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Duchesneau ED, Reeder-Hayes K, Stürmer T, Kim DH, Edwards JK, Lund JL. Longitudinal trajectories of a claims-based frailty measure during adjuvant chemotherapy in women with stage I-III breast cancer. Oncologist 2024:oyae092. [PMID: 38716777 DOI: 10.1093/oncolo/oyae092] [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: 11/27/2023] [Accepted: 04/16/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Frailty is a dynamic syndrome characterized by reduced physiological reserve to maintain homeostasis. Prospective studies have reported frailty worsening in women with breast cancer during chemotherapy, with improvements following treatment. We evaluated whether the Faurot frailty index, a validated claims-based frailty measure, could identify changes in frailty during chemotherapy treatment and identified predictors of trajectory patterns. METHODS We included women (65+ years) with stage I-III breast cancer undergoing adjuvant chemotherapy in the SEER-Medicare database (2003-2019). We estimated the Faurot frailty index (range: 0-1; higher scores indicate greater frailty) at chemotherapy initiation, 4 months postinitiation, and 10 months postinitiation. Changes in frailty were compared to a matched noncancer comparator cohort. We identified patterns of frailty trajectories during the year following chemotherapy initiation using K-means clustering. RESULTS Twenty-one thousand five hundred and ninety-nine women initiated adjuvant chemotherapy. Mean claims-based frailty increased from 0.037 at initiation to 0.055 4 months postchemotherapy initiation and fell to 0.049 10 months postinitiation. Noncancer comparators experienced a small increase in claims-based frailty over time (0.055-0.062). We identified 6 trajectory patterns: a robust group (78%), 2 resilient groups (16%), and 3 nonresilient groups (6%). Black women and women with claims for home hospital beds, wheelchairs, and Parkinson's disease were more likely to experience nonresilient trajectories. CONCLUSIONS We observed changes in a claims-based frailty index during chemotherapy that are consistent with prior studies using clinical measures of frailty and identified predictors of nonresilient frailty trajectories. Our study demonstrates the feasibility of using claims-based frailty indices to assess changes in frailty during cancer treatment.
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Affiliation(s)
- Emilie D Duchesneau
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Til Stürmer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dae Hyun Kim
- Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer L Lund
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Otto RB, Fields NL, Bennett M, Anderson KA. Positive Aging and Death or Dying: A Scoping Review. THE GERONTOLOGIST 2023; 63:1497-1509. [PMID: 36744720 DOI: 10.1093/geront/gnad006] [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: 10/28/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This scoping review aims to examine the extent and the manner in which research that utilizes successful, active, productive, and healthy aging framework(s) includes death or dying. RESEARCH DESIGN AND METHODS An examination of peer-reviewed academic journal articles was conducted following Joanna Briggs Institute's methodological standards for scoping reviews and conforming to Arskey and O'Malley's 5-stage framework. The initial search resulted in 1,759 articles for review, and following the rigorous screening, 35 studies were included for the final review. A qualitative thematic analysis was used to identify how research utilizes the concepts of death and dying in the context of 4 positive aging models. RESULTS The core themes identified include (a) the absence of death and dying dimensions in positive aging models; (b) older adults' outlooks on death and dying while aging well; (c) religious and spiritual dimensions of aging well; (d) negative consequences of positive aging models without death and dying dimensions; and (e) the future of death and dying in positive aging models. DISCUSSION AND IMPLICATIONS The review delivers a critique by researchers on the noticeable absence of death and dying processes within the framework of successful, active, productive, and healthy aging models. These findings represent a rich opportunity for future research on these concepts.
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Affiliation(s)
- Robin Brown Otto
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Noelle L Fields
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Michael Bennett
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Keith A Anderson
- Department of Social Work, University of Mississippi, Oxford, Mississippi, USA
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Duchesneau ED, Shmuel S, Faurot KR, Musty A, Park J, Stürmer T, Kinlaw AC, Yang YC, Lund JL. Missing data approaches in longitudinal studies of aging: A case example using the National Health and Aging Trends Study. PLoS One 2023; 18:e0286984. [PMID: 37289795 PMCID: PMC10249888 DOI: 10.1371/journal.pone.0286984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE Missing data is a key methodological consideration in longitudinal studies of aging. We described missing data challenges and potential methodological solutions using a case example describing five-year frailty state transitions in a cohort of older adults. METHODS We used longitudinal data from the National Health and Aging Trends Study, a nationally-representative cohort of Medicare beneficiaries. We assessed the five components of the Fried frailty phenotype and classified frailty based on their number of components (robust: 0, prefrail: 1-2, frail: 3-5). One-, two-, and five-year frailty state transitions were defined as movements between frailty states or death. Missing frailty components were imputed using hot deck imputation. Inverse probability weights were used to account for potentially informative loss-to-follow-up. We conducted scenario analyses to test a range of assumptions related to missing data. RESULTS Missing data were common for frailty components measured using physical assessments (walking speed, grip strength). At five years, 36% of individuals were lost-to-follow-up, differentially with respect to baseline frailty status. Assumptions for missing data mechanisms impacted inference regarding individuals improving or worsening in frailty. CONCLUSIONS Missing data and loss-to-follow-up are common in longitudinal studies of aging. Robust epidemiologic methods can improve the rigor and interpretability of aging-related research.
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Affiliation(s)
- Emilie D. Duchesneau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Shahar Shmuel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Keturah R. Faurot
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Allison Musty
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jihye Park
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Alan C. Kinlaw
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, United States of America
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Yang Claire Yang
- Department of Sociology, Carolina Population Center, Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jennifer L. Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Ronkainen NJ, Ryba TV, Tonge C, Tikkanen OM. Coaches' reflections on the meaning and value of Masters athletics. J Aging Stud 2019; 49:31-38. [DOI: 10.1016/j.jaging.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/30/2022]
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Domènech-Abella J, Perales J, Lara E, Moneta MV, Izquierdo A, Rico-Uribe LA, Mundó J, Haro JM. Sociodemographic Factors Associated With Changes in Successful Aging in Spain: A Follow-Up Study. J Aging Health 2017; 30:1244-1262. [PMID: 28621154 PMCID: PMC7237040 DOI: 10.1177/0898264317714327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Successful aging (SA) refers to maintaining well-being in old age. Several definitions or models of SA exist (biomedical, psychosocial, and mixed). We examined the longitudinal association between various SA models and sociodemographic factors, and analyzed the patterns of change within these models. METHOD This was a nationally representative follow-up in Spain including 3,625 individuals aged ≥50 years. Some 1,970 individuals were interviewed after 3 years. Linear regression models were used to analyze the survey data. RESULTS Age, sex, and occupation predicted SA in the biomedical model, while marital status, educational level, and urbanicity predicted SA in the psychosocial model. The remaining models included different sets of these predictors as significant. In the psychosocial model, individuals tended to improve over time but this was not the case in the biomedical model. CONCLUSION The biomedical and psychosocial components of SA need to be addressed specifically to achieve the best aging trajectories.
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Affiliation(s)
- Joan Domènech-Abella
- 1 Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,2 Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,3 Universitat de Barcelona, Spain
| | - Jaime Perales
- 4 University of Kansas Medical Center, Kansas City, USA
| | - Elvira Lara
- 1 Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,2 Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,3 Universitat de Barcelona, Spain
| | - Maria Victoria Moneta
- 1 Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,2 Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,5 Sant Joan de Déu Foundation, Barcelona, Spain
| | - Ana Izquierdo
- 2 Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,6 Universidad Autónoma de Madrid, Spain
| | - Laura Alejandra Rico-Uribe
- 2 Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,6 Universidad Autónoma de Madrid, Spain
| | | | - Josep Maria Haro
- 1 Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,2 Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,7 Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
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Abstract
RÉSUMÉUn indice de vieillissement réussi (SA) a été capturé dans une étude de cohorte longitudinale basée sur la population des personnes de 75 ans et plus, qui a été examiné longitudinalement en utilisant la modélisation d’un mélange de croissance (MMC) pour identifier les groupes ayant des trajectoires similaires utilisant la dernière interview complète de personnes décédées et jusqu’à quatre collections de données précédentes avant la mort. MMC a identifié un modèle avec trois classes. Les classes étaient : haut fonctionnement, pas de déclin (HPD); fonctionnement élevé, baisse progressive (HBP); et un faible fonctionnement, fort baisse (FB). Les individus de la classe HPD étaient significativement plus jeunes à la mort, et à la fin de l’examen, se composait de plus d’hommes, et plus susceptibles d’être mariées, comparativement aux individus HBP et FB. Ces résultats démontrent différentes façons dont les individus peuvent éprouver un vieillissement réussi à la fin de vie. Cette étude fournit le cadre pour la recherche future en ce qui concerne les processus du vieillissement pendant toute la vie, avec des implications importantes pour la politique et la pratique.
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Armstrong JJ, Mitnitski A, Andrew MK, Launer LJ, White LR, Rockwood K. Cumulative impact of health deficits, social vulnerabilities, and protective factors on cognitive dynamics in late life: a multistate modeling approach. ALZHEIMERS RESEARCH & THERAPY 2015; 7:38. [PMID: 26052349 PMCID: PMC4457088 DOI: 10.1186/s13195-015-0120-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/16/2015] [Indexed: 01/03/2023]
Abstract
Introduction Many factors influence late-life cognitive changes, and evaluating their joint impact is challenging. Typical approaches focus on average decline and a small number of factors. We used multistate transition models and index variables to look at changes in cognition in relation to frailty (accumulation of health deficits), social vulnerability, and protective factors in the Honolulu-Asia Aging Study (HAAS). Methods The HAAS is a prospective cohort study of 3,845 men of Japanese descent, aged 71 to 93 years at baseline. Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI). Baseline index variables were constructed of health deficits (frailty), social vulnerabilities, and protective factors. The chances of improvement/stability/decline in cognitive function and death were simultaneously estimated using multistate transition modeling for 3- and 6-year transitions from baseline. Results On average, CASI scores declined by 5.3 points (standard deviation (SD) = 10.0) over 3 years and 9.5 points (SD = 13.9) over 6 years. After adjusting for education and age, baseline frailty was associated with an increased risk of cognitive decline at 3 years (β = 0.18, 95% confidence interval (CI), 0.08 to 0.29) and 6 years (β = 0.40, 95% CI, 0.27 to 0.54). The social vulnerability index was associated with 3-year changes (β = 0.16, 95% CI, 0.09 to 0.23) and 6-year changes (β = 0.14, 95% CI, 0.05 to 0.24) in CASI scores. The protective index was associated with reductions in cognitive decline over the two intervals (3-year: β = −0.16, 95% CI, −0.24 to −0.09; 6-year: β = −0.21, 95% CI, −0.31 to –0.11,). Conclusions Research on cognition in late life needs to consider overall health, the accumulation of protective factors, and the dynamics of cognitive change. Index variables and multistate transition models can enhance understanding of the multifactorial nature of late-life changes in cognition. Electronic supplementary material The online version of this article (doi:10.1186/s13195-015-0120-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joshua J Armstrong
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Arnold Mitnitski
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Melissa K Andrew
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University, Halifax, NS Canada ; Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, NS Canada
| | - Lenore J Launer
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD USA
| | - Lon R White
- Pacific Health Research & Education Institute, Honolulu, HI USA
| | - Kenneth Rockwood
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University, Halifax, NS Canada ; Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, NS Canada
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Lamb S. Permanent personhood or meaningful decline? Toward a critical anthropology of successful aging. J Aging Stud 2014; 29:41-52. [PMID: 24655672 DOI: 10.1016/j.jaging.2013.12.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 12/30/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
The current North American successful aging movement offers a particular normative model of how to age well, one tied to specific notions of individualist personhood especially valued in North America emphasizing independence, productivity, self-maintenance, and the individual self as project. This successful aging paradigm, with its various incarnations as active, healthy and productive aging, has received little scrutiny as to its cultural assumptions. Drawing on fieldwork data with elders from both India and the United States, this article offers an analysis of cultural assumptions underlying the North American successful aging paradigm as represented in prevailing popular and scientific discourse on how to age well. Four key themes in this public successful aging discourse are examined: individual agency and control; maintaining productive activity; the value of independence and importance of avoiding dependence; and permanent personhood, a vision of the ideal person as not really aging at all in late life, but rather maintaining the self of one's earlier years. Although the majority of the (Boston-area, well-educated, financially privileged) US elders making up this study, and some of the most cosmopolitan Indians, embrace and are inspired by the ideals of the successful aging movement, others critique the prevailing successful aging model for insufficiently incorporating attention to and acceptance of the human realities of mortality and decline. Ultimately, the article argues that the vision offered by the dominant successful aging paradigm is not only a particular cultural and biopolitical model but, despite its inspirational elements, in some ways a counterproductive one. Successful aging discourse might do well to come to better terms with conditions of human transience and decline, so that not all situations of dependence, debility and even mortality in late life will be viewed and experienced as "failures" in living well.
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Affiliation(s)
- Sarah Lamb
- Department of Anthropology, Brandeis University, Waltham, MA, USA.
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