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Zhang Y, Xia H, Jiang X, Wang Q, Hou L. Prevalence and Outcomes of Cognitive Frailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. Res Gerontol Nurs 2024; 17:202-212. [PMID: 39047228 DOI: 10.3928/19404921-20240621-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE To systematically review the available evidence regarding the prevalence and outcomes of cognitive frailty-a clinical syndrome characterized by the combination of physical frailty and cognitive impairment, without dementia-in community-dwelling older adults. METHOD The following databases were searched: PubMed, Web of Science, Embase, EBSCO, Cochrane Central Register of Controlled Trials, ProQuest, CNKI, Wanfang, VIP, and CBMdisc (inception to October 2, 2023). RESULTS Twenty-four studies were included (N = 62,169) reporting a median prevalence of cognitive frailty among community-dwelling older adults of 12.2%. Frailty with cognitive impairment was independently associated with increased all-cause mortality (adjusted 8-year hazard ratio [HR] = 2.6, 95% confidence interval [CI] [2.05, 3.30]). There was evidence of increased risk of 3-year mortality for frailty (adjusted HR = 1.92, 95% CI [1.26, 2.93]) and prefrailty (adjusted HR = 1.79, 95% CI [1.33, 2.41]) with cognitive impairment. There was also evidence of increased risk of dementia for frailty (adjusted 24-month HR = 6.19, 95% CI [2.74, 13.99]; adjusted 4-year HR = 4.98, 95% CI [2.17, 11.41]) and prefrailty (adjusted 4-year HR = 5.21, 95% CI [2.95, 9.20]; adjusted 5-year HR = 14.5, 95% CI [1.68, 125.1]) with cognitive impairment. Activities of daily living (ADL) dependence was more frequent in individuals with cognitive impairment and frailty (adjusted 4-year odds ratio = 5.6, 95% CI [2.13, 14.72]). CONCLUSION Of community-dwelling older adults, 12.2% have cognitive frailty as well as increased risk of all-cause mortality, dementia, and ADL dependence. Further studies on prevention and treatment of cognitive frailty is warranted. Health care providers should formulate specific interventions to decrease the impact of cognitive frailty. [Research in Gerontological Nursing, 17(4), 202-212.].
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Işık K, Mete B, Tanrıöver F, Demirhindi H, Mete ED. Mediator Role of Frailty and Biological Deficits in Dementia Prognosis-Retrospective Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:910. [PMID: 38929527 PMCID: PMC11205344 DOI: 10.3390/medicina60060910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/15/2024] [Accepted: 05/26/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Dementia is increasing worldwide. This study aimed to examine the impact of comorbidity burden and frailty on dementia prognosis in patients with dementia. Materials and Methods: This retrospective cohort study was conducted with 47 patients with dementia who were followed for up to two years. The Modified Charlson Comorbidity Index (MCCI), Mini-Mental State Examination (MMSE-E), and Edmonton Fragility Scale were used besides laboratory and clinical findings. Results: The mean age of the 47 patients was 78.77 ± 12.44 years. During the follow-up period, MMSE-E scores were observed to improve in 50% of the patients. Initial MMSE-E scores were found to be lowest in men and patients with coronary artery disease or depression, while final MMSE-E scores were observed to be lowest in patients with depression and low vitamin B12 or vitamin D levels. The rates of decrease in MMSE-E scores in non-, moderately and severely frail patients were 21.4%, 55.6%, and 70.6%, respectively. There was a moderate negative correlation between MMSE-E scores and both comorbidity burden and frailty scores. The mediation analysis revealed that frailty was a complete mediator, and that comorbidity burden led to an increase in frailty and a decrease in MMSE-E scores. During the follow-up period, patients with moderate frailty, hypertension, diabetes mellitus, alcohol and tobacco use, low B12 levels, or hypothyroidism showed an increased risk of decrease in cognitive functions. Conclusions: There was a significant association between dementia prognosis and both frailty and biological deficits. We recommend the adoption of a syndemic approach in the follow-up of dementia, as we believe that the prevention of frailty and associated biological deficits will contribute to slowing dementia's clinical course.
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Affiliation(s)
- Kübra Işık
- Department of Neurology, Şanlıurfa Suruç State Hospital, Şanlıurfa 63800, Turkey;
| | - Burak Mete
- Department of Public Health, Faculty of Medicine, Cukurova University, Adana 01330, Turkey
| | - Fatma Tanrıöver
- Department of Radiology, Faculty of Medicine, Cukurova University, Adana 01330, Turkey;
| | - Hakan Demirhindi
- Department of Public Health, Faculty of Medicine, Cukurova University, Adana 01330, Turkey
| | - Esra Doğan Mete
- Child and Adolescent Psychiatry Department, Faculty of Medicine, Cukurova University, Adana 01330, Turkey;
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Guo R, Zhang S, Yu S, Li X, Liu X, Shen Y, Wei J, Wu Y. Inclusion of frailty improved performance of delirium prediction for elderly patients in the cardiac intensive care unit (D-FRAIL): A prospective derivation and external validation study. Int J Nurs Stud 2023; 147:104582. [PMID: 37672971 DOI: 10.1016/j.ijnurstu.2023.104582] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The elderly patients admitted to cardiac intensive care unit (CICU) are at relatively high risk for developing delirium. A simple and reliable predictive model can benefit them from early recognition of delirium followed by timely and appropriate preventive strategies. OBJECTIVE To explore the role of frailty in delirium prediction and develop and validate a delirium predictive model including frailty for elderly patients in CICU. DESIGN A prospective, observational cohort study. SETTINGS CICU at China-Japan Friendship Hospital from March 1, 2022 to August 25, 2022 (derivation cohort); CICU at Beijing Anzhen Hospital affiliated to Capital Medical University from March 14, 2023 to May 8, 2023 (external validation cohort). PARTICIPANTS A total of 236 and 90 participants were enrolled in the derivation and external validation cohorts, respectively. Participants in the derivation cohort were assigned into either the delirium (n = 70) or non-delirium group (n = 166) based on the occurrence of delirium. METHODS The simplified Chinese version of the Confusion Assessment Method for the Diagnosis of Delirium in the Intensive Care Unit was used to assess delirium twice a day at 8:00-10:00 and 18:00-20:00 until the onset of delirium or discharge from the CICU. Frailty was assessed using the FRAIL scale during the first 24 h in the CICU. Other possible risk factors were collected prospectively through patient interviews and medical records review. After processing missing data via multiple imputations, univariate analysis and bootstrapped forward stepwise logistic regression were performed to select optimal predictors and develop the models. The models were internally validated using bootstrapping and evaluated comprehensively via discrimination, calibration, and clinical utility in both the derivation and external validation cohorts. RESULTS The study developed D-FRAIL predictive model using FRAIL score, hearing impairment, Acute Physiology and Chronic Health Evaluation-II score, and fibrinogen. The area under the receiver operating characteristic curve (AUC) was 0.937 (95% confidence interval [CI]: 0.907-0.967) and 0.889 (95%CI: 0.840-0.938) even after bootstrapping in the derivation cohort. Inclusion of frailty was demonstrated to improve the model performance greatly with the AUC increased from 0.851 to 0.937 (p < 0.001). In the external validation cohort, the AUC of D-FRAIL model was 0.866 (95%CI: 0.782-0.907). Calibration plots and decision curve analysis suggested good calibration and clinical utility of the D-FRAIL model in both the derivation and external validation cohorts. CONCLUSIONS For elderly patients in the CICU, FRAIL score is an independent delirium predictor and the D-FRAIL model demonstrates superior performance in predicting delirium.
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Affiliation(s)
- Rongrong Guo
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Shan Zhang
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Saiying Yu
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Xiangyu Li
- School of Nursing, Capital Medical University, Beijing 100069, China
| | - Xinju Liu
- Cardiac Intensive Care Unit, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yanling Shen
- Surgical Intensive Care Unit, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jinling Wei
- Cardiac Intensive Care Unit, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing 100069, China.
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Khan J. Nutritional status, alcohol-tobacco consumption behaviour and cognitive decline among older adults in India. Sci Rep 2022; 12:21102. [PMID: 36473919 PMCID: PMC9726887 DOI: 10.1038/s41598-022-25563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Cognition capacity is essentially age-dependent and it is associated with the overall well-being of an individual. The public health aspects of cognitive research primarily focus on the possible delaying of cognitive decline among the older adult population. In this context, using the most recent round of the Longitudinal Ageing Study in India, 2017-2018 data, this study examines the cognition capacity among older adults aged 45 and above subject to their nutritional health and health behaviour (tobacco and alcohol consumption). It is observed that almost one in every tenth individual (10%) above 45 years of age in India shows low cognition scores. Low cognition is much more prevalent among 60 + females than males. Around one-fifth of the underweight older adults (18%) demonstrate low cognition capacity among them. Of those older adults who consume only tobacco, 11% of them demonstrate low cognition than the rest. The partial proportional odds model estimation shows that older adults are at higher risk of developing low cognition with increasing age and beyond age 65, the individuals carry a critically higher risk to experience low cognition. The estimation also shows that with increasing age older adults are higher likely to experience poor cognition independent of nutritional status, but underweight older adults are comparatively more likely to experience low cognition followed by normal and overweight older adults. In terms of alcohol-tobacco consumption behaviour, older adults who consume both are more likely to experience low cognition with increasing age followed by 'only alcohol consumers', and 'only tobacco consumers'.
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Affiliation(s)
- Junaid Khan
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Deonar, Mumbai, 400088 India ,grid.466534.60000 0004 8340 2194School of Public Health, Asian Institute of Public Health University, Bhubaneswar, 752101 India
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Huang X, Alcantara LS, Tan CS, Ng YL, van Dam RM, Hilal S. Handgrip Strength and Cognitive Performance in a Multiethnic Cohort in Singapore. J Alzheimers Dis 2022; 90:1547-1555. [PMID: 36314200 DOI: 10.3233/jad-220531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Handgrip strength (HGS) is an important marker of frailty but there is limited research on lifestyle and vascular determinants of HGS and its relationship with cognitive impairment. OBJECTIVE To identify determinants of HGS and the association of HGS with cognitive impairment in a multiethnic cohort from Singapore. METHODS This study (n = 2,109, median [Q1, Q3] age: 53 [48, 60] years, 59.6% women) was based on cross-sectional data from Singapore Multi-Ethnic Cohort. HGS was collected using hand-held Electronic Dynamometer. The potential determinants of HGS included age, sex, ethnicity, smoking, physical activity, serum cholesterol and history of hypertension, diabetes, and stroke. Cognition, assessed with the Mini-Mental State Examination (MMSE), was analyzed as both continuous and binary outcome (cognitively impaired [scores < 26] and cognitively normal [scores≥26]). RESULTS In total, 239 (11.3%) participants were cognitively impaired. Older age, female sex, Malay or Indian compared with Chinese ethnicity, and diabetes history were associated with decreased HGS, whereas higher education, higher body mass index, and more physical activity were associated with higher HGS. Higher HGS was associated with higher MMSE scores (β: 0.34, 95% CI: 0.20, 0.49) and 37% lower odds of cognitive impairment (OR: 0.63, 95% CI: 0.49-0.82). These associations were significantly stronger in participants who were older (50-90 years), female, of Malay and Indian ethnicity (compared with Chinese), and less educated. CONCLUSION In this multi-ethnic Asian population, demographics, vascular risk factors, and lifestyle behaviors were associated with HGS. Additionally, higher HGS was associated with substantially better cognitive function, which association was modified by age, sex, ethnicity, and education level.
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Affiliation(s)
- Xiangyuan Huang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Leicester Shawn Alcantara
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Yi Lin Ng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Department of Pharmacology, National University of Singapore, Singapore.,Memory Aging and Cognition Center, National University Health System, Singapore
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Das S. Cognitive frailty among community-dwelling rural elderly population of West Bengal in India. Asian J Psychiatr 2022; 70:103025. [PMID: 35189474 DOI: 10.1016/j.ajp.2022.103025] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/06/2022] [Accepted: 02/11/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES There has been growing interest in the links between physical frailty and cognitive impairment: both can increase the risk of emerging life-threatening health problems and are currently prominent within the global geriatric health agenda. A recent consensus proposes the idea of 'cognitive frailty' defined by the presence of both physical frailty and cognitive impairment in the absence of dementia. Present study is intended to determine the prevalence of cognitive frailty and its associated factors. METHODS Cross-sectional survey was conducted among the rural community-dwelling elderly population of West Bengal, India (n = 510), without diagnosed dementia at baseline. An Interview-based questionnaire was administered to obtain information on sociodemographic, physical and psychosocial characteristics. Study participants were categorized as non-cognitive impairment (NCI) and cognitive impairment (CI) by Bangla Adaptation of Mini-Mental State Exam (BMSE ≤ 25) scale, as non-physical frailty (NPF) and physical frailty (PF) using Modified Fried Frailty Phenotype (FP ≥ 3) scale, as robust (NPF + NCI), pre-cognitive frailty (NPF + CI or PF + NCI) and cognitive frailty (PF + CI). RESULTS The overall prevalence of cognitive frailty was 21.8%. In multinomial regression analysis, final model indicated that increasing age, being woman, out-of-wedlock, poor education and non-working sociodemographic status had significant association with cognitive frailty. Poor nutritional status, low health-related quality of life and depression are also prone among the cognitively frail participants. CONCLUSIONS Present study allows us to understand complementary relationships between sociodemographic, physical, psychosocial characteristics and cognitive frailty. There is a dire need for multidimensional approach for providing appropriate and comprehensive geriatric health care for developing countries like India.
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Affiliation(s)
- Sayani Das
- Biological Anthropology Unit, Indian Statistical Institute, Kolkata, India.
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7
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D'Agnelli S, Amodeo G, Franchi S, Verduci B, Baciarello M, Panerai AE, Bignami EG, Sacerdote P. Frailty and pain, human studies and animal models. Ageing Res Rev 2022; 73:101515. [PMID: 34813977 DOI: 10.1016/j.arr.2021.101515] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/01/2022]
Abstract
The hypothesis that pain can predispose to frailty development has been recently investigated in several clinical studies suggesting that frailty and pain may share some mechanisms. Both pain and frailty represent important clinical and social problems and both lack a successful treatment. This circumstance is mainly due to the absence of in-depth knowledge of their pathological mechanisms. Evidence of shared pathways between frailty and pain are preliminary. Indeed, many clinical studies are observational and the impact of pain treatment, and relative pain-relief, on frailty onset and progression has never been investigated. Furthermore, preclinical research on this topic has yet to be performed. Specific researches on the pain-frailty relation are needed. In this narrative review, we will attempt to point out the most relevant findings present in both clinical and preclinical literature on the topic, with particular attention to genetics, epigenetics and inflammation, in order to underline the existing gaps and the potential future interventional strategies. The use of pain and frailty animal models discussed in this review might contribute to research in this area.
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Robinson TL, Gogniat MA, Miller LS. Frailty and Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. Neuropsychol Rev 2021; 32:274-293. [PMID: 33886024 DOI: 10.1007/s11065-021-09497-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
The relationship between cognitive function and frailty among older adults is a growing area of research due to the implications of cognitive and physical decline for functional independence in late life. Multiple studies demonstrate a meaningful relationship between these two factors, which together may constitute increased risk of negative health outcomes for older adults. The current analysis was conducted to 1) systematically review current evidence for differences in cognitive performance based on frailty status among older adults and provide quantitative evidence for the magnitude of this effect, and 2) assess the influence of demographic and methodological variables on this effect. The preregistered protocol (CRD42018087138) included a search of EBSCOhost, Pubmed, and Embase online databases and reference lists to identify cross-sectional studies comparing frail and non-frail or robust older adults (60+) on cognitive performance. In total, 42 effects were retrieved from 38 studies, expressed as Hedges' g, and pooled based on a random-effects model. Results indicated an overall significant, negative effect of frailty status on cognitive function among tests of global cognitive function (g = 0.734: 95% CI = 0.601-0.867) and individual cognitive domains (g = 0.439: 95% CI = 0.342-0.535). Age, frailty assessment used, and cognitive status of the sample did not significantly moderate the overall effect. Post-hoc moderator analysis revealed that difference in mean age of frail and robust groups significantly moderated the overall effect (R2 = 0.38, β = .0974, 95% CI = 0.0537-0.141). Implications for future research are discussed.
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Liu X, Wang C, Qiao X, Si H, Jin Y. Sleep quality, depression and frailty among Chinese community-dwelling older adults. Geriatr Nurs 2021; 42:714-720. [PMID: 33836251 DOI: 10.1016/j.gerinurse.2021.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 01/22/2023]
Abstract
We aimed to explore the relationship between sleep quality and frailty, and depression as a mediator and its interaction with sleep quality on frailty. This was a cross-sectional study among 936 Chinese community-dwelling adults aged≥60 years. Sleep quality, frailty and depression were measured by the Pittsburgh Sleep Quality Index (PSQI), the Frailty Phenotype and the 5-item Geriatric Depression Scale (GDS-5), respectively. We found that depression mediated the association between poor sleep quality and physical frailty, attenuating the association between poor sleep and physical frailty by 51.9%. Older adults with both poor sleep quality and depression had higher risk of frailty than those with poor sleep quality or depression alone. These results implicate multidisciplinary care for frail older adults with poor sleep quality.
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Affiliation(s)
- Xinyi Liu
- School of Nursing, Shandong University, 250012 Jinan, China
| | - Cuili Wang
- School of Nursing, Peking University, 100191 Beijing, China.
| | - Xiaoxia Qiao
- School of Nursing, Peking University, 100191 Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, 100191 Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, 100191 Beijing, China
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10
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Masse FAA, Ansai JH, Fiogbe E, Rossi PG, Vilarinho ACG, Takahashi ACDM, Pires de Andrade L. Progression of Gait Changes in Older Adults With Mild Cognitive Impairment: A Systematic Review. J Geriatr Phys Ther 2021; 44:119-124. [PMID: 33534339 DOI: 10.1519/jpt.0000000000000281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The identification of altered gait and its progression over time is important to gaining a better understanding of the clinical aspects of mild cognitive impairment (MCI) in older adults. The aim of the present systematic review was to determine changes in gait variables over time among older adults with MCI. METHODS The PubMed, Web of Science, Scopus, and Science Direct databases were searched for relevant articles using the following keywords and Medical Subject Headings: Aged AND "Mild cognitive impairment" AND (gait OR locomotion). A hand search was also performed of the reference lists of the selected articles in an attempt to find additional records. The following were the inclusion criteria: longitudinal studies and clinical trials involving a control group without intervention; samples of individuals 65 years or older; and characterization of gait using a single or dual task. RESULTS AND DISCUSSION The initial search led to the retrieval of 6979 studies, 9 of which met the inclusion criteria. The duration of follow-up among the studies ranged from 6 months to 2 years. Most trials investigated gait speed. Other gait variables were step length, time required to walk a given distance, and mean weekly gait speed. Altered gait progressed in older adults with MCI. The main alterations were gait speed and variability in daily number of steps in follow-up periods lasting more than 1 year. No significant changes in gait variables were found in shorter follow-up periods (up to 6 months). CONCLUSIONS The progression of gait changes in older adults with MCI has been underinvestigated. MCI leads to reduced gait speed in longer follow-up periods. Such information can contribute to the determination of motor interventions for older adults with MCI, especially in the early stages.
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Affiliation(s)
| | - Juliana Hotta Ansai
- Course of Physical Therapy, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Elie Fiogbe
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Paulo Giusti Rossi
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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Zhang XM, Jiao J, Xie XH, Wu XJ. The Association Between Frailty and Delirium Among Hospitalized Patients: An Updated Meta-Analysis. J Am Med Dir Assoc 2021; 22:527-534. [PMID: 33549566 DOI: 10.1016/j.jamda.2021.01.065] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of our meta-analysis was to update evidence for the association between frailty and delirium in different types of hospitalized patients, given the large volume of new studies with inconsistent results. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS In this updated meta-analysis, we searched 3 databases (Embase, PubMed, and the Cochrane Library) for observational studies, exploring the association between frailty and delirium from database inception to September 21, 2020, among hospitalized patients. Relevant data were extracted from the studies that were included. A random effects model was conducted to synthesize and pool the effect size of frailty on delirium due to different frailty score instruments, different countries, and various delirium assessments that were used. The participants enrolled in this meta-analysis were hospitalized patients. MEASURES Delirium risk due to frailty. RESULTS A total of 30 independent studies from 9 countries, consisting of 217,623 patients, was identified, and the prevalence of frailty ranged from 16.20% to 78.00%. Frail patients exhibited an increased risk for delirium compared to those without frailty [odds ratio (OR) 2.96, 95% confidence interval (CI) 2.36-3.71]. In addition, different types of hospitalized patients had various OR values, which were 2.43 for selective surgical patients (95% CI 1.88-3.14), 3.61 for medical patients (95% CI 3.61-7.89), 3.76 for urgent surgical patients (95% CI 2.88-4.92), and 6.66 for emergency or critical illness patients (95% CI 1.41-31.47). Subgroup analysis based on the frailty score instrument showed the association still existed when using the Clinical Frailty Scale (OR 4.07, 95% CI 2.71-6.11), FRAIL Scale (OR 2.83, 95% CI 1.56-5.13), Frailty Index (OR 6.15, 95% CI 3.75-10.07), frailty phenotype (OR 2.30, 95%CI 1.35-5.66), or Erasmus Frailty Score (OR 2.79, 95% CI 1.63-4.77). However, an association between frailty and delirium was not observed when the Edmonton Frail Scale was used (OR 1.45, 95% CI 0.91-2.30). CONCLUSIONS AND IMPLICATIONS A 2.96-fold incremental risk of delirium in frail patients underscores the need for early screening of frailty and comprehensive delirium prevention. Appropriate interventions by clinicians should be performed to manage delirium, potentially reducing adverse clinical outcomes for hospitalized patients.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Xiao-Hua Xie
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Xin-Juan Wu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China.
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Gilmore N, Mohile S, Lei L, Culakova E, Mohamed M, Magnuson A, Loh KP, Maggiore R, Belcher E, Conlin A, Weiselberg L, Ontko M, Janelsins M. The longitudinal relationship between immune cell profiles and frailty in patients with breast cancer receiving chemotherapy. Breast Cancer Res 2021; 23:19. [PMID: 33546731 PMCID: PMC7863416 DOI: 10.1186/s13058-021-01388-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/05/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Frailty is associated with an increased risk of chemotherapy toxicity. Cellular markers of inflammation can help identify patients with frailty characteristics. However, the role of cellular markers of inflammation in identifying patients at risk of developing chemotherapy-induced frailty and their clinical utility are not fully understood. METHODS This study was a secondary analysis of a large nationwide cohort study of women with stage I-IIIC breast cancer (n = 581, mean age 53.4; range 22-81). Measures were completed pre-chemotherapy (T1), post-chemotherapy (T2), and 6 months post-chemotherapy (T3). Frailty was assessed at all three time points using a modified Fried score consisting of four self-reported measures (weakness, exhaustion, physical activity, and walking speed; 0-4, 1 point for each). Immune cell counts as well as neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR) were obtained at T1 and T2 time points. Separate linear regressions were used to evaluate the associations of (1) cell counts at T1 with frailty at T1, T2, and T3 and (2) change in cell counts (T2-T1) with frailty at T2 and T3. We controlled for relevant covariates and frailty at the T1 time point. RESULTS From T1 to T2, the mean frailty score increased (1.3 vs 2.0; p < 0.01) and returned to T1 levels by the T3 time point (1.3 vs 1.3; p = 0.85). At the T1 time point, there was a positive association between cellular markers of inflammation and frailty: WBC (β = 0.04; p < 0.05), neutrophils (β = 0.04; p < 0.05), and NLR (β = 0.04; p < 0.01). From T1 to T2, a greater increase in cellular markers of inflammation was associated with frailty at T2 (WBC: β = 0.02, p < 0.05; neutrophils: β = 0.03, p < 0.05; NLR: β = 0.03; p < 0.01). These associations remained significant after controlling for the receipt of growth factors with chemotherapy and the time between when laboratory data was provided and the start or end of chemotherapy. CONCLUSIONS In patients with breast cancer undergoing chemotherapy, cellular markers of inflammation are associated with frailty. Immune cell counts may help clinicians identify patients at risk of frailty during chemotherapy. TRIAL REGISTRATION ClinicalTrials.gov , NCT01382082.
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Affiliation(s)
- Nikesha Gilmore
- Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - Supriya Mohile
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Lianlian Lei
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Eva Culakova
- Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Mostafa Mohamed
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ronald Maggiore
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Elizabeth Belcher
- Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Alison Conlin
- Pacific Cancer Research Consortium NCORP, Providence Cancer Institute Franz Clinic, Portland, Oregon, USA
| | - Lora Weiselberg
- Northwell Health NCORP, The Monter Cancer Center, Lake Success, New York, USA
| | - Mary Ontko
- Dayton Clinical Oncology Program, Dayton, Ohio, USA
| | - Michelle Janelsins
- Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
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Rossi PG, Carnavale BF, Farche ACS, Ansai JH, de Andrade LP, Takahashi ACDM. Effects of physical exercise on the cognition of older adults with frailty syndrome: A systematic review and meta-analysis of randomized trials. Arch Gerontol Geriatr 2020; 93:104322. [PMID: 33360014 DOI: 10.1016/j.archger.2020.104322] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To analyze the effects of physical exercise on the cognition of community-dwelling older adults with frailty syndrome, through randomized clinical trials. DATA SOURCES Articles published until March 2020 were searched in the databases Science Direct, Scopus, Web of Science, PubMed, Lilacs, Cochrane, IEEE, EMBASE, and SciELO. Search terms included frailty, aged, exercise, rehabilitation, and cognition. For the Portuguese language, equivalent terms were used. STUDY SELECTION Only randomized clinical trials that used physical exercise as an intervention method in community-dwelling older adults (≥ 60y.) with frailty syndrome, and which performed cognitive assessments before and after the intervention were included. DATA EXTRACTION Two authors performed data extraction using predefined data fields. The risk of bias of the six included studies was assessed using the PEDro scale. DATA SYNTHESIS In total, 4501 studies were found. After the selection process, 6 studies were included in the systematic review and 4 studies in the meta-analysis, all with a low risk of bias. The studies included 655 community-dwelling older adults with frailty syndrome. The types of intervention varied, with multicomponent physical exercise being the most frequent. The cognitive assessments were diverse, and the Mini-mental State Examination, Trail Making Test forms A and B, and Digit Span test were the most frequently applied. A meta-analysis was performed with Global Cognition and Trail Making Test forms A and B. The data from the meta-analysis showed that physical exercise improves Global Cognition (Mean Difference = 2.26; 95% CI, 0.42 - 4.09; P = 0.02) and mental flexibility (Trail Making Test B) (Mean Difference = -30.45; 95% CI; - 47.72 - -13.19; P = 0.0005). CONCLUSION Interventions with physical exercise promote benefits in global cognition and mental flexibility of older adults with frailty syndrome.
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Affiliation(s)
- Paulo Giusti Rossi
- Research Laboratory of Older Adults Health (LaPeSI), Department of Physical Therapy (DFisio), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Bianca Ferdin Carnavale
- Research Laboratory of Older Adults Health (LaPeSI), Department of Physical Therapy (DFisio), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Ana Claudia Silva Farche
- Research Laboratory of Older Adults Health (LaPeSI), Department of Physical Therapy (DFisio), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Juliana Hotta Ansai
- Department of Gerontology (DGero), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil; Movement Science Graduate Program, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.
| | - Larissa Pires de Andrade
- Research Laboratory of Older Adults Health (LaPeSI), Department of Physical Therapy (DFisio), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Anielle Cristhine de Medeiros Takahashi
- Research Laboratory of Older Adults Health (LaPeSI), Department of Physical Therapy (DFisio), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
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Lorenzo-López L, Blanco-Fandiño J, Cibeira N, Buján A, López-López R, Maseda A, Millán-Calenti JC. Clinical and Neuropsychological Correlates of Prefrailty Syndrome. Front Med (Lausanne) 2020; 7:609359. [PMID: 33240913 PMCID: PMC7680970 DOI: 10.3389/fmed.2020.609359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Physical frailty is closely associated with cognitive impairment. We aim to investigate the neuropsychological profiles of prefrail and non-frail dementia-free community-dwelling older adults using a comprehensive neuropsychological evaluation, and to examine the association between specific frailty criteria and clinical and neuropsychological scores. Participants completed a comprehensive standardized neuropsychological evaluation (covering cognitive domains such as memory, executive functions, language and attention), and frailty assessment. Frailty was assessed according to biological criteria: unintentional weight loss, exhaustion, low physical activity, slowness, and weakness. The sample comprised 60 dementia-free community-dwelling adults, aged 65 years or older (range 65-89 years; 60.0% women). Forty-two participants were classified as robust (no frailty criteria present), and 18 as prefrail (1 or 2 frailty criteria present). We explored neurocognitive differences between the groups and examined the association between specific criteria of frailty phenotype and clinical and neuropsychological outcomes with bivariate tests and multivariate models. Prefrail participants showed poorer cognitive performance than non-frail participants in both memory and non-memory cognitive domains. However, delayed episodic memory was the only cognitive subdomain that remained significant after controlling for age, gender, and educational level. Gait speed was significantly associated with general cognitive performance, immediate memory, and processing speed, while grip strength was associated with visual episodic memory and visuoconstructive abilities. Both gait speed and grip strength were negatively associated with depressive scores. Our results suggest that prefrailty is associated with cognitive dysfunction. The fact that specific cognitive domains may be susceptible to subclinical states of physical frailty may have important clinical implications. Indeed, early detection of specific cognitive dysfunctions may allow opportunities for reversibility.
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Affiliation(s)
- Laura Lorenzo-López
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain
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15
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Llano PMPD, Lange C, Sequeira CADC, Jardim VMDR, Castro DSP, Santos F. Factors associated with frailty syndrome in the rural elderly. Rev Bras Enferm 2020; 72:14-21. [PMID: 31826186 DOI: 10.1590/0034-7167-2017-0079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/19/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE determine the prevalence and factors associated with frailty syndrome (FS) in the elderly in the rural population of Pelotas. METHOD Quantitative, analytical, transversal study conducted with 820 elderly subjects registered in the Family Health Strategy (FHS) in the rural area in the municipality of Pelotas, from July to October 2014. RESULTS among those evaluated, 43.41% showed FS. These factors were consolidated as associated with the condition: low income (PR: 1.54, p ≤ 0.001), low educ. level (PR: 1.45, p ≤ 0.001), nutritional status (obesity) (PR:1.89, p ≤ 0.001), physical inactivity (PR:1.93, p = 0.003), cognitive deficit (PR:2.07, p = 0.005), and poor self-perceived health (PR: 8.21, p ≤ 0.001). CONCLUSION the findings may contribute effectively to the establishment of prevention and screening measures for frailty among the elderly by health professionals, especially nurses, aiming to prevent the occurrence of the syndrome and adverse and undesirable outcomes.
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Affiliation(s)
| | - Celmira Lange
- Universidade Federal de Pelotas. Pelotas, Rio Grande do Sul, Brazil
| | | | | | | | - Fernanda Santos
- Universidade Federal de Pelotas. Pelotas, Rio Grande do Sul, Brazil
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16
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Gilmore N, Kadambi S, Lei L, Loh KP, Mohamed M, Magnuson A, Cole S, Esparaz BT, Giguere JK, Mohile S, Janelsins M. Associations of inflammation with frailty in patients with breast cancer aged 50 and over receiving chemotherapy. J Geriatr Oncol 2020; 11:423-430. [PMID: 30992181 PMCID: PMC6790284 DOI: 10.1016/j.jgo.2019.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/15/2019] [Accepted: 04/03/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE Chronic inflammation is a significant physiologic feature of frailty; however, its role and clinical utility in cancer-related frailty remains unknown. We sought to determine if pre-chemotherapy inflammation is predictive of frailty after chemotherapy in patients with breast cancer. METHODS Female patients (N = 144; age ≥ 50) with stage I-III breast cancer scheduled to receive chemotherapy and age-matched non-cancer controls (N = 142) were included in this secondary analysis and assessed pre- and post-chemotherapy. Controls were assessed at equivalent time-points. Frailty was assessed using a modified Fried's score (0-4) using self-reported measures of weakness, exhaustion, walking speed, and physical activity. Serum levels of interleukin (IL) 6, and soluble tumor necrosis factor-alpha (sTNFR) I and II were measured. Associations between pre-chemotherapy cytokine and receptors level (median as cutoff) and post-chemotherapy frailty were evaluated using t-tests. RESULTS Pre-chemotherapy, patients with breast cancer were more frail than non-cancer controls (mean score: 1.17 vs 0.65; p < .01). Patients also became more frail post-chemotherapy (mean score: 1.17 vs 2.08; p < .01). Patients with pre-chemotherapy serum levels of IL-6, sTNFRI, and sTNFRII above the median were more frail after chemotherapy than those with levels below the median [IL-6 (2.31 vs. 1.86; p = .03), sTNFRI (2.30 vs. 1.88; p = .04), and sTNFRII (2.30 vs. 1.88; p = .04)]. No differences were observed in non-cancer controls within the same timeframe. CONCLUSIONS Both cancer and chemotherapy were associated with frailty. Higher pre-chemotherapy inflammatory cytokine levels were associated with post-chemotherapy frailty. This supports the utility of inflammatory cytokines to identify patients who develop worsening of frailty characteristics with chemotherapy.
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Affiliation(s)
- Nikesha Gilmore
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America.
| | - Sindhuja Kadambi
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America
| | - Lianlian Lei
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America
| | - Kah Poh Loh
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America
| | - Mostafa Mohamed
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America
| | - Allison Magnuson
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America
| | - Sharon Cole
- Dayton Clinical Oncology Program, 3123 Research Blvd # 150, Dayton, OH 45420, United States of America; University of Rochester NCI Community Oncology Research Program, 265 Crittenden Blvd, Rochester, NY 14642, United States of America
| | - Benjamin T Esparaz
- Heartland Cancer Research NCORP, 2300 North Edward Street Decatur, IL 62526, United States of America; University of Rochester NCI Community Oncology Research Program, 265 Crittenden Blvd, Rochester, NY 14642, United States of America
| | - Jeffrey K Giguere
- NCORP of the Carolinas (Greenville Health System NCORP), 701 Grove Road, Greenville, SC 29605, United States of America; University of Rochester NCI Community Oncology Research Program, 265 Crittenden Blvd, Rochester, NY 14642, United States of America
| | - Supriya Mohile
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America; University of Rochester NCI Community Oncology Research Program, 265 Crittenden Blvd, Rochester, NY 14642, United States of America
| | - Michelle Janelsins
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America; University of Rochester NCI Community Oncology Research Program, 265 Crittenden Blvd, Rochester, NY 14642, United States of America.
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17
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Dixe MDA, Braúna M, Camacho T, Couto F, Apóstolo J. Mild cognitive impairment in older adults: Analysis of some factors. Dement Neuropsychol 2020; 14:28-34. [PMID: 32206195 PMCID: PMC7077858 DOI: 10.1590/1980-57642020dn14-010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mild cognitive decline is a feared aspect of aging associated with frailty
experienced by individuals.
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Affiliation(s)
- Maria Dos Anjos Dixe
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria (IPLeiria), Leiria, Portugal
| | - Mônica Braúna
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria (IPLeiria), Leiria, Portugal
| | - Timóteo Camacho
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria (IPLeiria), Leiria, Portugal
| | - Filipa Couto
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - João Apóstolo
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
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18
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Miyamura K, Fhon JRS, Bueno ADA, Fuentes-Neira WL, Silveira RCDCP, Rodrigues RAP. Frailty syndrome and cognitive impairment in older adults: systematic review of the literature. Rev Lat Am Enfermagem 2019; 27:e3202. [PMID: 31664410 PMCID: PMC6818658 DOI: 10.1590/1518-8345.3189.3202] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 06/29/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to synthesize the knowledge about the association of frailty syndrome and cognitive impairment in older adults. METHOD the Joanna Briggs Institute's systematic review of etiology and risk factors was adopted. The search for the studies was conducted by two independent reviewers in the databases MEDLINE, Embase, CINAHL and LILACS and by manual search was performed by tow reviewers independently. The measures of association Odds Ratio and Relative Risk were used in the meta-analysis. The software R version 3.4.3 and the meta-analysis package Metafor 2.0 were used for figure analysis. RESULTS three studies identified the association of frailty syndrome and cognitive impairment through Odds Ratio values show that frail older adults are 1.4 times more likely to present cognitive impairment than non-frail older adults. Four studies analyzed the association through the measure of Relative Risk and found no statistical significance, and four studies used mean values. CONCLUSION despite of the methodological differences of the studies and the lack of definition of an exact proportion in the cause and effect relationship, most studies indicate Frailty Syndrome as a trigger for Cognitive decline.
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Affiliation(s)
- Karen Miyamura
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Jack Roberto Silva Fhon
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Alexandre de Assis Bueno
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | | | | | - Rosalina Aparecida Partezani Rodrigues
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil
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19
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Kowalczyk-Habiak I. Frailty as the basis for physiotherapeutic procedures for 65+ patients. REHABILITACJA MEDYCZNA 2019. [DOI: 10.5604/01.3001.0013.3768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The frailty syndrome (FS) is a syndrome of functional limitations related to the older age, and its specificity, as well as the scale of occurrence, justify the need for its description and ordering of knowledge in this area. Aim: The aim of the literature review is to systematize knowledge in the field of individual descriptive elements of FS and rehabilitation dedicated to FS. Material and metods: The publication is a review and systematizes research material in the field of syndrome frailty. The narrative review was based on the analysis of publications contained in the Pubmed database in the period 2012-2017 and Polish sources published in this period. The sources were selected in accordance with the purpose of the work. Results: The frailty syndrome is defined and defined in various ways, although the main reference refers to its first description, formulated by L. Fried et al. There are three main phenotypes of the weakness group, classified based on the criteria of the creators of this team. Different scales are used in diagnostics: CHS, FRAIL, ESF, as well as GFI, TFI and PLFI indicators. The frailty syndrome develops based on the causes and effects of the so-called a cascade of weaknesses, among them chronic inflammatory processes, sarcopenia and immunological changes are of key importance. Recommended physiotherapy regimens cover various cycles and types of physical activity, with the use of a 12-week program of exercises of various types most often emphasized. Conclusions: Frailty is a state of exhaustion of reserves and functional limitations of the older age, also referred to as a team of weakness, frailty and fragility. Most reports confirm the use and usefulness of the CHS scale. Lack of unambiguous physiotherapy regimens for FS. Article received: 04.01.2019; Accepted: 16.07.2019 Key words: frailty, weakness syndrome, exhaustion syndrome, the elderly, rehabilitation
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Araújo Júnior FB, Machado ITJ, Santos-Orlandi AAD, Pergola-Marconato AM, Pavarini SCI, Zazzetta MS. Frailty, profile and cognition of elderly residents in a highly socially vulnerability area. CIENCIA & SAUDE COLETIVA 2019; 24:3047-3056. [PMID: 31389551 DOI: 10.1590/1413-81232018248.26412017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/28/2017] [Indexed: 11/22/2022] Open
Abstract
This study aimed to associate frailty with sociodemographic profile and cognition of elderly people living in highly socially vulnerable contexts registered at a Social Assistance Referral Centers in a city of inland São Paulo. This is a cross-sectional and quantitative study with 48 elderly. Data was collected with a sociodemographic interview, the Edmonton Frail Scale and the Montreal Cognitive Assessment, and was analyzed with the Jonckheere-Terpstra test, Spearman's correlation and logistic regression (α = 5.0%). This study was approved under Opinion Nº 72182. Of the 48 elderly interviewed, 33.4% were non-frail, 20.8% were apparently vulnerable and 45.8% were frail at some level (mild, moderate or severe). Women (OR = 4.64) and nonwhites (OR = 3.99) were more likely of being frail. The realms with the greatest influence in the determination of frailty were cognition, independence and functional performance, general health and mood, although gender (p = 0.0373) and ethnicity (p = 0.0284) had a significant association. Worth highlighting is that considering the frailty profile of the elderly warrants the development of specific care strategies for this segment of the population in a vulnerable area, preventing futures complications.
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Affiliation(s)
- Fábio Baptista Araújo Júnior
- Departamento de Gerontologia, Universidade Federal de São Carlos (UFSCar). Rod. Washington Luís km 235, Cidade Universitária. São Carlos SP Brasil.
| | | | | | | | | | - Marisa Silvana Zazzetta
- Departamento de Gerontologia, Universidade Federal de São Carlos (UFSCar). Rod. Washington Luís km 235, Cidade Universitária. São Carlos SP Brasil.
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Giusti Rossi P, Pires de Andrade L, Hotta Ansai J, Silva Farche AC, Carnaz L, Dalpubel D, Ferriolli E, Assis Carvalho Vale F, de Medeiros Takahashi AC. Dual-Task Performance: Influence of Frailty, Level of Physical Activity, and Cognition. J Geriatr Phys Ther 2019. [DOI: 10.1519/jpt.0000000000000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Martins NIM, Caldas PR, Cabral ED, Lins CCDSA, Coriolano MDGWDS. Instrumentos de avaliação cognitiva utilizados nos últimos cinco anos em idosos brasileiros. CIENCIA & SAUDE COLETIVA 2019; 24:2513-2530. [DOI: 10.1590/1413-81232018247.20862017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/04/2017] [Indexed: 11/22/2022] Open
Abstract
Resumo A detecção e o monitoramento do déficit cognitivo em idosos são necessários já que podem causar impacto em sua funcionalidade. O objetivo dessa revisão integrativa é analisar a produção científica sobre uso de instrumentos de avaliação cognitiva em idosos brasileiros por meio de artigos publicados nos últimos cinco anos, indexados nas bases de dados Web of Science, PubMed, Scopus e Bireme. Os critérios de inclusão foram: artigos originais publicados em inglês e português, de 2012 a 2016, com critério de idade definido para ser considerado idoso, e escore maior que 6 no CASP adaptado. O critério de exclusão foi: ser resumo de congresso. A amostra final foi composta por 100 artigos. Foram apresentados os 61 instrumentos de avaliação cognitiva utilizados nos estudos, com destaque para o Mini Exame do Estado Mental. Essa revisão apresenta o uso de instrumentos cognitivos na pesquisa brasileira, suas diferentes versões e quais domínios são avaliados. O número de instrumentos presentes na literatura foi amplo. Os mais utilizados foram o MEEM (versão de Brucki e colaboradores), o Teste de Fluência Verbal (categoria animais) e o Teste Span de dígitos (ordem direta e inversa). Os achados apresentados nessa revisão são relevantes não apenas para área da pesquisa observacional e experimental, mas também para a prática clínica.
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Furtado GE, Letieri R, Hogervorst E, Teixeira AB, Ferreira JP. Physical Frailty and cognitive performance in older populations, part I: systematic review with meta-analysis. CIENCIA & SAUDE COLETIVA 2019; 24:203-218. [PMID: 30698254 DOI: 10.1590/1413-81232018241.03692017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 06/04/2017] [Indexed: 01/10/2023] Open
Abstract
The purpose of present study was to analyze the magnitude of the effect-size in the assessment of the cognitive status of populations over 60 years of age. The search strategy included PubMed, B-on, Ebsco, Ebsco Health, Scielo, Eric, Lilacs and Sportdiscus data bases. Only observational, cohort and cross-sectional studies were included in the meta-analysis. The central descriptors were elderly-frail, older adults, cognition and geriatric assessment and other additional terms. After applying the additional search criteria, 12 manuscripts were selected from an initial universe of 1,078 identified. When comparing the mean cognitive profile scores of the participants of the pre-frail (n =11,265) and frail (n = 2,460) groups, significant statistical differences were found (p<0,001), with lower mean scores emerging in frail-group. The results showed that cognitive decline is strongly associated with frailty, being a probable main clinical outcome. In this sense, any strategy aimed at mitigating or reversing the incidence of frailty with ageing should take into account that physical and cognitive frailty seem to have similar temporal trajectories.
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Affiliation(s)
- Guilherme Eustáquio Furtado
- Centro de Investigação em Desporto e Atividade Física, Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra. Av. Conímbriga/Estádio Universitário de Coimbra Pavilhão III, Santa Clara. 3040248 Coimbra Portugal.
| | - Rubens Letieri
- Núcleo de pesquisa multidisciplinar em EducaçãoFísica, Universidade Federal de Tocantins. Tocantinópolis TO Brasil
| | - Eef Hogervorst
- Grupo de Pesquisa Cognição Aplicada, Escola de Ciências do Esporte e do Ecercício, Universidade de Loughborough. Loughborough Reino Unido
| | - Ana Botelho Teixeira
- Centro de Investigação em Desporto e Atividade Física, Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra. Av. Conímbriga/Estádio Universitário de Coimbra Pavilhão III, Santa Clara. 3040248 Coimbra Portugal.
| | - José Pedro Ferreira
- Centro de Investigação em Desporto e Atividade Física, Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra. Av. Conímbriga/Estádio Universitário de Coimbra Pavilhão III, Santa Clara. 3040248 Coimbra Portugal.
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Abstract
BACKGROUND AND PURPOSE Gait speed is an important measure of functional ability and has been widely used in older adults as an indicator of frailty. However, the diversity in measurement protocols in clinical settings creates variability in outcome measures. The aim of this study was to systematically review the literature relating to the measurement of gait speed in older adults, to propose a protocol suitable for use in clinical and community settings. METHODS A total of 5 electronic English databases were searched (PubMed, EMBASE, AMED, CINAHL, and SPORTDiscus) using key words and synonyms related to gait speed. RESULTS Fifty relevant articles were identified, with variability being found between studies in the essential elements (timing device, walking distance, timing points, use of walking aids, pace of performance, and total tests recorded) of gait measurement. The majority of studies used unspecified timing devices while others used electronic gait mats or infrared beams linked to electronic stopwatches. Walking distance was assessed over distances between 2.4 and 15 m, with 4 m most commonly used. Most studies permitted the use of walking aids, with assessments being repeated at a usual pace, and the maximum value recorded in meters per second. CONCLUSION A standardized measurement protocol is proposed for measuring gait speed in older adults.
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Affiliation(s)
- Hanife Mehmet
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
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Duarte YADO, Nunes DP, Andrade FBD, Corona LP, Brito TRPD, Santos JLFD, Lebrão ML. Frailty in older adults in the city of São Paulo: Prevalence and associated factors. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 21Suppl 02:e180021. [PMID: 30726366 DOI: 10.1590/1980-549720180021.supl.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/10/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Frailty is a preventable and reversible syndrome characterized by a cumulative decline of physiological systems, causing greater vulnerability to adverse conditions. OBJECTIVE To describe the prevalence of frailty among older adults and analyze its associated factors and progression. METHOD This is a longitudinal study that used the Health, Well-being, and Aging Study (Saúde, Bem-Estar e Envelhecimento - SABE) database of 2006 and 2010. Five components identified the frailty syndrome: weight loss; fatigue; decreased strength, low physical activity, and reduced walking speed. Older adults were classified as "pre-frail" (1-2 components) and "frail" (3 or more). We used a hierarchical multiple multinomial regression to analyze associated factors. RESULTS Out of the total number of older adults (n = 1,399), 8.5% were frail, and the associated factors were age, functional impairment, cognitive decline, hospitalization, and multimorbidity. In four years, 3.3% of non-frail and 14.7% of pre-frail older adults became frail. CONCLUSION Identifying the prevalence of frailty and its associated factors can help to implement adequate interventions early to improve the quality of life of older adults.
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Affiliation(s)
| | | | | | | | | | | | - Maria Lúcia Lebrão
- Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
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26
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Del Brutto OH, Mera RM, Zambrano M, Sedler MJ. Influence of Frailty on Cognitive Decline: A Population-Based Cohort Study in Rural Ecuador. J Am Med Dir Assoc 2018; 20:213-216. [PMID: 30455048 DOI: 10.1016/j.jamda.2018.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the influence of frailty on cognitive decline. DESIGN Population-based prospective cohort study. SETTINGS/PARTICIPANTS Community-dwelling older adults living in a rural Ecuadorian village, fulfilling the following criteria: age ≥60 years at baseline Montreal Cognitive Assessment (MoCA) and frailty assessment, a baseline brain magnetic resonance imaging, and a follow-up MoCA performed at least 12 months after the baseline. MEASURES Frailty was evaluated by the Edmonton Frailty Scale (EFS) and cognitive performance by MoCA. The relationship between baseline EFS and MoCA decline was assessed by longitudinal linear and fractional polynomial models, adjusted for relevant confounders. The score of the cognitive component of the EFS was subtracted, and an alternative fractional polynomial model was fitted to settle the impact of such cognitive question on the model. RESULTS A total of 252 individuals, contributing 923.7 person-years of follow-up (mean: 3.7 ± 0.7 years) were included. The mean EFS score was 4.7 ± 2.5 points. The mean baseline MoCA score was 19.5 ± 4.5 points, and that of the follow-up MoCA was 18.1 ± 4.9 points (P = .001). Overall, 154 (61%) individuals had lower MoCA scores in the follow-up. The best fitted longitudinal linear model showed association between baseline EFS score and MoCA decline (P = .027). There was a continuous increase in MoCA decline in persons with an EFS ≥7 points (nonlinear relationship). Fractional polynomials explained the effect of the EFS on MoCA decline. For the complete EFS score, the β coefficient was 2.43 (95% confidence interval 1.22-3.63). For the effect of the EFS (without its cognitive component) on MoCA decline, the relationship was still significant (β 4.86; 95% confidence interval 2.6-7.13). CONCLUSIONS/IMPLICATIONS Over a 3.7-year period, 61% of older adults living in Atahualpa experienced cognitive decline. Such decline was significantly associated with frailty status at baseline. Region-specific risk factors influencing this relationship should be further studied to reduce its burden in rural settings.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador.
| | | | | | - Mark J Sedler
- School of Medicine, Stony Brook University, New York, NY
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Konda PR, Sharma PK, Gandhi AR, Ganguly E. Correlates of Cognitive Impairment among Indian Urban Elders. JOURNAL OF GERONTOLOGY & GERIATRIC RESEARCH 2018; 7:489. [PMID: 31406631 PMCID: PMC6690611 DOI: 10.4172/2167-7182.1000489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cognitive impairment among elderly is increasing owing to increases in life expectancy globally. The problem is multifactorial. The objective of the present paper was to study the correlates of cognitive impairment in an urban elderly population in India. METHODS A cross sectional study was conducted among 100 randomly selected urban elderly population. Data was collected upon household visits using a predesigned pretested questionnaire administered by a trained investigator. Measurements included cognitive function assessment using Mini Mental State Examination, depression assessment using Geriatric Depression Scale, blood pressure measurement and anthropometry. Cognitive impairment was defined at MMSE score <24. Logistic regression was done to identify independently associated factors with cognitive impairment. RESULTS Prevalence of cognitive impairment among elderly was 10%. Women had a higher prevalence than men. Higher age, no schooling, living single, lower weight, lower waist and hip ratios, difficulty in activities of daily living, poor self-reported health, bedridden and depression significantly associated with cognitive impairment. The independently associated factors upon logistic regression were increasing age, no schooling and bedridden status for past six months. CONCLUSION Although the current prevalence of cognitive impairment among Indian urban elderly is low, several associated factors exist in this population that may increase the burden in future. Geriatric health policy should address the modifiable risk factors to manage the problem of cognitive impairment and its consequent outcomes.
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Affiliation(s)
| | - Pawan Kumar Sharma
- Department of Community Medicine, Mediciti Institute of Medical Sciences, Ghanpur, Hyderabad, India
- Department of Epidemiology, University of Pittsburgh, and Share India, Fogarty International NIH, USA
| | - Atul R Gandhi
- Consultant Statistician & Chief Manager-Monitoring and Evaluation, EdelGive Foundation, Edelweiss House, Mumbai, India
| | - Enakshi Ganguly
- Department of Community Medicine, Mediciti Institute of Medical Sciences, Ghanpur, Hyderabad, India
- Department of Epidemiology, University of Pittsburgh, and Share India, Fogarty International NIH, USA
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28
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Liu Z, Hsu FC, Trombetti A, King AC, Liu CK, Manini TM, Fielding RA, Pahor M, Newman AB, Kritchevsky S, Gill TM. Effect of 24-month physical activity on cognitive frailty and the role of inflammation: the LIFE randomized clinical trial. BMC Med 2018; 16:185. [PMID: 30352583 PMCID: PMC6199791 DOI: 10.1186/s12916-018-1174-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/12/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Whether physical activity can reduce cognitive frailty-a relatively new "compound" phenotype proposed in 2013-and whether the effect of physical activity differs based on levels of inflammation are unknown. Therefore, this study aimed to evaluate the effect of physical activity on cognitive frailty and whether baseline interleukin-6 (IL-6) levels modified this effect. METHODS We used data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter, single-blinded randomized trial conducted at eight US field centers between February 2010 and December 2013. The main outcome was cognitive frailty at 24 months, expressed as an ordinal variable based on the six combinations of its two components: frailty (non-frail, pre-frail, and frail) and mild cognitive impairment (yes, no). Frailty and cognition were assessed by the Study of Osteoporotic Fractures (SOF) index and the Modified Mini-Mental State Examination (3MSE) scale, respectively. Plasma IL-6 was measured at baseline. Of the 1635 original randomized sedentary participants (70-89 years), this study included 1298 participants with data on both cognitive frailty and IL-6 assessments at baseline. RESULTS After adjusting for field center, sex, and baseline levels of cognitive frailty, the ordinal logistic regression model revealed that participants in the physical activity group had 21% lower odds (odds ratio, 0.79; 95% confidence interval, 0.64-0.98) of worsening cognitive frailty over 24 months than those in the health education group. The effect of physical activity on cognitive frailty did not differ according to baseline IL-6 levels (P for interaction = 0.919). The results did not change after additional adjustment for IL-6 subgroups and the inverse probability of remaining in the study. Comparable results were observed according to age, sex, ethnicity/race, and short physical performance battery score (P for interaction = 0.835, 0.536, 0.934, and 0.458, respectively). CONCLUSIONS A 24-month structured, moderate-intensity physical activity program reduced cognitive frailty compared with a health education program in sedentary older persons, and this beneficial effect did not differ according to baseline levels of inflammatory biomarker IL-6. These findings suggest that the new cognitive frailty construct is modifiable and highlight the potential of targeting cognitive frailty for promoting healthy aging. TRIAL REGISTRATION Clinicaltrials.gov, NCT01072500.
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Affiliation(s)
- Zuyun Liu
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston Salem, NC, USA
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Abby C King
- Department of Health Research and Policy and the Stanford Prevention Research Center, Department of Medicine, Stanford University, School of Medicine, Stanford, CA, USA
| | - Christine K Liu
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.,Section of Geriatrics, Boston University School of Medicine, Boston, MA, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
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Furtado GE, Caldo A, Rieping T, Filaire E, Hogervorst E, Teixeira AMB, Ferreira JP. Physical frailty and cognitive status over-60 age populations: A systematic review with meta-analysis. Arch Gerontol Geriatr 2018; 78:240-248. [PMID: 30029093 DOI: 10.1016/j.archger.2018.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 01/10/2023]
Abstract
The aim of this meta-analysis was to analyse the magnitude of the effect-size of the cognitive status of populations over 60 years of age, when comparing nonfrail versus pre-frail and nonfrail versus frail subgroups. A systematic review of prospective studies published from 2000 to 2017 was completed in Medline, B-on, Ebsco, Ebsco Health, Scielo, ERIC, LILACS and Sport discus databases and observational, cohort and cross-sectional studies were selected. The Mini-Mental State Examination to screening cognitive status and the Fried phenotype for assess physical frailty state was used as clinical outcomes. After applying additional search criteria, 14 manuscripts (26,798 old participants) were selected from an initial universe of 1681 identified. When comparing the scores of cognitive status of the participants who were non-frail (n = 12,729, 47.4%) versus pre-frail (n = 11,559, 43.2%) and non-frail versus frail (n = 2452, 9.4%) subgroups, significant statistical differences were found for both comparisons (M ± SD = 0.60, 95%CI: 0.50-0.62, p < 0.001 and M ± SD = 3.43, 95%CI: 2.26-4.60, p < 0.001, respectively). It is clear that poor cognitive function is strongly closed associated with pre-frailty and frailty subgroups in older populations around the world.
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Affiliation(s)
- Guilherme Eustáquio Furtado
- Research Unit of Physical Activity and Sport at Faculty of Sport Sciences and Physical Education (CIDAF, UID/PDT/04213/2016) - University of Coimbra, Portugal; Medical Psychology Unit, School of Medicine, Clinical Neuroscience and Mental Health, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Adriana Caldo
- Research Unit of Physical Activity and Sport at Faculty of Sport Sciences and Physical Education (CIDAF, UID/PDT/04213/2016) - University of Coimbra, Portugal; Medical Psychology Unit, School of Medicine, Clinical Neuroscience and Mental Health, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Taís Rieping
- Laboratory of Sport and Exercise Psychology of Faculty of Sport Sciences and Physical Education of University of Coimbra, Portugal; Medical Psychology Unit, School of Medicine, Clinical Neuroscience and Mental Health, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Edith Filaire
- CIAMS, University Paris-Sud, Université, Paris-Saclay, 91405, Orsay Cedex, France; CIAMS, Université d'Orléans, 45067, Orléans, France; Research Team ECRIN, INRA, UMR 1019, Clermont-Ferrand, France; Medical Psychology Unit, School of Medicine, Clinical Neuroscience and Mental Health, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Eef Hogervorst
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom; Medical Psychology Unit, School of Medicine, Clinical Neuroscience and Mental Health, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Ana Maria Botelho Teixeira
- Research Unit of Physical Activity and Sport at Faculty of Sport Sciences and Physical Education (CIDAF, UID/PDT/04213/2016) - University of Coimbra, Portugal; Medical Psychology Unit, School of Medicine, Clinical Neuroscience and Mental Health, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - José Pedro Ferreira
- Research Unit of Physical Activity and Sport at Faculty of Sport Sciences and Physical Education (CIDAF, UID/PDT/04213/2016) - University of Coimbra, Portugal; Medical Psychology Unit, School of Medicine, Clinical Neuroscience and Mental Health, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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Liu Z, Han L, Gahbauer EA, Allore HG, Gill TM. Joint Trajectories of Cognition and Frailty and Associated Burden of Patient-Reported Outcomes. J Am Med Dir Assoc 2018; 19:304-309.e2. [PMID: 29146224 PMCID: PMC6054444 DOI: 10.1016/j.jamda.2017.10.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate joint trajectories of cognition and frailty and their association with the cumulative burden of patient-reported outcomes, including hospitalization, nursing home admission, and disability. DESIGN Longitudinal study of 754 community-living persons aged 70 or older. PARTICIPANTS 690 participants who had a baseline and at least one follow-up assessment of cognition and frailty between 1998 and 2009. MEASUREMENTS Cognition was assessed using the Mini-Mental State Examination (MMSE). Frailty was defined by the 5 criteria for the Fried phenotype: muscle weakness, exhaustion, low physical activity, shrinking, and slow walking speed. A group-based, mixture modeling approach was used to fit the joint trajectories of cognition and frailty. The cumulative burden of hospitalization, nursing home admission, and disability over 141 months associated with the joint trajectories was evaluated using a series of generalized estimating equation Poisson models. RESULTS Four joint trajectories were identified, including No cognitive frailty (27.8%), Slow cognitive decline and progressive frailty (45.5%), Rapid cognitive decline and progressive frailty (20.2%), and Cognitive frailty (6.5%). For each joint trajectory group, the interval-specific incidence density rates of all patient-reported outcomes tended to increase over time, with the exception of hospitalization for which the increasing trend was apparent only for the Slow cognitive decline and progressive frailty group. The No cognitive frailty group had the lowest cumulative burden of all patient-reported outcomes [eg, nursing home admissions, 7.5/1000 person-months, 95% confidence interval (CI): 4.8-11.7], whereas the Cognitive frailty group had the highest cumulative burden (eg, nursing home admissions, 381.1/1000 person-months, 95% CI: 294.5-493.1), with the exception of hospitalization. Compared with the No cognitive frailty group, the 3 other joint trajectory groups all had significantly greater burden of the patient-reported outcomes. CONCLUSION Community-living older persons exhibit distinct joint trajectories of cognition and frailty and experience an increasing burden of nursing home admission and disability as they age, with the greatest burden for those on a cognitive frailty trajectory.
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Affiliation(s)
- Zuyun Liu
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | | | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
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Bello GA, Lucchini RG, Teitelbaum SL, Shapiro M, Crane MA, Todd AC. Development of a Physiological Frailty Index for the World Trade Center General Responder Cohort. Curr Gerontol Geriatr Res 2018; 2018:3725926. [PMID: 29681931 PMCID: PMC5846374 DOI: 10.1155/2018/3725926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/24/2018] [Indexed: 12/21/2022] Open
Abstract
Responders to the 9/11/2001 WTC attacks were exposed to multiple toxic pollutants. Since 2002, the health of the responder cohort has been continuously tracked by the WTC Health Monitoring Program. However, no assessments have been made of frailty, an important health metric given the current average age of the WTC responder cohort (55 years). In this study, we use laboratory test results and other physiological parameters to construct a physiological frailty index (FI-Lab) for this cohort. The study sample comprised responders aged 40 years or older who completed a health monitoring visit at Mount Sinai Center within the past 5 years. For each subject, FI-Lab was computed as the proportion of 20 physiological parameters (lab tests, pulmonary function, and blood pressure) on which the subject had abnormal values. Using negative binomial regression models, we tested FI-Lab's association with the SF-12 wellbeing score and various demographic characteristics. FI-Lab showed strong associations with the physical and mental components of the SF-12 as well as age, race, and smoking status. Using a cutoff of 0.25 to define presence of physiological/preclinical frailty, we found frailty prevalence in the study sample to be approximately 12%. This study demonstrates the feasibility of assessing preclinical frailty in the WTC responder cohort.
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Affiliation(s)
- Ghalib A. Bello
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan L. Teitelbaum
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Moshe Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael A. Crane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Chiou JH, Liu LK, Lee WJ, Peng LN, Chen LK. What factors mediate the inter-relationship between frailty and pain in cognitively and functionally sound older adults? A prospective longitudinal ageing cohort study in Taiwan. BMJ Open 2018; 8:e018716. [PMID: 29453297 PMCID: PMC5829604 DOI: 10.1136/bmjopen-2017-018716] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The main aim was to investigate the complex inter-relationship between frailty and pain, and the mediating roles of cognitive function, morbidity and mood in this nexus. DESIGN A cross-sectional analysis. SETTING A prospective community-dwelling population-based cohort. PARTICIPANTS 1682 adults age ≥50 years without evident cognitive or functional impairment, or history of cancer. PRIMARY AND SECONDARY OUTCOME MEASURES The mediating effect of depression, cognitive function and comorbidity on the nexus between pain and frailty among older and middle-aged adults. RESULTS The pain score among older subjects (≥65 years), increased with the degree of frailty (robust=0.96±0.82; pre-frail=1.13±0.86; frail=1.63±1.02; P<0.001); multivariate analysis gave the same result, while moderate pain was associated with frailty in older subjects (OR=3.00, 95% CI 1.30 to 6.60). Conversely, pain and frailty among middle-aged subjects (aged 50-64 years) did not appear to be significantly related; in mediation analysis, pain exerted an indirect effect on frailty via depression (indirect effect=0.03, 95% CI 0.01 to 0.07), while neither cognitive function nor comorbidity had any significant effect in mediating the relationship between pain and frailty. CONCLUSION In cognitively and functionally sound community-dwelling adults aged ≥50 years, moderate pain was related to frailty in those older than 65 years, but not younger ones. Besides the direct influence of pain on frailty, depression partially mediated the pain-frailty nexus. The mechanism by which depression influences pain and frailty requires further investigation.
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Affiliation(s)
- Jing-Hui Chiou
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Kuo Liu
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ju Lee
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Taipei, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
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Chen S, Honda T, Narazaki K, Chen T, Kishimoto H, Haeuchi Y, Kumagai S. Physical Frailty Is Associated with Longitudinal Decline in Global Cognitive Function in Non-Demented Older Adults: A Prospective Study. J Nutr Health Aging 2018; 22:82-88. [PMID: 29300426 DOI: 10.1007/s12603-017-0924-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the relationship between physical frailty and subsequent decline in global cognitive function in the non-demented elderly. DESIGN AND SETTING A prospective population-based study in a west Japanese suburban town, with two-year follow-up. PARTICIPANTS Community-dwellers aged 65 and older without placement in long-term care, and not having a history of dementia, Parkinson's disease and depression at baseline, who participated in the cohort of the Sasaguri Genkimon Study and underwent follow-up assessments two years later (N = 1,045). MEASUREMENTS Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Physical frailty was identified according to the following five components: weight loss, low grip strength, exhaustion, slow gait speed and low physical activities. Linear regression models were used to examine associations between baseline frailty status and the MoCA scores at follow-up. Logistic regression models were used to estimate the risk of cognitive decline (defined as at least two points decrease of MoCA score) according to baseline frailty status. RESULTS Seven hundred and eight non-demented older adults were included in the final analyses (mean age: 72.6 ± 5.5 years, male 40.3%); 5.8% were frail, and 40.8% were prefrail at baseline. One hundred and fifty nine (22.5%) participants experienced cognitive decline over two years. After adjustment for baseline MoCA scores and all confounders, being frail at baseline was significantly associated with a decline of 1.48 points (95% confidence interval [CI], -2.37 to -0.59) in MoCA scores, as compared with non-frailty. Frail persons were over two times more likely to experience cognitive decline (adjusted odds ratio 2.28; 95% CI, 1.02 to 5.08), compared to non-frail persons. CONCLUSION Physical frailty is associated with longitudinal decline in global cognitive function in the non-demented older adults over a period of two years. Physically frail older community-dwellers should be closely monitored for cognitive decline that can be sensitively captured by using the MoCA.
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Affiliation(s)
- S Chen
- Dr. Shuzo Kumagai, Department of Behavior and Health Sciences, Graduate School of Human-Environment Studies, Kyushu University, 6-1 Kasuga Koen, Kasuga City, Fukuoka Prefecture, 816-8580, Japan, Telephone number: +81 92-583-7853, Fax number: +81 92-583-7853, E-mail:
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Ma L, Zhang L, Zhang Y, Li Y, Tang Z, Chan P. Cognitive Frailty in China: Results from China Comprehensive Geriatric Assessment Study. Front Med (Lausanne) 2017; 4:174. [PMID: 29104866 PMCID: PMC5655005 DOI: 10.3389/fmed.2017.00174] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/02/2017] [Indexed: 12/31/2022] Open
Abstract
Objective Cognitive frailty (CF) refers to the co-occurrence of physical frailty (PF) and cognitive impairment in persons without dementia. We aimed to explore the prevalence and associated factors of CF in China. Method Data were obtained from the China Comprehensive Geriatric Assessment Study. A total of 5,708 community-dwelling older adults without dementia were included. CF was assessed using the Mini-Mental State Examination for the evaluation of cognitive status and the Comprehensive Geriatric Assessment-Frailty Index for the evaluation of PF. Participants with both cognitive impairment and PF were classified as having CF. Sociodemographic and clinical history was also collected. Logistic analysis was used to explore the association between the associated factors and CF. Results The overall crude prevalence of CF was 3.3% [95% confidence interval (CI) = 3.0-4.0], and the standard prevalence of CF was 2.7% (95% CI = 2.0-3.0). The prevalence of CF was significantly higher in women than men and higher in residents of rural areas than urban areas. Moreover, the prevalence of CF was found to increase with age. Multiple factor analysis showed that depression (OR = 2.462, 95% CI = 1.066-5.687) and hearing impairment (OR = 2.713, 95% CI = 1.114-6.608) were independent associated factors of CF in elderly individuals with PF. Conclusion Our results provide the first empirical evidence of CF in China. We have identified several associated factors with CF which should be considered while assessing older adults. More studies in Chinese population with CF are demanded to confirm with our findings.
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Affiliation(s)
- Lina Ma
- Department of Geriatrics, Beijing Geriatric Healthcare Center, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing Institute for Brain Disorders, China National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Li Zhang
- Department of Geriatrics, Beijing Geriatric Healthcare Center, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing Institute for Brain Disorders, China National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Yaxin Zhang
- Department of Geriatrics, Beijing Geriatric Healthcare Center, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing Institute for Brain Disorders, China National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Yun Li
- Department of Geriatrics, Beijing Geriatric Healthcare Center, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing Institute for Brain Disorders, China National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Zhe Tang
- Department of Geriatrics, Beijing Geriatric Healthcare Center, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing Institute for Brain Disorders, China National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Piu Chan
- Department of Geriatrics, Beijing Geriatric Healthcare Center, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing Institute for Brain Disorders, China National Clinical Research Center for Geriatric Disorders, Beijing, China.,Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China
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Llano PMPD, Lange C, Nunes DP, Pastore CA, Pinto AH, Casagranda LP. Fragilidade em idosos da zona rural: proposta de algoritmo de cuidados. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Resumo Objetivo: Apresentar algoritmo de cuidados para Síndrome de Fragilidade no Idoso. Métodos: Estudo de abordagem quantitativa, descritiva, com delineamento de corte transversal, com 820 pessoas com idade igual ou superior a 60 anos, residentes na zona rural do Município de Pelotas/Rio Grande do Sul, Brasil. A coleta de dados ocorreu no período de julho a outubro de 2014, com uso de um formulário semiestruturado. Para avaliar a fragilidade utilizou-se o instrumento autorreferido obtido por meio de informações relatadas pelo idoso ou por seu respondente substituto/auxiliar. Utilizou-se Regressão de Poisson Múltipla para a análise dos fatores associados. Mediante a identificação dos fatores associados, elaborou-se o Algoritmo de cuidados para a Síndrome de Fragilidade. Resultados: Constatou-se que 43,4% dos idosos apresentaram fragilidade. Os fatores associados à síndrome da fragilidade foram baixa escolaridade (RP: 1,45; p<0,001); obesidade (RP: 1,89; p=0,001), não realização de atividade física (RP: 1,93; p<0,001); apresentar déficit cognitivo (RP: 2,07; p=0,002); autopercepção de saúde ruim (RP: 8,21; p<0,001), queda nos últimos 12 meses (RP: 1,70; p<0,001) e presença de doença morbidade (RP: 2,22; p<0,014). Esses fatores direcionaram a elaboração do algoritmo de cuidados, que foi estruturado em cuidados para idosos não frágeis e pré-frágeis/frágeis. Conclusão: Percebe-se a importância dos profissionais de saúde, em destaque os enfermeiros, na identificação do perfil e estilo de vida dos idosos, a fim de intervir nos problemas associados à fragilidade, tendo o algoritmo de cuidados à fragilidade como um guia para a tomada de decisão, visando postergar e prevenir a progressão da síndrome.
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Santos-Orlandi AAD, Brito TRPD, Ottaviani AC, Rossetti ES, Zazzetta MS, Pavarini SCI. Elderly who take care of elderly: a study on the Frailty Syndrome. Rev Bras Enferm 2017; 70:822-829. [DOI: 10.1590/0034-7167-2016-0474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/02/2017] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: Identifying prevalence of frailty in elderly caregivers inserted in a high social vulnerability context and its correlation with sociodemographic and health aspects. Method: Descriptive, correlational and cross-sectional study. Forty elderly caregivers were evaluated with: questionnaire for caregiver characterization, Mini Mental State Examination, Katz Index, Lawton instrumental activities of daily living scale, Geriatric Depression Scale and the frailty phenotype proposed by Fried. Interviews were conducted at their residences and scheduled in advance. All ethical precautions were observed. Data were analyzed with the Stata statistical program version 11.0. Results: 10% of elderly caregivers were frail. There was a significant correlation between frailty and sex, instrumental activities of daily living and cognition. Conclusion: Female caregivers, partially dependent individuals regarding instrumental activities of daily living and with worse cognitive state deserve a special attention from health services.
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37
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Fougère B, Delrieu J, Del Campo N, Soriano G, Sourdet S, Vellas B. Cognitive Frailty: Mechanisms, Tools to Measure, Prevention and Controversy. Clin Geriatr Med 2017; 33:339-355. [PMID: 28689567 DOI: 10.1016/j.cger.2017.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Physical frailty is often associated with cognitive impairment, possibly because of common underlying pathophysiologic mechanisms. To stimulate research in this field, the concept cognitive frailty was proposed, emphasizing the important role of brain aging. Cognitive frailty was defined as the presence of cognitive deficits in physically frail older persons without dementia. This subtype of frailty is deemed important, as it may represent a prodromal phase for neurodegenerative diseases and is potentially a suitable target for early intervention. The aim of this report is to refine the framework for the definition and mechanisms of cognitive frailty and relevant screening tools.
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Affiliation(s)
- Bertrand Fougère
- Ge´rontopoˆ le, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Universite´ de Toulouse III Paul Sabatier, Toulouse, France
| | - Julien Delrieu
- Ge´rontopoˆ le, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Natalia Del Campo
- Ge´rontopoˆ le, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre of Exellence in Neurodegeneration, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Gaëlle Soriano
- Ge´rontopoˆ le, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sandrine Sourdet
- Ge´rontopoˆ le, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Universite´ de Toulouse III Paul Sabatier, Toulouse, France
| | - Bruno Vellas
- Ge´rontopoˆ le, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Universite´ de Toulouse III Paul Sabatier, Toulouse, France
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Cezar NO, Izbicki R, Cardoso D, Almeida JG, Valiengo L, Camargo MV, Forlenza OV, Yassuda MS, Aprahamian I. Frailty in older adults with amnestic mild cognitive impairment as a result of Alzheimer's disease: A comparison of two models of frailty characterization. Geriatr Gerontol Int 2017; 17:2096-2102. [DOI: 10.1111/ggi.13028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/12/2017] [Accepted: 01/25/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Natália O.C. Cezar
- Institute and Department of Psychiatry, Faculty of Medicine; University of São Paulo; São Paulo Brazil
| | - Rafael Izbicki
- Department of Statistics; Federal University of São Carlos (UFSCar); São Paulo Brazil
| | - Diego Cardoso
- Department of Statistics; Federal University of São Carlos (UFSCar); São Paulo Brazil
| | - Jouce G. Almeida
- Laboratory of Neuroscience LIM-27, Institute and Department of Psychiatry, Faculty of Medicine; University of São Paulo; São Paulo Brazil
| | - Leandro Valiengo
- Laboratory of Neuroscience LIM-27, Institute and Department of Psychiatry, Faculty of Medicine; University of São Paulo; São Paulo Brazil
| | - Marina V.Z. Camargo
- Laboratory of Neuroscience LIM-27, Institute and Department of Psychiatry, Faculty of Medicine; University of São Paulo; São Paulo Brazil
| | - Orestes V. Forlenza
- Laboratory of Neuroscience LIM-27, Institute and Department of Psychiatry, Faculty of Medicine; University of São Paulo; São Paulo Brazil
| | - Monica S. Yassuda
- Department of Neurology, Faculty of Medicine; University of São Paulo; São Paulo Brazil
- School of Arts, Sciences and Humanities; University of São Paulo; São Paulo Brazil
| | - Ivan Aprahamian
- Institute and Department of Psychiatry, Faculty of Medicine; University of São Paulo; São Paulo Brazil
- Department of Internal Medicine; Faculty of Medicine of Jundiaí; São Paulo Brazil
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Sargent L, Brown R. Assessing the Current State of Cognitive Frailty: Measurement Properties. J Nutr Health Aging 2017; 21:152-160. [PMID: 28112769 DOI: 10.1007/s12603-016-0735-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Currently, an estimated 25-30% of people ages 85 or older have dementia, with a projected 115 million people worldwide living with dementia by 2050. With this worldwide phenomenon fast approaching, early detection of at-risk older adults and development of interventions focused on preventing loss in quality of life are increasingly important. A new construct defined by the International Consensus Group (I.A.N.A/I.A.G.G) as «cognitive frailty» combines domains of physical frailty with cognitive impairment and provides a framework for research that may provide a means to identify individuals with cognitive impairment caused by nonneurodegenerative conditions. Using the integrative review method of Whittemore and Knafl., 2005 this study examines and appraises the optimal measures for detecting cognitive frailty in clinical populations of older adults. METHODS The integrative review was conducted using PubMed, CINAHL, Web of Science, PsycInfo, and ProQuest Dissertations and Theses. From the total 185 articles retrieved, review of titles and key words were conducted. Following the initial review, 168 articles did not meet the inclusion criteria for association of frailty and cognition. Of the 18 fulltext articles reviewed, 11 articles met the inclusion criteria; these articles were reviewed in-depth to determine validity and reliability of the cognitive frailty measures. RESULTS Predictive validity was established by the studies reviewed in four main areas: frailty and type of dementia MCI (OR 7.4, 95% CI 4.2-13.2), vascular dementia (OR 6.7, 95% CI 1.6-27.4) and Alzheimer's dementia (OR 3.2, 95% CI 1.7-6.2), frailty and vascular dementia (VaAD) is further supported by the rate of change in frailty x macroinfarcts (r = 0.032, p < 0.001); frailty and the individual domains of cognitive function established with the relationship of neurocognitive speed and change in cognition using regression coefficients; individual components of frailty and individual domains of cognitive function associations inculded slow gait and executive function (β -0.20, p < 0.008 ), attention (β -0.25 p < 0.008), processing speed (β -0.16, p < 0.008), word recall (β - 0.18, p = 0.02), and logical memory (β = 0.04, p =0.04). Weak grip was predictive for changes in executive function (β - 0.16, p =0.008). Physical activity was associated with changes in executive function (β = -0.18, p= 0.02) and word recall (β = 0.17, p= 0.02), individual components of frailty and global cognitive function were found in several studies which included grip strength (r = - 0.51, p < 0.001), gait speed (r = - 0.067, p < 0.001), and exhaustion (β - 0.18, p < 0.008). CONCLUSIONS This paper presents the first-known review of the measurement properties for the cognitive frailty construct since the published results from the International Consensus Group (I.A.N.A/I.A.G.G). Evidence presented in this review continues to support the link between physical frailty and cognition with developing validity to support distinct relationships between components of physical frailty and cognitive decline. Results call attention to inconsistencies in reporting of reliability, validity, and heterogeneity in the measurements and operational definition for cognitive frailty. Further research is needed to establish an operational definition and develop psychometrically appropriate clinical measures to construct an understanding of the relationship between physical frailty and cognitive decline.
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Affiliation(s)
- L Sargent
- L. Sargent, Candidate at Medical University of South Carolina, Faculty of Virginia Commonwealth University, School of Nursing, Richmond, VA, USA,
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40
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Panza F, Seripa D, Solfrizzi V, Tortelli R, Greco A, Pilotto A, Logroscino G. Targeting Cognitive Frailty: Clinical and Neurobiological Roadmap for a Single Complex Phenotype. J Alzheimers Dis 2016; 47:793-813. [PMID: 26401761 DOI: 10.3233/jad-150358] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Late-life cognitive disorders may be prevented by influencing age-related conditions such as frailty, characterized by decreased resistance to stressors and increased risk for adverse health outcomes. In the present review article, we examined clinical and epidemiological studies investigating the possible role of different frailty models in modulating the risk of Alzheimer's disease (AD), dementia, vascular dementia (VaD), mild cognitive impairment (MCI), and late-life cognitive impairment/decline that have been published over the past 3 years. Both deficit accumulation and physical frailty models were associated with late-life cognitive impairment/decline, incident dementia, AD, MCI, VaD, non-AD dementias, and AD pathology, proposing cognitive frailty as a new clinical construct with coexisting physical frailty and cognitive impairment in nondemented older subjects. Two subtypes of this new clinical condition have been recently proposed: "potentially reversible" cognitive frailty and "reversible" cognitive frailty. The physical factors should be physical prefrailty and frailty, while the cognitive impairment of potentially reversible cognitive frailty should be MCI (Clinical Dementia rating Scale = 0.5), while the cognitive impairment of reversible cognitive frailty should be pre-MCI Subjective Cognitive Decline (SCD), as recently proposed by the SCD Initiative Working Group. The mechanisms underlying the cognitive-frailty link are multifactorial and vascular, inflammatory, nutritional, and metabolic influences may be of major relevance. Considering both physical frailty and cognition as a single complex phenotype may be crucial in the prevention of dementia and its subtypes with secondary preventive trials on cognitive frail older subjects.
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Affiliation(s)
- Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.,Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Davide Seripa
- Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro, Bari, Italy
| | - Rosanna Tortelli
- Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Antonio Greco
- Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Alberto Pilotto
- Geriatrics Unit, Department of OrthoGeriatrics, Rehabilitation and Stabilization, Frailty Area, Galliera Hospital NR-HS, Genova, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
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41
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Sex Differences in Fear of Falling among Older Adults with Low Grip Strength. IRANIAN JOURNAL OF PUBLIC HEALTH 2016; 45:569-77. [PMID: 27398329 PMCID: PMC4935700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fear of falling is not only a risk factor for falls, but it is also an important clinical predictor of functional decline in older adults. This study identified sex differences in fear of falling and related factors in older adults with low grip strength. METHODS The data of 902 older adults from the 2012 Korean National Survey, conducted as a research project by the Korea Employment Information Service, were analyzed. Grip strength, activities of daily living, cognitive function, depressive symptoms, and fear of falling were assessed. Multiple regression analysis was performed by a simultaneous data entry method. RESULTS Fear of falling was greater in older women with low grip strength than in their male equivalents (P<0.001). Regression analysis showed that age, fall experience within the previous 2 yr, activities of daily living, and depressive symptoms collectively accounted for 15.3% (P<0.001) of the variance among men. Meanwhile, age, fall experience within the previous 2 yr, grip strength, activities of daily living, and depressive symptoms collectively accounted for 13.4% (P<0.001) of the variance among women. CONCLUSION Thus, the predictors of fear of falling differ between older men and women with low grip strength. Therefore, sex differences must be considered when developing intervention strategies for reducing fear of falling in this demographic.
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Gross AL, Xue QL, Bandeen-Roche K, Fried LP, Varadhan R, McAdams-DeMarco MA, Walston J, Carlson MC. Declines and Impairment in Executive Function Predict Onset of Physical Frailty. J Gerontol A Biol Sci Med Sci 2016; 71:1624-1630. [PMID: 27084314 DOI: 10.1093/gerona/glw067] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 03/20/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Clinical cognitive impairment and physical frailty often co-occur. However, it is unclear whether preclinical impairment or decline in cognitive domains are associated with onset of physical frailty. We tested this hypothesis and further hypothesized that preclinical impairment and decline in executive functioning are more strongly associated with frailty onset than memory or general cognitive performance. METHODS We used 9 years of data from the Women's Health and Aging Study II (six visits) that longitudinally measured psychomotor speed and executive functioning using the Trail Making Test, parts A and B, respectively, and immediate and delayed word-list recall from the Hopkins Verbal Learning Test. We used Cox proportional hazards models to regress time to frailty on indicators for impairment on these cognitive tests and on rates of change of the tests. Models adjusted for depressive symptoms, age, years of education, and race. RESULTS Of the 331 women initially free of dementia and frailty, 44 (13%) developed frailty. A binary indicator of impaired executive functioning (Trail Making Test, part B [TMT-B]) was most strongly associated with hazard, or risk, of frailty onset (hazard ratio [HR] = 3.3, 95% confidence interval [CI] = 1.4, 7.6) after adjustment for covariates and other tests. Adjusting for baseline cognitive performance, faster deterioration on TMT-B (HR = 0.6, 95% CI = 0.4, 1.0) was additionally associated with hazard of frailty onset. CONCLUSIONS Findings inform the association of executive functioning with transitions to frailty, suggesting both impairments in and declines in executive functioning are associated with risk of frailty onset. It remains to be determined whether these associations are causal or whether shared aging related or other mechanisms are involved.
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Affiliation(s)
- Alden L Gross
- Department of Epidemiology, .,Department of Mental Health
| | - Qian-Li Xue
- Department of Epidemiology.,Division of Geriatric Medicine and Gerontology, Department of Medicine, and.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Karen Bandeen-Roche
- Division of Geriatric Medicine and Gerontology, Department of Medicine, and.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Linda P Fried
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Care Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Department of Medicine, and
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Faria GSE, Ribeiro TMDS, Vieira RA, Silva SLAD, Dias RC. Transição entre níveis de fragilidade em idosos no município de Belo Horizonte, Minas Gerais. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2016. [DOI: 10.1590/1809-98232016019.140232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo: Observar possíveis transições entre níveis de fragilidade, segundo o fenótipo de fragilidade em idosos de Belo Horizonte-MG, em um período de 24 meses. Método: Trata-se de um estudo exploratório longitudinal. Dos 601 indivíduos que compuseram a linha de base da Rede FIBRA de Belo Horizonte, selecionou-se 40 indivíduos de ambos os sexos, com mais de 65 anos, classificados como frágeis, residentes na comunidade, que possuíssem marcha independente ou com auxílio de dispositivos e que não fossem portadores de doenças que inviabilizassem a realização dos testes. Após 24 meses, os participantes foram reavaliados com o mesmo inquérito padronizado usado na linha de base do estudo. Resultados: A amostra inicial foi composta por 40 indivíduos, com média de idade de 78,03 (±6,46) anos. Após 24 meses, localizaram-se 22 indivíduos da amostra inicial. Foi realizada comparação da pontuação obtida para a classificação do fenótipo de fragilidade entre as duas amostras, considerando os mesmos 22 indivíduos. Esta comparação mostrou que 16 indivíduos apresentaram um menor número de itens positivos para o fenótipo de fragilidade na avaliação após 24 meses, três apresentaram pontuação positiva maior e três não apresentaram alteração na pontuação entre as avaliações (p=0,004). Conclusão: O presente estudo observou que a grande maioria dos indivíduos apresentou melhora na classificação do fenótipo de fragilidade.
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Abstract
BACKGROUND As the population ages, the prevalence and clinical importance of frailty are increasing. There have been few published studies about frailty in developing world. This study aims to review the evidence from developing countries on the prevalence of frailty, definition of frailty and factors associated with frailty. METHOD A literature search was conducted via MEDLINE and EMBASE. Keywords included "frail", "frailty", "prevalence", "criteria", "definition", "risk factors", "outcomes", "developing country", "developing world", and names of low and middle income countries according to the classification of the World Bank. RESULT A total of 14 articles were reviewed from Brazil (n=6), China (n=3), Mexico (n=2), and one each from Russia, India, and Peru. There were 9 articles from community-based studies and 5 articles from hospital-based studies. Fried's phenotype for frailty was used to define frailty in the majority of studies. The prevalence of frailty in community-dwelling older people was 17%-31% in Brazil, 15% in Mexico, 5%-31% in China, and 21%-44% in Russia. The prevalence of frailty was 49% in institutionalized older patients in Brazil and 32% in hospitalized older patients in India. The prevalence of frailty in outpatient clinics was 55%-71% in Brazil and 28% in Peru. Frailty was associated with increased mortality and comorbidities, decreased physical and cognitive function, and poor perceptions of health. CONCLUSION The limited studies available suggest that frailty occurs frequently in older people in the developing world and it appears to be associated with adverse outcomes. This has implications for policy and health care provision for these ageing populations.
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Affiliation(s)
- T N Nguyen
- Tu Nguyen, MD, PhD Candidate, Room 121A Edward Ford Building, School of Public Health, The University of Sydney NSW 2006 Australia, Phone. (+61) 02 93516898
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Panza F, Solfrizzi V, Barulli MR, Santamato A, Seripa D, Pilotto A, Logroscino G. Cognitive Frailty: A Systematic Review of Epidemiological and Neurobiological Evidence of an Age-Related Clinical Condition. Rejuvenation Res 2015; 18:389-412. [PMID: 25808052 DOI: 10.1089/rej.2014.1637] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Advancing age is the focus of recent studies on familial and sporadic Alzheimer's disease (AD), suggesting a prolonged pre-clinical phase several decades before the onset of dementia symptoms. Influencing some age-related conditions, such as frailty, may have an impact on the prevention of late-life cognitive disorders. Frailty reflects a nonspecific state of vulnerability and a multi-system physiological change with increased risk for adverse health outcomes in older age. In this systematic review, frailty indexes based on a deficit accumulation model were associated with late life cognitive impairment and decline, incident dementia, and AD. Physical frailty constructs were associated with late-life cognitive impairment and decline, incident AD and mild cognitive impairment, vascular dementia, non-AD dementias, and AD pathology in older persons with and without dementia, thus also proposing cognitive frailty as a new clinical condition with co-existing physical frailty and cognitive impairment in non-demented older subjects. Considering both physical frailty and cognitive impairment as a single complex phenotype may be central in the prevention of dementia and its subtypes with secondary preventive trials on cognitive frail older subjects. The mechanisms underlying the cognitive-frailty link are multi-factorial, and vascular, inflammatory, nutritional, and metabolic influences may be of major relevance. There is a critical need for randomized controlled trials of intervention investigating the role of nutrition and/or physical exercise on cognitive frail subjects with the progression to dementia as primary outcome. These preventive trials and larger longitudinal population-based studies targeting cognitive outcomes could be useful in further understanding the cognitive-frailty interplay in older age.
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Affiliation(s)
- Francesco Panza
- 1 Geriatric Unit & Laboratory of Gerontology and Geriatrics , Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Solfrizzi
- 2 Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro , Bari, Italy
| | - Maria Rosaria Barulli
- 3 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy .,4 Department of Clinical Research in Neurology, University of Bari Aldo Moro , "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Andrea Santamato
- 5 Department of Physical Medicine and Rehabilitation,"OORR Hospital", University of Foggia , Italy
| | - Davide Seripa
- 1 Geriatric Unit & Laboratory of Gerontology and Geriatrics , Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Alberto Pilotto
- 1 Geriatric Unit & Laboratory of Gerontology and Geriatrics , Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy .,6 Geriatric Unit, Azienda ULSS 16 Padova, Hospital S. Antonio , Padova, Italy
| | - Giancarlo Logroscino
- 3 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy .,4 Department of Clinical Research in Neurology, University of Bari Aldo Moro , "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
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Brigola AG, Rossetti ES, Dos Santos BR, Neri AL, Zazzetta MS, Inouye K, Pavarini SCI. Relationship between cognition and frailty in elderly: A systematic review. Dement Neuropsychol 2015; 9:110-119. [PMID: 29213952 PMCID: PMC5619349 DOI: 10.1590/1980-57642015dn92000005] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to analyze the relationship between cognition and
frailty in the elderly. Methods A systematic review on the currently existing literature concerning the
subject was carried out. The search strategy included LILACS, SCOPUS,
SciELO, PsycINFO, PubMed and Web of Science databases. Results A total of 19 studies were selected for review, from which 10 (52.6%) were
cross-sectional and 9 (47.4%) longitudinal, and the majority Brazilian. All
of the studies established a link between cognition and frailty. There was a
relationship between components of frailty and the cognitive domains. Risk
of Mild Cognitive Impairment (MCI), dementia and mortality were all
evidenced in the relationship between frailty and cognitive impairment. Conclusion The theory remains limited, but results show the variables that appear to be
linked to cognition and frailty in elderly. This data can help in
implementing actions to improve the quality of life among elderly.
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Affiliation(s)
- Allan Gustavo Brigola
- Bacharel, Mestrando do Programa de Pós Graduação em Enfermagem da Universidade Federal de São Carlos
| | - Estefani Serafim Rossetti
- Bacharel, Mestrando do Programa de Pós Graduação em Enfermagem da Universidade Federal de São Carlos
| | | | - Anita Liberalesso Neri
- Professor Doutor, Docente do Programa de Pós Graduação em Gerontologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas
| | - Marisa Silvana Zazzetta
- Professor Doutor, Docente do Departamento de Gerontologia da Universidade Federal de São Carlos
| | - Keika Inouye
- Professor Doutor, Docente do Departamento de Gerontologia da Universidade Federal de São Carlos
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Sathasivam J, Kamaruzzaman SB, Hairi F, Ng CW, Chinna K. Frail Elders in an Urban District Setting in Malaysia: Multidimensional Frailty and Its Correlates. Asia Pac J Public Health 2015; 27:52S-61S. [PMID: 25902935 DOI: 10.1177/1010539515583332] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the past decade, the population in Malaysia has been rapidly ageing. This poses new challenges and issues that threaten the ability of the elderly to independently age in place. A multistage cross-sectional study on 789 community-dwelling elderly individuals aged 60 years and above was conducted in an urban district in Malaysia to assess the geriatric syndrome of frailty. Using a multidimensional frailty index, we detected 67.7% prefrail and 5.7% frail elders. Cognitive status was a significant correlate for frailty status among the respondents as well as those who perceived their health status as very poor or quite poor; but self-rated health was no longer significant when controlled for sociodemographic variables. Lower-body weakness and history of falls were associated with increasing frailty levels, and this association persisted in the multivariate model. This study offers support that physical disability, falls, and cognition are important determinants for frailty. This initial work on frailty among urban elders in Malaysia provides important correlations and identifies potential risk factors that can form the basis of information for targeted preventive measures for this vulnerable group in their prefrail state.
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Affiliation(s)
- Jeyanthini Sathasivam
- University of Malaya, Kuala Lumpur, Malaysia Jalan Abdul Samad, Johor Bahru, Johor, Malaysia
| | | | | | - Chiu Wan Ng
- University of Malaya, Kuala Lumpur, Malaysia
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Bourgeois J, Elseviers MM, Van Bortel L, Petrovic M, Vander Stichele RH. The impact of chronic benzodiazepine use on cognitive evolution in nursing home residents. Hum Psychopharmacol 2015; 30:85-93. [PMID: 25639725 DOI: 10.1002/hup.2456] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 11/12/2014] [Accepted: 11/26/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Chronic use of benzodiazepines and Z-drugs (BZD/Zs) has been linked to cognitive decline. In this one-year prospective cohort study, we explored the impact of chronic BZD/Z use on cognitive decline compared to nonusers. METHODS In cognitively capable BZD/Z users and nonusers in 10 Belgian nursing homes, we investigated cognition with the MiniMentalStateExamination(MMSE) at baseline and one year. A decrease of ≥ 4 points on the MMSE (clinically relevant decrease) was used in multiple logistic regression. We collected baseline demographics, functional, psychometric and social characteristics potentially influencing cognition. RESULTS In both the 131 BZD/Z users and 95 nonusers, the cognition decreased significantly over time, but without significant difference between the groups. Clinically relevant decrease was present in 34% BZD/Z users and 27% nonusers (NS). Controlled for age, gender, education and BZD/Z use, the significant risk factors for clinically relevant cognitive decline were depression, hearing and functional impairment. Frequent reading was associated with less MMSE decrease. Our findings could not demonstrate with statistical significance that BZD/Z use was associated with fast cognitive decline. The risk factors for fast decline were depression, hearing and functional impairment, and the absence of a reading attitude. In addition, BZD/Z use and depression were associated, indicating a complex relationship.
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Affiliation(s)
- Jolyce Bourgeois
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
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Abstract
PURPOSE OF REVIEW To provide a comprehensive review of the recent literature (published over the last 12 months) exploring the relationship between frailty and cognition. RECENT FINDINGS Fourteen studies were retained for the present review. No randomized controlled trial was found. Overall, the main findings of the selected studies appeared to be mainly confirmatory of the previous evidence. In longitudinal studies, physical frailty was found to predict the incidence of cognitive impairment and dementia. Cross-sectional studies showed that frail individuals have lower cognitive performance compared with nonfrail persons. Interestingly, few studies examined the association between frailty and specific cognitive functions and domains, reporting a significant impairment of attention and executive functions. Finally, we found several studies including cognitive measures in the operational definitions of frailty. SUMMARY The present findings are suggestive of an almost complete lack of evidence on the addressed topic. In particular, randomized controlled trials are strongly needed in order to gain insights about the possibility of positively affecting the frailty syndrome by acting of cognition and improving cognitive impairment by targeting the physical components of frailty. Moreover, these studies may produce the first evidences about the novel concept of 'cognitive frailty' and its potential for reversibility.
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Affiliation(s)
- Marco Canevelli
- aDepartment of Neurology and Psychiatry, Memory Clinic, 'Sapienza' University, Rome, Italy bGérontopôle, Centre Hospitalier Universitaire de Toulouse cInserm UMR1027 dUniversité de Toulouse III Paul Sabatier, Toulouse, France
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One-Year Evolution of Sleep Quality in Older Users of Benzodiazepines: A Longitudinal Cohort Study in Belgian Nursing Home Residents. Drugs Aging 2014; 31:677-82. [DOI: 10.1007/s40266-014-0203-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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