
- Internal medicine, cardiology and intensive care medicine, Heart Center Dresden, Technical University Dresden, Dresden, Germany
| | - Axel Linke
- Internal medicine, cardiology and intensive care medicine, Heart Center Dresden, Technical University Dresden, Dresden, Germany
| | - Marian Christoph
- Internal medicine, cardiology and intensive care medicine, Heart Center Dresden, Technical University Dresden, Dresden, Germany
| | - Christian Pfluecke
- Internal medicine, cardiology and intensive care medicine, Heart Center Dresden, Technical University Dresden, Dresden, Germany.
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Panhwarr YN, Naghdy F, Stirling D, Naghdy G, Potter J. Quantitative Frailty Assessment Based on Kinematic Parameters of Daily Living Activities. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4233-4238. [PMID: 33018931 DOI: 10.1109/embc44109.2020.9175799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Frailty is a prevailing phenomena in older people. It is an age related syndrome that can increase the risk of fall in elderly. The people with age above 65 suffers from various functional decline and cognitive impairments. Such deficiencies are conventionally measured subjectively by geriatrics using questionnaire-based methods and clinical tests. Activities of daily living are also assessed in clinical settings by analysing simple tasks performed by the subject such as sit to stand and walking some distances. The clinical methods used to assess frailty and analyse the activity of daily living are subjective in nature and prone to human error. An objective method is proposed to quantitatively measure frailty using inertial sensor mounted on healthy, frail and nonfrail subjects while performing the sit to stand test (SiSt). An artificial neural networks based algorithm is developed to classify the frailty by extracting a unique set of features from 2D -Centre of Mass (CoM) trajectories derived from SiSt clinical test. The results indicate that the proposed algorithms provides an objective assessment of frailty that can be used by geriatrics in turn to make a more objective judgement of frailty status of older people.
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