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Nguyen TV, Tran HM, Trinh HBT, Vu VH, Bang VA. Prevalence of frailty according to the Hospital Frailty Risk Score and related factors in older patients with acute coronary syndromes in Vietnam. Australas J Ageing 2024; 43:288-296. [PMID: 38576179 DOI: 10.1111/ajag.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES (1) To investigate the prevalence of frailty defined by the Hospital Frailty Risk Score (HFRS), a new scale for assessing frailty, in older patients with acute coronary syndrome (ACS); (2) To identify associations between frailty and the prescriptions of cardiovascular medications, percutaneous coronary intervention (PCI) and in-hospital adverse outcomes. METHODS An observational study was conducted in patients aged older than 60 years with ACS at Thong Nhat Hospital from August to December 2022. The Hospital Frailty Risk Score is retrospectively calculated for all participants based on ICD-10 codes, and those with HFRS scores ≥5 were defined as frail. Logistic regression models were applied to examine the relationship between frailty and the study outcomes. RESULTS There were 511 participants in the study. The median age was 72.7, 60% were male and 29% were frail. Frailty was associated with lower odds of beta-blocker use at admission (OR .49 95% CI .25-.94), treatment with PCI during hospitalisation (OR .48, 95% CI .30-.75), but did not show an association with prescriptions of cardiovascular drugs at discharge. Frailty was significantly associated with increased odds of adverse outcomes, including major bleeding (OR 4.07, 95% CI1.73-9.54), hospital-acquired pneumonia (OR 2.55, 95% CI 1.20-5.42), all-cause in-hospital mortality (OR 3.14, 95% CI 1.37-7.20) and non-cardiovascular in-hospital mortality (OR 10.73, 95% CI 1.93-59.55). CONCLUSIONS The HFRS was an effective tool for stratifying frailty and predicting adverse health outcomes in older patients with ACS. Further research is needed to compare the HFRS with other frailty assessment tools in this population.
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Affiliation(s)
- Tan Van Nguyen
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Huy Minh Tran
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ha Bich Thi Trinh
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vu Hoang Vu
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vien Ai Bang
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Chen Y, Ku E, Tsai P, Lin C, Ko N, Huang S, Wang J, Yang Y. The relationship between oral frailty and oral dysbiosis among hospitalized patients aged older than 50 years. Clin Exp Dent Res 2024; 10:e890. [PMID: 38816943 PMCID: PMC11139674 DOI: 10.1002/cre2.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/24/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE This study aimed to clarify the relationship between oral frailty and oral dysbiosis among hospitalized patients aged ≥ 50 years. METHODS A prospective observational study was conducted. Number of teeth, masticatory ability, articulatory oral motor skill, tongue pressure, swallowing pressure, and choking were used to assess oral frailty. Saliva samples were collected from the oral cavity for bacterial culture. RESULTS A total 103 in patients enrolled and 53.4% suffered from oral frailty. Oral frailty was found to have a 3.07-fold correlation with the presence of Enterobacterales in the oral cavity (p = 0.037), especially in poor articulatory oral motor skill, which showed at greater risk of Enterobacterales isolated from the oral cavity by 5.58-fold (p = 0.01). CONCLUSION Half of hospitalized patients was found to have oral frailty that was related to more Enterobacterales in the oral cavity. This evidence suggests that the enhancement of articulatory oral motor skills may serve as a potential strategy for mitigating the presence of Enterobacterales within the oral cavity.
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Affiliation(s)
- Yen‐Chin Chen
- College of MedicineNational Sun Yat‐sen UniversityKaohsiungTaiwan
- Department of Nursing, College of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - En‐Ni Ku
- Department of NursingLinkou Chang Gung Memorial HospitalTaipeiTaiwan
| | - Pei‐Fang Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Che‐Wei Lin
- Department of Biomedical Engineering, College of EngineeringNational Cheng Kung UniversityTainanTaiwan
| | - Nai‐Ying Ko
- Department of Nursing, College of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Shun‐Te Huang
- Division of Pediatric Dentistry and Special Care DentistryKaohsiung Medical University HospitalKaohsiungTaiwan
| | - Jiun‐Ling Wang
- Department of Medicine, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Internal Medicine, National Cheng Kung University HospitalCollege of Medicine, National Cheng Kung UniversityTainanTaiwan
| | - Yi‐Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Family Medicine, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Geriatric and Gerontology, National Cheng Kung University HospitalCollege of Medicine, National Cheng Kung UniversityTainanTaiwan
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Qiu R, Gu Y. Network analysis of frailty indicators in hospitalized elderly patients: unveiling the role of depression and hemoglobin as core factors. Aging Clin Exp Res 2023; 35:3189-3203. [PMID: 38036899 DOI: 10.1007/s40520-023-02608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Frailty is a significant concern among hospitalized older adults, influenced by multiple factors. Understanding the complex interactions between these variables can be facilitated through a network perspective. AIM This study aimed to identify the core factor and physiological indicator of frailty in hospitalized elderly patients and visualize their interactions within the network structure. METHODS Frailty was assessed using the Tilburg Frailty Indicators, with a score of 5 or higher indicating frailty. Additional variables related to sociodemographic, physical and clinical, psychological and cognitive aspects, as well as physiological indicators, were extracted from electronic health records. A partial correlation network analysis was conducted using an adaptive LASSO algorithm, based on univariate correlation and logistic regression, to examine the network structure and identify influential nodes. RESULTS The average age of participants was 70.74 ± 7.52 years, with 24.27% classified as frail. Frailty was associated with 38 of 145 initially included variables (P < 0.05). The network analysis revealed depression as the most central node, followed by drugs used, sleep disorders, loneliness, masticatory obstacles, drinking, and number of teeth missing. Hemoglobin emerged as the most central biochemical indicator in the network, based on network center index analysis (Strength = 4.858, Betweenness = 223, Closeness = 0.034). CONCLUSIONS Frailty in hospitalized older adults is influenced by various social, physical, and psychological factors, with depression as the core factor of utmost importance. Changes in hemoglobin levels could serve as an essential indicator. This innovative network approach provides insights into the multidimensional structure and relationships in real-world settings.
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Affiliation(s)
- Ruxia Qiu
- Department of Nursing, Shanghai Fifth People's Hospital, Fudan University, No.801, Heqing Road, Minhang District, Shanghai, China
- Center for Community Health Research of Fudan University, No.801, Heqing Road, Minhang District, Shanghai, China
- School of Nursing, Fudan University, No.305, Fenglin Road, Xuhui District, Shanghai, China
| | - Yanhong Gu
- Department of Nursing, Shanghai Fifth People's Hospital, Fudan University, No.801, Heqing Road, Minhang District, Shanghai, China.
- Center for Community Health Research of Fudan University, No.801, Heqing Road, Minhang District, Shanghai, China.
- School of Nursing, Fudan University, No.305, Fenglin Road, Xuhui District, Shanghai, China.
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Pham HM, Nguyen AP, Nguyen HTT, Nguyen TN, Nguyen TX, Nguyen TTH, Nguyen HTT, Nguyen AT, Nguyen QN, Tran GS, Vu HTT. The Frail Scale - A Risk Stratification in Older Patients with Acute Coronary Syndrome. J Multidiscip Healthc 2023; 16:1521-1529. [PMID: 37274424 PMCID: PMC10239255 DOI: 10.2147/jmdh.s409535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose The aim of this study was to explore the impact of frailty on in-hospital adverse outcomes and net adverse clinical events (NACE) in older patients with acute coronary syndrome. Patients and Methods This observational study included elderly patients (≥60 years old), diagnosed with acute coronary syndrome (ACS) at admission from February 2021 to August 2021. The primary outcome was net adverse clinical events (NACE) defined as a composite of all-cause mortality, stroke, and major bleeding. Secondary outcome was in-hospital adverse outcomes including arrhythmia, acquired pneumonia, stroke, major bleeding, and all-cause mortality. Frailty was assessed using the Frail scale (FS). Data about socio-demographics, comorbidities, body mass index, ACS type, coronary angiography, left ventricular ejection fraction, and length of hospital stay were also collected. Univariate and multivariate logistic regressions were employed to identify the potential association between frailty and outcomes. Results Of the 116 ACS patients, 38 patients were frail (32.76%). Frail subjects were more often female (50%) and older (p < 0.01) and had higher rates of in-hospital adverse outcomes (OR = 2.37, p = 0.05) and NACE (OR = 7.12; p < 0.01). In univariate analysis, the increased frail score was significantly associated with increased odds of NACE (unadjusted OR = 1.98, 95% CI 1.17-3.35 for each score increase in Frail Score). In multivariable logistic regression, models controlling for age, gender, PCI, LVEF, and coronary angiography (adjusted OR 2.19, 95% CI 1.12-4.29 for each score increase in Frail Score). Conclusion This study revealed the reference data of frailty assessment in older patients with ACS in Vietnam. Our result indicated that over 30% of ACS older patients presented with frailty which was associated with an increased risk of in-hospital adverse outcomes and NACE. This study also provided promising information about the simple FRAIL scale's potential role in the risk stratification of older patients with ACS.
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Affiliation(s)
- Hung Manh Pham
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Anh Phuong Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Huong Thi Thanh Nguyen
- Physiology Department, Hanoi Medical University, Hanoi, 100000, Vietnam
- Dinh Tien Hoang Institute of Medicine, Hanoi, 100000, Vietnam
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Quang Ngoc Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Giang Song Tran
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
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Morita AA, Munhoz RF, Guzzi GL, Probst VS. Comparison of Two Frailty Assessment Methods and Their Association with Functionality in Subjects with Exacerbation of COPD. Curr Gerontol Geriatr Res 2023; 2023:6660984. [PMID: 37215461 PMCID: PMC10195168 DOI: 10.1155/2023/6660984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/24/2023] Open
Abstract
Objectives To verify the prevalence of frailty in patients hospitalized with acute exacerbation of COPD; to compare two frailty assessment methods: Edmonton Scale and the Fried Frailty Phenotype, and to associate frailty with functioning in these patients. Methods Patients hospitalized due to an acute exacerbation of COPD were included. The assessment of pulmonary function, frailty, and functioning was performed. Frailty assessment was performed by the Edmonton Scale and Fried Frailty Phenotype. Individuals were classified into "frail," "pre-frail" and "non-frail." Functioning was evaluated by the one sit-to-stand test. Results Thirty-five individuals were included (17 male, 69 ± 9 years; FEV1/FVC 47 ± 10%; FEV1 34 (24-52) % predicted). Participants scored 3 (3-4) points on the Edmonton Scale and 7 (5-9) points on the Fried Frailty Phenotype. According to the Fried model, 17% were considered prefrail and 83% frail and in the Edmonton scale, 20% were classified as nonfrail, 29% prefrail, and 51% frail. There was a positive moderate correlation between the two methods (r = 0.42; p=0.011); however, there was no agreement between them (p=0.20). This probably occurs because they assess the same construct, i.e., frailty; however, they are different in their components. There was a negative and moderate correlation between the Fried Frailty Phenotype and functioning (r = -0.43; p=0.009). Conclusion Most hospitalized individuals with exacerbated COPD with severe and very severe airflow limitation are frail and the assessment methods correlate, but there is no agreement. Additionally, there is association between frailty and functioning in this population.
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Affiliation(s)
- Andrea Akemi Morita
- Stricto Sensu Graduate Program in Rehabilitation Science of State University of Londrina and Pitágoras Unopar University, Londrina, Paraná, Brazil
| | | | - Giovana Labegalini Guzzi
- Stricto Sensu Graduate Program in Rehabilitation Science of State University of Londrina and Pitágoras Unopar University, Londrina, Paraná, Brazil
| | - Vanessa Suziane Probst
- Stricto Sensu Graduate Program in Rehabilitation Science of State University of Londrina and Pitágoras Unopar University, Londrina, Paraná, Brazil
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Vitolo M, Ziveri V, Gozzi G, Busi C, Imberti JF, Bonini N, Muto F, Mei DA, Menozzi M, Mantovani M, Cherubini B, Malavasi VL, Boriani G. DIGItal Health Literacy after COVID-19 Outbreak among Frail and Non-Frail Cardiology Patients: The DIGI-COVID Study. J Pers Med 2022; 13:jpm13010099. [PMID: 36675760 PMCID: PMC9863916 DOI: 10.3390/jpm13010099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Telemedicine requires either the use of digital tools or a minimum technological knowledge of the patients. Digital health literacy may influence the use of telemedicine in most patients, particularly those with frailty. We aimed to explore the association between frailty, the use of digital tools, and patients' digital health literacy. METHODS We prospectively enrolled patients referred to arrhythmia outpatient clinics of our cardiology department from March to September 2022. Patients were divided according to frailty status as defined by the Edmonton Frail Scale (EFS) into robust, pre-frail, and frail. The degree of digital health literacy was assessed through the Digital Health Literacy Instrument (DHLI), which explores seven digital skill categories measured by 21 self-report questions. RESULTS A total of 300 patients were enrolled (36.3% females, median age 75 (66-84)) and stratified according to frailty status as robust (EFS ≤ 5; 70.7%), pre-frail (EFS 6-7; 15.7%), and frail (EFS ≥ 8; 13.7%). Frail and pre-frail patients used digital tools less frequently and accessed the Internet less frequently compared to robust patients. In the logistic regression analysis, frail patients were significantly associated with the non-use of the Internet (adjusted odds ratio 2.58, 95% CI 1.92-5.61) compared to robust and pre-frail patients. Digital health literacy decreased as the level of frailty increased in all the digital domains examined. CONCLUSIONS Frail patients are characterized by lower use of digital tools compared to robust patients, even though these patients would benefit the most from telemedicine. Digital skills were strongly influenced by frailty.
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Affiliation(s)
- Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Valentina Ziveri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Giacomo Gozzi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Chiara Busi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Federico Muto
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Davide Antonio Mei
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Matteo Menozzi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Marta Mantovani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Benedetta Cherubini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- Correspondence:
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Nguyen TT, Nguyen TX, Nguyen TTH, Nguyen TN, Nguyen HTT, Nguyen HTT, Nguyen AT, Pham T, Vu HTT. Symptom Burden among Hospitalised Older Patients with Heart Failure in Hanoi, Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13593. [PMID: 36294170 PMCID: PMC9602984 DOI: 10.3390/ijerph192013593] [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: 09/02/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to assess the symptom burden among older patients hospitalised for heart failure. This hospital-based, cross-sectional study was conducted at the National Geriatric Hospital, Hanoi, Vietnam, from June 2019 to August 2020. Face-to-face interviews were performed to gather the following information: socio-demographic characteristics, heart failure classification, and clinical characteristics (comorbidities, polypharmacy, pro-B-type natriuretic peptide, left ventricular ejection fraction (LVEF), symptom burden, and depression). Symptom burden was assessed using the Edmonton Symptom Assessment Scale (ESAS), and depression was measured using the Patient Health Questionnaire. A total of 314 patients participated in the study. The mean participant age was 72.67 (SD = 9.42) years. The most frequently reported symptoms on the ESAS were shortness of breath (95.5%), fatigue (94.8%), and anxiety (81.2%). In univariate analyses, depression was significantly associated with heart failure class (p < 0.05). Multivariate linear regression revealed that major depression was significantly associated with total symptom burden score (Beta: 11.74; 95% CI: 9.24-14.23) and LVEF (Beta: -0.09; 95% CI: -0.17-(-0.007)). Patients hospitalised for heart failure experienced a high burden of symptoms. Further studies addressing adverse outcomes and expanding to community-dwelling older people are essential. Palliative care approaches that target symptom reduction should be considered in patients with heart failure.
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Affiliation(s)
- Thanh Thi Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huong Thi Thanh Nguyen
- Dinh Tien Hoang Institute of Medicine, Hanoi 100000, Vietnam
- Physiology Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thang Pham
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
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Huynh TQH, Pham TLA, Vo VT, Than HNT, Nguyen TV. Frailty and Associated Factors among the Elderly in Vietnam: A Cross-Sectional Study. Geriatrics (Basel) 2022; 7:geriatrics7040085. [PMID: 36005261 PMCID: PMC9407721 DOI: 10.3390/geriatrics7040085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Frailty syndrome is common among older people and can lead to various adverse consequences such as falls, cognitive decline, disability, dependent living, increased mortality, excessive drug use, and prolonged hospital stays. OBJECTIVES This research determined the prevalence of frailty and associated factors among older adults in Vietnam. METHODS A cross-sectional study was conducted on 584 older adults across five Ho Chi Minh City wards from November 2020 to January 2021. Based on the modified Fried frailty scale, the participants were divided into three categories: robust, pre-frail, and frail. A chi-square test (or Fisher's test) examined the relationship between frailty categories and other variables. Multivariable logistic regression used variates with a cut-off of p ≤ 0.05 in the univariate analysis. RESULTS The prevalence rates of frailty and pre-frailty were 19% and 64%, respectively. The most common frailty component was weak grip strength (63.9%), followed by slowness (36.1%), weight loss (21.6%), low physical activity (19.5%), and exhaustion (18.5%). In addition, the prevalence of frailty was significantly associated with age, BMI levels, living alone, and sarcopenia. CONCLUSION The community's prevalence of frailty among older adults is high. Frailty can lead to many adverse consequences for the elderly. As there were some modifiable factors associated with frailty, it should be assessed in older people through community-based healthcare programs for early diagnosis and management.
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Affiliation(s)
- Trung Quoc Hieu Huynh
- Department of Graduate Training, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
- Correspondence: ; Tel.: +84-973-555-567
| | - Thi Lan Anh Pham
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Van Tam Vo
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Ha Ngoc The Than
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Tan Van Nguyen
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
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Akan S, Aktas G. Relationship between frailty, according to three frail scores, and clinical and laboratory parameters of the geriatric patients with type 2 Diabetes Mellitus. Rev Assoc Med Bras (1992) 2022; 68:1073-1077. [PMID: 36000603 PMCID: PMC9574998 DOI: 10.1590/1806-9282.20220271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/30/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: Type 2 diabetes mellitus is associated with significant morbidity and mortality. The term “frailty in the elderly” has become increasingly important with the increase of the elderly population, especially in diabetic subjects. Frailty is established by various scoring scales, such as Edmonton, Frail, and Prisma-7 scores. We aimed to evaluate the association between frailty and clinical and laboratory parameters of the geriatric type 2 diabetic patients. METHODS: Diabetic patients over 65 years of age who presented to outpatient internal medicine clinics of our institution between June 2020 and January 2021 were enrolled to the study. Edmonton, Frail, and Prisma-7 scores were administered to the subjects. Study parameters were compared between well-controlled and poorly controlled diabetic groups according to diabetes control level and between frail and non-frail groups, according to each frailty scores. RESULTS: Frailty according to Edmonton score was associated with increased risks of hospitalization (p=0.005) and mortality (p=0.02). Frailty according to frail score was associated with increased risk of hospitalization (p=0.009). Frailty according to Prisma-7 score was associated with increased risk of mortality (p<0.001). CONCLUSION: We suggest that Edmonton frail score is superior to Frail and Prisma-7 scores in determining frailty in geriatric patients with type 2 diabetes mellitus, since it is associated with both increased risk of hospitalization and mortality within 6 months.
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Affiliation(s)
- Seyma Akan
- Abant Izzet Baysal University Hospital, Department of Internal Medicine - Bolu, Turkey
| | - Gulali Aktas
- Abant Izzet Baysal University Hospital, Department of Internal Medicine - Bolu, Turkey
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Blum LV, Zierentz P, Hof L, Kloka JA, Messroghli L, Zacharowski K, Meybohm P, Choorapoikayil S. The impact of intravenous iron supplementation in elderly patients undergoing major surgery. BMC Geriatr 2022; 22:293. [PMID: 35392839 PMCID: PMC8988356 DOI: 10.1186/s12877-022-02983-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Age and preoperative anaemia are risk factors for poor surgical outcome and blood transfusion. The aim of this study was to examine the effect of iron supplementation in iron-deficient (ID) elderly patients undergoing major surgery. METHOD In this single-centre observational study, patients ≥ 65 years undergoing major surgery were screened for anaemia and ID. Patients were assigned to the following groups: A- (no anaemia); A-,ID+,T+ (no anaemia, iron-deficient, intravenous iron supplementation); A+ (anaemia); and A+,ID+,T+ (anaemia, iron-deficient, intravenous iron supplementation). RESULTS Of 4,381 patients screened at the anaemia walk-in clinic, 2,381 (54%) patients were ≥ 65 years old and 2,191 cases were included in analysis. The ID prevalence was 63% in patients with haemoglobin (Hb) < 8 g/dl, 47.2% in patients with Hb from 8.0 to 8.9 g/dl, and 44.3% in patients with Hb from 9 to 9.9 g/dl. In severely anaemic patients, an Hb increase of 0.6 (0.4; 1.2) and 1.2 (0.7; 1.6) g/dl was detected with iron supplementation 6-10 and > 10 days before surgery, respectively. Hb increased by 0 (-0.1; 0) g/dl with iron supplementation 1-5 days before surgery, 0.2 (-0.1; 0.5) g/dl with iron supplementation 6-10 days before surgery, and 0.2 (-0.2; 1.1) g/dl with supplementation > 10 days before surgery (p < 0.001 for 1-5 vs. 6-10 days). Overall, 58% of A+,ID+,T+ patients showed an Hb increase of > 0.5 g/dl. The number of transfused red blood cell units was significantly lower in patients supplemented with iron (0 (0; 3)) compared to non-treated anaemic patients (1 (0; 4)) (p = 0.03). Patients with iron supplementation > 6 days before surgery achieved mobility 2 days earlier than patients with iron supplementation < 6 days. CONCLUSIONS Intravenous iron supplementation increases Hb level and thereby reduces blood transfusion rate in elderly surgical patients with ID anaemia.
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Affiliation(s)
- Lea Valeska Blum
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Philipp Zierentz
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Lotta Hof
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Jan Andreas Kloka
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Leila Messroghli
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Suma Choorapoikayil
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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Chou CP, Chen KM, Tung HT, Belcastro F, Hsu HF. Physical fitness and frailty status of frail older adults in long-term care facilities after acupunch exercises: A cluster-randomized controlled trial. Exp Gerontol 2022; 163:111799. [PMID: 35390490 DOI: 10.1016/j.exger.2022.111799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Frailty is a complex geriatric syndrome and serves as an indicator for functional degradation in older adults. Regular exercise intervention could reduce the level of frailty and improve general physical fitness. The aim of this study was to test the effects of the Vitality Acupunch (VA) exercise on the promotion of physical fitness and the improvement of frailty status among frail older adults in long-term care facilities. METHOD This study was a cluster-randomized controlled trial adopted a pretest-posttest design. Using convenience sampling, 81 frail adults older than 65 years of age from 10 long-term care facilities participated in this study. The older adults were cluster-randomized by facility into an intervention group (5 long-term care facilities, n = 40) and a control group (5 long-term care facilities, n = 41). The intervention group engaged in the VA exercise 3 times a week, each lasting 40 min, for 24 weeks. The control group maintained regular activities of daily living. The outcome measures for physical fitness were assessed before study began (pretest), at the 12th week (posttest 1), and at the 24th week (posttest 2) in the study. RESULTS After a 24-week intervention, the frail older adults who engaged in the VA exercise program showed significant improvements in handgrip strength, upper-limb muscle endurance, lung function, shoulder flexibility, forward flexion, shoulder joint flexion, and shoulder joint abduction (all p < .05) but not in lower-limb muscle endurance (p = .502) compared against their pretest data. The intervention group had significantly better physical fitness and positive changes in frailty status than the control group (all p < .001), except for the lower-limb muscle endurance (p = .557). CONCLUSION Regular engagement in the VA exercise program for 24 weeks significantly improved the physical fitness and frailty status of frail older adults in long-term care facilities.
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Affiliation(s)
- Chia-Pei Chou
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Dapi Rd., Niaosong District, Kaohsiung 83301, Taiwan; College of Medicine, Chang Gung University, Taiwan.
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, 100 Shih-Chuan 1(st) Rd., Sanmin District, Kaohsiung, Taiwan; Center for Long-term Care Research, Kaohsiung Medical University, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Taiwan.
| | - Hsiao-Ting Tung
- Department of Nursing, Kaohsiung Armed Forces General Hospital, 2 Zhongzheng 1st Rd., Lingya District, Kaohsiung 80284, Taiwan
| | - Frank Belcastro
- Department of Education and Psychology, University of Dubuque, 2000 University Ave., Dubuque, Iowa 52001, USA
| | - Hui-Fen Hsu
- Center for Long-term Care Research, Kaohsiung Medical University, 100 Shih-Chuan 1(st) Rd., Sanmin District, Kaohsiung 80708, Taiwan.
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Health Care Utilization and Out-of-Pocket Payments among Elderly with Cognitive Frailty in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063361. [PMID: 35329059 PMCID: PMC8954898 DOI: 10.3390/ijerph19063361] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 01/27/2023]
Abstract
Background: Cognitive frailty (CF) as a potential risk factor for dementia, functional disability, poor quality of life, and mortality. The aim of this study was to explore the health care-related utilization and out-of-pocket (OOP) expenditures, sociodemographic characteristics, and comorbidities among elderly Malaysians with CF. Methods: A cross-sectional study targeting elderly Malaysian aged ≥65 years was conducted. The study included all participants of the fourth phase of the Malaysian representative Long-Term-Research-Grant-Scheme Towards-Useful-Aging (LRGS-TUA) community-based study. A structured and validated interview questionnaire was used. Results: In total, 1006 elderly were interviewed, with a 66.18% response rate. Only 730 respondents met the inclusion criteria. Of the eligible respondents, the CF prevalence was 4.5%. Around 60.6% of the participants with CF had utilized outpatient care at government clinics within the past 6 months. The estimated mean total OOP payments for CF during the past 6 months was 84 Malaysian Ringgit (RM) (SD 96.0). Conclusions: CF among elderly Malaysians is within the internationally recognized range of prevalence. The OOP payments for seeking health care among CF elderly are not different from that of other elderly categories. There is a high possibility of underutilization of the health care services of CF cases while they are still needy.
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Kato D, Takegami Y, Seki T, Nakashima H, Osawa Y, Suzuki K, Yamada H, Hasegawa Y, Imagama S. DNA methylation is associated with muscle loss in community-dwelling older men -the Yakumo study- : a preliminary experimental study. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:60-68. [PMID: 35392004 PMCID: PMC8971031 DOI: 10.18999/nagjms.84.1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/17/2021] [Indexed: 12/04/2022]
Abstract
Frailty is a state of reduced muscle strength and activity in older people. DNA methylation is associated with osteoporosis and muscle loss in murine and other animal studies, but there are no epidemiological studies in humans. This study aimed to assess the association of osteoporosis and muscle loss with DNA methylation in community-dwelling older people. This cross-sectional study was performed in a rural part of Japan. We analyzed 204 subjects (98 men and 106 women). In univariate analysis, the two groups were compared according to the presence or absence of osteoporosis and of muscle loss. Logistic regression analysis was performed to determine predictors of frailty in the muscle loss group. We used age, sex, body mass index, smoking history, drinking history, serum albumin and C-reactive protein levels, diabetes, hypertension, hyperlipidemia, heart disease history, and LINE-1 DNA methylation as the factors. Probability values < 0.05 were considered to be statistically significant. The levels of LINE-1 DNA methylation in leukocytes were associated with muscle loss in men over the age of 60. LINE-1 DNA methylation levels were not associated with bone mineral density in either the men or women over the age of 60. LINE-1 DNA methylation levels in leukocytes correlated significantly with the risk of frailty in men over the age of 60. Promoting an understanding of DNA methylation may lead to a better understanding of the pathophysiology of muscle loss.
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Affiliation(s)
- Daisaku Kato
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Suzuki
- Department of Preventive Medical Sciences, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroya Yamada
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Science, Kashiwabara, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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14
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Li Y, Gao Y, Hu S, Chen H, Zhang M, Yang Y, Liu Y. Effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults: A meta-analysis of randomised controlled trials. J Clin Nurs 2022; 32:1795-1805. [PMID: 34989056 DOI: 10.1111/jocn.16196] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/11/2021] [Accepted: 12/21/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study aims to evaluate the effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults living in the community and provide the latest evidence from published randomised controlled trials (RCTs). BACKGROUND The number of frail older adults is rapidly increasing. Previous studies have reported that multicomponent exercise is one of the best types of intervention for increasing muscle strength, muscle endurance and balance for frail older adults. However, due to the small sample size and lack of evidential support, a meta-analysis of RCTs remains necessary. METHODS RCTs reporting the effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults, published in English, were retrieved from five electronic databases: PubMed, CINAHL, Web of Science, Embase and Cochrane Library available from their inception up to January 2021. RevMan5.3 software was adopted for statistical analysis. This study followed the PRSIMA checklist. RESULTS A total of 10 articles and 667 patients were included in this study. Meta-analysis showed that multicomponent exercise could improve the muscle strength [MD = 2.46, p = .007], muscle endurance [MD = 2.16, p = .03] and balance [MD = .39, p = .03] of frail older adults, and subgroup analysis showed the muscle endurance of frail older adults was significantly improved as the intervention lasted for >12 weeks. CONCLUSIONS RCTs provided in this study show the latest evidence that multicomponent exercise can improve the muscle strength, endurance and balance of frail older adults and that long-duration (>12weeks) multicomponent exercise is more effective for improving muscle endurance. RELEVANCE TO CLINICAL PRACTICE Multicomponent exercise contributes to improving the muscle strength, muscle endurance and balance of frail older adults, so it can be considered as a complement to the physical function management programme for frail older adults.
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Affiliation(s)
- Yao Li
- Nursing Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Gao
- School of Continuing Education, Peking University, Haidian, Beijing, China
| | - Shuang Hu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongyu Chen
- Nursing Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Minyi Zhang
- Nursing Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yi Yang
- Neurosurgery Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Liu
- Neurosurgery Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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15
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Correlation between frail status and lower extremity function in elderly inpatients with hypertension. NUTR HOSP 2021; 39:39-45. [PMID: 34907780 DOI: 10.20960/nh.03283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION the frail status of elderly hypertensive patients easily damages the function of many physiological systems. OBJECTIVES we aimed to investigate the correlation between the frail status and lower extremity function of elderly hospitalized patients with hypertension. METHODS a total of 336 eligible subjects were assigned to frail, pre-frail and non-frail groups according to the "Frail" scale. Lower extremity function was assessed by the Short Physical Performance Battery including chair-sit-to-stand, three-posture balance and 6-meter gait speed tests. The influences of factors on frailty were evaluated using the Cox multivariate regression analysis. The correlation between frailty score and lower extremity function score was explored by Spearman's analysis. The values of factors for predicting frail status were analyzed by plotting receiver operating characteristic (ROC) curves. RESULTS the three groups had similar age, systolic blood pressure, and nutritional, sleepiness and lower extremity function statuses (p < 0.05). Compared with the non-frail group, the lower extremity function score of the frail group was lower (p < 0.05). Age, systolic blood pressure and sleepiness status were the independent risk factors of frailty (p < 0.05), and lower extremity function parameters were independent protective factors (p < 0.05). There were negative correlations between frail status and lower extremity function parameters (p < 0.05). The area under the ROC curve was 0.850, and the optimal cutoff value was 7.80. Lower extremity function had a high value for predicting frail status. CONCLUSIONS lower extremity function is negatively correlated with the frail status of elderly hospitalized patients with hypertension, as a protective factor of frailty, which can be used to predict frail status.
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Abstract
Frailty is an important clinical syndrome of age-related decline in physiologic reserve and increased vulnerability. In older adults, frailty leads to progressive multisystem decline and increased adverse clinical outcomes. The pathophysiology of frailty is hypothesized to be driven by dysregulation of neuroendocrine, inflammatory, and metabolic pathways. Sex-specific differences in the prevalence of frailty have been observed. Treatment interventions of geriatric care can be applied to the care of frail older women with these differences in mind. As additional evidence regarding sex-specific differences in frailty emerges, research efforts should encompass the development of screening tools and therapeutic interventions that optimize outcomes.
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Affiliation(s)
- Caroline Park
- Section of Geriatrics, Division of Primary Care & Population Health, Stanford School of Medicine, Stanford Senior Care, 211 Quarry Road. Suite 4C, Palo Alto, CA 94304, USA
| | - Fred C Ko
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY 10029, USA; Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.
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17
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Bhardwaj PV, Rastegar V, Meka R, Sawalha K, Brennan M, Stefan MS. The Association Between Body Mass Index, Frailty and Long-Term Clinical Outcomes in Hospitalized Older Adults. Am J Med Sci 2021; 362:268-275. [PMID: 33894183 DOI: 10.1016/j.amjms.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/14/2020] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND While frailty is thought to be a wasting disorder, there is scarce data regarding the association between frailty and body mass index (BMI). The aim of this study was to determine the relationship between BMI, frailty, and mortality among hospitalized older adults. METHODS This is a secondary analysis of a prospective cohort study of patients aged ≥65 years admitted to a tertiary center between 2014 and 2016. Frailty was assessed by Reported Edmonton Frailty Scale (REFS) and categorized as: not frail, vulnerable/mild frail, and moderate/severe frail. BMI (kg/m2) was categorized as: underweight (<18.5), normal (18.5-24.9), overweight (25.0- 29.9), or obese (≥ 30.0). Primary outcome was all-cause one-year mortality. RESULTS Among 769 patients included in the study, 55.4% were frail. There was no statistically significant association between frailty categories and levels of BMI. Frail patients had a higher risk of death than non-frail after adjusting for confounders [HR: 1.98, 95% CI (1.46, 2.70) for mild frail and HR 2.03, 95% CI (1.43, 2.87) for moderate/severe frail]. Compared with normal weight patients, those who were overweight had a survival advantage if they were non-frail [HR 0.55, 95% CI (0.31, 0.96)] or vulnerable/mild frail [HR 0.65, 95% CI (0.43, 0.97)] but not if they were moderate/severe frail. There were no other statistically significant differences in survival by BMI and frailty categories. CONCLUSIONS We did not find a relationship between BMI and frailty among hospitalized older adults. Overweight patients had a survival advantage if they were non-frail or vulnerable. There is need for further longitudinal studies assessing the interaction between frailty and BMI in older adults.
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Affiliation(s)
- Prarthna V Bhardwaj
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
| | - Vida Rastegar
- Institute for Healthcare Delivery and Population Science, Springfield, MA, USA.
| | - Rohini Meka
- Department of Hospital Medicine, Baystate Medical Center, Springfield, MA, USA.
| | - Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
| | - Maura Brennan
- Division of Geriatrics, University of Massachusetts Medical School - Baystate, Springfield MA, USA.
| | - Mihaela S Stefan
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA; Institute for Healthcare Delivery and Population Science, Springfield, MA, USA.
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Alqahtani BA, Alenazi AM, Alshehri MM, Osailan AM, Alsubaie SF, Alqahtani MA. Prevalence of frailty and associated factors among Saudi community-dwelling older adults: a cross-sectional study. BMC Geriatr 2021; 21:185. [PMID: 33731034 PMCID: PMC7972196 DOI: 10.1186/s12877-021-02142-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background Prevalence of frailty has been previously established in different Western countries; however, the prevalence and the burden of in the aging populations of Saudi Arabia has not been examined. Therefore, the aim of this study was to examine the prevalence of frailty, and associated factors among Saudi older population. Methods The study included a total of 486 community-dwelling elderly adults aged 60 years and over living in the Riyadh area. This study took place from August 2019 to June 2020. The prevalence of frailty was determined using the Fried’s frailty phenotype. Association between sociodemographic features and clinical factors and frailty was estimated by Odds Ratio and confidence intervals (OR, IC 95%) using a multinomial logistic regression model. Results The overall prevalence of pre-frailty and frailty were 47.3 and 21.4%, respectively. The following factors were associated with being frail: age (OR: 6.92; 95%CI 3.11–15.41); living alone (OR: 2.50; 95%CI: 1.12–5.59); had more chronic conditions (OR: 1.96; 95%CI: 1.16–3.30); and cognitive impairment (OR: 7.07; 95%CI: 3.92–12.74). Conclusions The Compared with other populations, the prevalence of frailty and pre-frailty in the Riyadh region of Saudi Arabia was high. The implications of frailty in this population should be discussed in future study.
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Affiliation(s)
- Bader A Alqahtani
- Department of Health and Rehabilitation sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia.
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia
| | - Mohammed M Alshehri
- Physical Therapy Department, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ahmed M Osailan
- Department of Health and Rehabilitation sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia
| | - Saud F Alsubaie
- Department of Health and Rehabilitation sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia
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Rezaei-Shahsavarloo Z, Atashzadeh-Shoorideh F, Gobbens RJJ, Ebadi A, Ghaedamini Harouni G. The impact of interventions on management of frailty in hospitalized frail older adults: a systematic review and meta-analysis. BMC Geriatr 2020; 20:526. [PMID: 33272208 PMCID: PMC7712609 DOI: 10.1186/s12877-020-01935-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/26/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND One of the most challenging issues for the elderly population is the clinical state of frailty. Frailty is defined as a cumulative decline across psychological, physical, and social functioning. Hospitalization is one of the most stressful events for older people who are becoming frail. The aim of the present study was to determine the effectiveness of interventions focused on management of frailty in hospitalized frail older adults. METHODS A systematic review and meta-analysis of research was conducted using the Medline, Embase, Cochrane, ProQuest, CINAHL, SCOPUS and Web of Science electronic databases for papers published between 2000 and 2019. Randomized controlled studies were included that were aimed at the management of frailty in hospitalized older adults. The outcomes which were examined included frailty; physical, psychological, and social domains; length of stay in hospital; re-hospitalization; mortality; patient satisfaction; and the need for post discharge placement. RESULTS After screening 7976 records and 243 full-text articles, seven studies (3 interventions) were included, involving 1009 hospitalized older patients. The quality of these studies was fair to poor and the risk of publication bias in the studies was low. Meta-analysis of the studies showed statistically significant differences between the intervention and control groups for the management of frailty in hospitalized older adults (ES = 0.35; 95% CI: 0. 067-0.632; z = 2.43; P < 0.015). However, none of the included studies evaluated social status, only a few of the studies evaluated other secondary outcomes. The analysis also showed that a Comprehensive Geriatric Assessment unit intervention was effective in addressing physical and psychological frailty, re-hospitalization, mortality, and patient satisfaction. CONCLUSIONS Interventions for hospitalized frail older adults are effective in management of frailty. Multidimensional interventions conducted by a multidisciplinary specialist team in geriatric settings are likely to be effective in the care of hospitalized frail elderly. Due to the low number of RCTs carried out in a hospital setting and the low quality of existing studies, there is a need for new RCTs to be carried out to generate a protocol appropriate for frail older people.
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Affiliation(s)
- Zahra Rezaei-Shahsavarloo
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life style institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Zupo R, Castellana F, Bortone I, Griseta C, Sardone R, Lampignano L, Lozupone M, Solfrizzi V, Castellana M, Giannelli G, De Pergola G, Boeing H, Panza F. Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty. Ageing Res Rev 2020; 64:101148. [PMID: 32827687 DOI: 10.1016/j.arr.2020.101148] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
Abstract
Different methods have been proposed for the assessment of the nutritional status in frailty phenotypes. In the present narrative review article, we have summarized the number and specifications of nutritional items in existing frailty tools, in order to develop a possible means of assessment and operational definition of the nutritional frailty phenotype. In six different databases until December 2019, we searched for original articles regarding frailty tools (i.e., scales, indexes, scores, questionnaires, instruments, evaluations, screening, indicators), analyzing each tool regarding nutritional items. We identified 160 articles describing 71 frailty tools. Among the selected frailty tools, 54 were community-based (70 %), 17 hospital-based (22 %), 4 validated in long-term care institutions for older adults (LTCIOA) (5.1 %) and 2 validated in both community- and hospital-based settings, including LTCIOA (2.5 %). Fifty-two of these tools (73 %) included at least one nutritional item. Twenty-two (42 %) reported two or more nutritional items. The items were grouped in the following categories: A) anthropometric measurements, B) laboratory measurements, and C) other nutritional-related measurements. Anthropometric measurements stood out compared to all other items. Nutritional items are included in the majority of frailty tools, strengthening the concept that they may have a direct implication on an increased risk of adverse health-related outcomes in frail subjects. This supports the development of the concept of nutritional frailty as an independent frailty phenotype. Subsequent steps will be to assess the contribution of each nutritional item to a possible operational definition of nutritional frailty and define the items that may best identify this new frailty phenotype.
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Pérez-Zepeda MU, Carrillo-Vega MF, Theou O, Jácome-Maldonado LD, García-Peña C. Hospital Complications and Frailty in Mexican Older Adults: An Emergency Care Cohort Analysis. Front Med (Lausanne) 2020; 7:505. [PMID: 33134303 PMCID: PMC7550456 DOI: 10.3389/fmed.2020.00505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives: To describe the association of frailty level on admittance to the Emergency Department (ED) with various hospital complications including delirium, low phase angle, and low handgrip strength. Design: Prospective cohort. Setting: ED rooms of two public general hospitals in Mexico City. Participants: A total of 548 persons 60 years or older who were admitted to the ED and who were alive during follow-up testing at home were included. Measurements: A 32-item frailty index (FI) was measured on admission to the ED. Outcome measures included delirium, phase angle, and hand grip strength measured during different stages of the hospitalization (i.e., from admission to the ED through to follow-up at home). Results: From this final sample, mean age was 76 years (± SD 7.2) and 58.4% (n = 320) were women. Mean waiting time in the ED was 5.1 h (± SD 6.2), the average stay in the ED was 99.9 (±68.2) h, and 274 subjects (50%) were admitted to a general ward after ED admission. FI was not associated with phase angle and was negatively associated with handgrip strength at admission to ED (β = −3.97, confidence interval [CI] 95% −5.56 −2.38, p < 0.001), discharge from ED (β = −3.94, CI 95% −5.97 −1.90, p < 0.001), and discharge from hospital (β = −4.93, CI 95% −7.68 −2.18, p = 0.01). FI was positively associated with delirium (β = 3.68, CI 95% 1.53–5.83, p < 0.01). Conclusion: Higher frailty at ED admission was associated with lower hand grip strength and delirium during hospitalization in Mexican older adults.
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Affiliation(s)
- Mario Ulises Pérez-Zepeda
- Dirección de Investigación, Instituto Nacional de Geriatría, México City, México.,Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan de Degollado, Mexico
| | | | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.,School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | | | - Carmen García-Peña
- Dirección de Investigación, Instituto Nacional de Geriatría, México City, México
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The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia. J Clin Med 2020; 9:jcm9093055. [PMID: 32971851 PMCID: PMC7564707 DOI: 10.3390/jcm9093055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Limited available evidence suggests that a small proportion of inpatients undergo prolonged hospitalization and use a disproportionate number of bed days. Understanding the factors contributing to prolonged hospitalization may improve patient care and reduce the length of stay in such patients. Methods: We undertook a retrospective cohort study of adult (≥20 years) patients admitted for at least 24 h between 14 November 2016 and 14 November 2018 to hospitals in Victoria, Australia. Data including baseline demographics, admitting specialty, survival status and discharge disposition were obtained from the Victorian Admission Episode Dataset. Multivariable logistic regression analysis was used to identify factors independently associated with prolonged hospitalization (≥14 days). Cox proportional hazard regression model was used to examine the association between various factors and in-hospital mortality. Results: There were almost 5 million hospital admissions over two years. After exclusions, 1,696,112 admissions lasting at least 24 h were included. Admissions with prolonged hospitalization comprised only 9.7% of admissions but utilized 44.2% of all hospital bed days. Factors independently associated with prolonged hospitalization included age, female gender, not being in a relationship, being a current smoker, level of co-morbidity, admission from another hospital, admission on the weekend, and the number of admissions in the prior 12 months. The in-hospital mortality rate was 5.0% for those with prolonged hospitalization compared with 1.8% in those without (p < 0.001). Prolonged hospitalization was also independently associated with a decreased likelihood of being discharged to home (OR 0.53, 95% CI 0.52–0.54). Conclusions: Patients experiencing prolonged hospitalization utilize a disproportionate proportion of bed days and are at higher risk of in-hospital death and discharge to destinations other than home. Further studies are required to identify modifiable factors contributing to prolonged hospitalization as well as the quality of end-of-life care in such admissions.
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Sadjapong U, Yodkeeree S, Sungkarat S, Siviroj P. Multicomponent Exercise Program Reduces Frailty and Inflammatory Biomarkers and Improves Physical Performance in Community-Dwelling Older Adults: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3760. [PMID: 32466446 PMCID: PMC7312630 DOI: 10.3390/ijerph17113760] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 01/06/2023]
Abstract
The efficacy of exercise to reverse frailty in the aging population has not been extensively investigated. This study aimed to investigate the effectiveness of a multicomponent exercise program (MCEP) on frailty, physical performance (handgrip strength, Berg Balance Scale (BBS), Timed Up and Go test (TUG), and VO2Max), blood biomarkers (Interleukin-6 (IL-6) and C-reactive protein (CRP)) in frail older adults. A randomized controlled trial using an allocation concealment method, included 64 older adults (77.78 ± 7.24 years), were divided into two parallel groups using block randomization: an MCEP group (n = 32) and a control group (n = 32). The combined center- and home-based MCEP training consisted of chair aerobic, resistance, and balance, which was carried out 3 days per week for 24 weeks. A mixed model repeated measure ANOVA demonstrated significant interaction effects of group x time for BBS, TUG and frailty scores (p < 0.001). Additionally, the post-hoc analysis revealed that the MCEP group showed significantly improved BBS, TUG, and frailty scores (p < 0.01), at both 12- and 24-weeks. When compared with controls at 12-weeks, the MCEP group decreased IL-6 and CRP levels (p < 0.05). The combined center- and home-based MCEP were effective in reversing frailty to pre-frailty and improving physical performance especially balance in the older population.
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Affiliation(s)
- Uratcha Sadjapong
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Supachai Yodkeeree
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Somporn Sungkarat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Penprapa Siviroj
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
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A Pilot Study of the Clinical Frailty Scale to Predict Frailty Transition and Readmission in Older Patients in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051582. [PMID: 32121380 PMCID: PMC7084649 DOI: 10.3390/ijerph17051582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Clinical Frailty Scale (CFS) is gaining increasing acceptance due to its simplicity and applicability. AIMS This pilot study aims to examine the role of CFS in identifying the prevalence of frailty, frailty transition, and the impact of frailty on readmission after discharge in older hospitalized patients. METHODS Patients aged ≥60 admitted to the geriatric ward of a hospital in Vietnam were recruited from 9/2018-3/2019 and followed for three months. Frailty was assessed before discharge and after three months, using the CFS (robust: score 1-2, pre-frail: 3-4, and frail: ≥5). Multivariate logistic regression was applied to investigate the associated factors of frailty transition and the impact of frailty on readmission. RESULTS There were 364 participants, mean age 74.9, 58.2% female. At discharge, 4 were robust, 160 pre-frail, 200 frail. Among the 160 pre-frail participants at discharge, 124 (77.5%) remained pre-frail, and 36 (22.5%) became frail after 3 months. Age (adjusted OR1.09, 95% CI 1.03-1.16), number of chronic diseases (adjusted OR 1.37, 95% CI 1.03-1.82), and polypharmacy at discharge (adjusted OR 3.68, 95% CI 1.15-11.76) were significant predictors for frailty after 3 months. A frailty status at discharge was significantly associated with increased risk of readmission (adjusted OR2.87, 95% CI 1.71-4.82). CONCLUSIONS Frailty was present in half of the participants and associated with increased risk of readmission. This study suggests further studies to explore the use of the CFS via phone calls for monitoring patients' frailty status after discharge, which may be helpful for older patients living in rural and remote areas.
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Cai Y, Xu W, Xiao H, Liu H, Chen T. Correlation between Frailty and Adverse Outcomes Among Older Community-Dwelling Chinese Adults: The China Health and Retirement Longitudinal Study. J Nutr Health Aging 2020; 24:752-757. [PMID: 32744572 DOI: 10.1007/s12603-020-1368-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Frailty is a state of decreased resilience when a person is exposed to an apparently innocuous stressor that is associated with numerous adverse outcomes. The aim is to examine frailty prevalence in China by demographic and investigate the correlation between frailty and outcome. DESIGN Cohort study. SETTING Community-dwelling adults from 28 Chinese provinces. METHODS The participants were 2,273 adults aged ≥65 years from the China Health and Retirement Longitudinal Study. Frailty was scored on the FRAIL scale. We estimated frailty prevalence in the overall sample. The association of frailty with adverse outcomes was evaluated by multinomial logistic regression analysis. RESULTS We found that 17.0% of adults aged ≥65 years were frail. Frail individuals had a higher prevalence of comorbidities, falls, and need for medical care than non-frail individuals. The multinomial logistic regression analysis demonstrated that frail status (OR = 2.061, 95% CI: 1.422-2.985) and pre-frail status (OR = 1.540, 95% CI: 1.135-2.089) were associated with falls in the previous two years. Serious falls in the previous two years were related to pre-frailty (OR = 1.815, 95% CI: 1.153-2.859) and frailty (OR = 2.797, 95% CI: 1.655-4.727). In addition, frail individuals were found to be at higher risk for outpatient visits over the previous month (OR = 2.091, 95% CI: 1.502-2.911) and readmission over the previous year (OR = 2.033, 95% CI: 1.480-2.792) in the analysis. CONCLUSIONS Pre-frailty and frailty were positively associated with major adverse outcomes, including falls and serious falls; they were also associated with more frequent outpatient visits and readmissions in the past.
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Affiliation(s)
- Y Cai
- Hongbin Liu, Chinese PLA General Hospital, China, , T. Chen, e-mail:
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26
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Nguyen TV, Le D, Tran KD, Bui KX, Nguyen TN. Frailty in Older Patients with Acute Coronary Syndrome in Vietnam. Clin Interv Aging 2019; 14:2213-2222. [PMID: 31908432 PMCID: PMC6925543 DOI: 10.2147/cia.s234597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/27/2019] [Indexed: 12/26/2022] Open
Abstract
Background There has been limited evidence about frailty in older patients with acute coronary syndrome (ACS) in Vietnam. Aim (1) To investigate the prevalence of frailty in older patients hospitalised with ACS and its associated factors; (2) To investigate the impact of frailty on percutaneous coronary intervention (PCI) and adverse outcomes in this population. Methods Patients aged ≥60 with ACS admitted to two teaching hospitals in Vietnam were recruited from 9/2017 to 4/2018. Frailty was defined by the Reported Edmonton Frail Scale. Multivariate logistic regression was applied to investigate the associated factors of frailty and the impact of frailty on PCI and adverse outcomes. Results There were 324 participants, mean age 73.5±8.3, 39.2% female. The prevalence of frailty was 48.1%. Advanced age, female gender, history of hypertension, heart failure, stroke and chronic kidney disease were significantly associated with a frailty status. Overall, 50.3% of the participants received PCI (58.3% in the non-frail vs 41.7% in the frail, p=0.003). However, frailty did not have an independent impact on PCI (adjusted OR 0.66, 95% CI 0.41–1.08). Frailty was significantly associated with increased risk of having arrhythmia during hospitalisation (adjusted OR 2.24, 95% CI 1.32–3.80), hospital-acquired pneumonia (adjusted OR 2.27, 95% CI 1.24–4.17), in-hospital mortality (adjusted OR 3.02, 95% CI 1.35–6.75), 30-day mortality (adjusted OR 3.28, 95% CI 1.59–6.76), and 30-day readmission (adjusted OR 2.53, 95% CI 1.38–4.63). Conclusion In this study, frailty was present in nearly half of older patients with ACS and was associated with increased adverse outcomes. These findings suggest that frailty screening should be performed in older patients with ACS in Vietnam.
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Affiliation(s)
- Tan Van Nguyen
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Duong Le
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Khuong Dang Tran
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Khai Xuan Bui
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Tu Ngoc Nguyen
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Chen CL, Chen CM, Wang CY, Ko PW, Chen CH, Hsieh CP, Chiu HC. Frailty is Associated with an Increased Risk of Major Adverse Outcomes in Elderly Patients Following Surgical Treatment of Hip Fracture. Sci Rep 2019; 9:19135. [PMID: 31836751 PMCID: PMC6910954 DOI: 10.1038/s41598-019-55459-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/23/2019] [Indexed: 02/08/2023] Open
Abstract
We intended to explore the effect of level of frailty on, and relationship with, 1-, 3-, and 6-month postoperative emergency department visits, readmissions, and mortality. This is a prospective multicenter observational cohort study design. Patients aged 50 years or older treated for hip fracture (n = 245) were taken from Orthopedic wards in one medical center (n = 131) and one district hospital (n = 114) in Changhua County, Taiwan. Frailty was defined as measured by the validated Clinical Frailty Scale and categorized as robust, pre-frail, and frail. We used Kaplan-Meier analysis to estimate survival rates and Cox regression to estimate the risk of frailty associated with adverse outcomes. To examine the longitudinal associations between frailty and adverse outcome, the cross-lagged models were explored. Of the 245 patients, 55 (22.4%) were classified as frail, 113 (46.1%) as pre-frail, and 77 (31.4%) as robust. More cumulative events occurred for frail than for robust patients for each adverse outcome. Frailty has long-term effect on each adverse outcome after discharge, rather than the effect simultaneously. Targeting pre-frailty and frailty is essential for prevent adverse outcomes and improving the overall health of older adults after discharge for hip fracture.
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Affiliation(s)
- Chiu-Liang Chen
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chun-Min Chen
- Research Education and Epidemiology Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chun-Yi Wang
- Department of Orthopedic Surgery, Yuanlin Christian Hospital, Changhua, Taiwan
| | - Po-Wei Ko
- Department of Orthopedic Surgery, Yuanlin Christian Hospital, Changhua, Taiwan
| | - Chung-Hwan Chen
- Orthopedic Research Centre, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Pu Hsieh
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Herng-Chia Chiu
- Institute of Hospital Management, Tsinghua University, Beijing, China. .,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Health Policy and Management, Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland, United States of America.
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