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Chirap-Mitulschi IA, Antoniu S, Schreiner TG. The impact of palliative care on the frailty-stroke continuum: from theoretical concepts to practical aspects. Postgrad Med 2024:1-9. [PMID: 38954726 DOI: 10.1080/00325481.2024.2374701] [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: 03/02/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
With a constant increase in prevalence and incidence worldwide, stroke remains a public health issue in the 21st century. Additionally, population aging inevitably leads to increased vulnerability in the general population, a clinical state known as frailty. While there are adequate guidelines on the treatment of stroke in the acute setting, there are a lot of gaps regarding the chronic management of stroke patients, particularly the frail ones. From the therapeutic point of view, palliative care could be the key to offering complex and individualized treatment to these frail chronic stroke patients. In the context of the heterogeneous data and incomplete therapeutic guidelines, this article provides a new and original perspective on the topic, aiming to increase awareness and understanding and improve palliative care management in stroke patients. Based on current knowledge, the authors describe a new concept called the frailty-stroke continuum and offer a detailed explanation of the intricate stroke-frailty connection in the first part. After understanding the role of palliative care in managing this kind of patients, the authors discuss the most relevant practical aspects aiming to offer an individualized framework for daily clinical practice. The novel approach consists of developing a four-step scale for characterizing frail stroke patients, with the final aim of providing personalized treatment and correctly evaluating prognosis. By pointing out the limitations of current guidelines and the challenges of new research directions, this article opens the pathway for the better evaluation of frail stroke patients, offering a better perception of patients' prognosis.
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Affiliation(s)
- Ioan-Alexandru Chirap-Mitulschi
- Department of Medicine II/Nursing-Palliative Care, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania
- Neurology Clinic, Clinical Rehabilitation Hospital, Iasi, Romania
| | - Sabina Antoniu
- Department of Medicine II/Nursing-Palliative Care, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania
| | - Thomas Gabriel Schreiner
- Department of Electrical Measurements and Materials, Faculty of Electrical Engineering and Information Technology, Gheorghe Asachi Technical University of Iasi, Iasi, Romania
- Department of Medicine III/Neurology, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania
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Iwasawa T, Aoyagi Y, Suda S, Ishiyama D, Toi K, Ohashi M, Kimura K. Prevalence and outcome of pre-onset frailty in patients with acute stroke. Top Stroke Rehabil 2024; 31:493-500. [PMID: 38108292 DOI: 10.1080/10749357.2023.2291898] [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: 05/04/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Frailty in older individuals is an underappreciated condition that affects the incidence and/or prognosis of stroke. OBJECTIVES We evaluated the prevalence of pre-onset frailty in patients with acute first-onset and recurrent strokes and association between pre-onset frailty and functional disability at hospital discharge. METHODS This prospective cohort study included 210 acute stroke patients admitted to the Stroke Unit of Nippon Medical School Hospital during November 2021-June 2022. The mean participant age was 79.2 ± 7.4 years. Age, sex, pre-onset frailty, body mass index (BMI), stroke type, medical history, and National Institutes of Health Stroke Scale (NIHSS) score at admission were evaluated. Frailty was defined as a clinical frailty scale (CFS) score ≥ 5. Frailty prevalence was calculated for all patients, and scores of functional disabilities at discharge were evaluated using modified Rankin scale. RESULTS Overall frailty prevalence was 31% in all stroke patients, with 24% and 47% of first-onset and recurrent strokes, respectively. Pre-onset frailty, NIHSS score at admission, age, stroke type, previous stroke, sex, BMI, dyslipidemia, and atrial fibrillation were significantly associated with functional disability at discharge. Logistic regression analysis revealed that CFS score, NIHSS score at admission, and previous stroke were independent predictors of functional disability at discharge. CONCLUSIONS Approximately one-fourth of patients with first-onset stroke had pre-onset frailty; the rate doubled in recurrent stroke; these rates appear to be much larger than rate in healthy individuals. Pre-onset frailty, a negative independent factor affecting functional disability at discharge, is important for pre-onset frailty evaluation and rehabilitation intervention in acute stroke patients.
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Affiliation(s)
- Tatsuya Iwasawa
- Department of Rehabilitation Medicine, Nippon Medical School Hospital, Tokyo, Japan
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine, Nippon Medical School Hospital, Tokyo, Japan
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoshi Suda
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Daisuke Ishiyama
- Department of Rehabilitation Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Kennosuke Toi
- Department of Rehabilitation Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Miho Ohashi
- Department of Rehabilitation Medicine, Nippon Medical School Hospital, Tokyo, Japan
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
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He H, Liu M, Li L, Zheng Y, Nie Y, Xiao LD, Li Y, Tang S. The impact of frailty on short-term prognosis in discharged adult stroke patients: A multicenter prospective cohort study. Int J Nurs Stud 2024; 154:104735. [PMID: 38521005 DOI: 10.1016/j.ijnurstu.2024.104735] [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: 01/02/2024] [Accepted: 02/24/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Frailty is commonly observed in stroke patients and it is associated with adverse outcomes. However, there remains a gap in longitudinal studies investigating the causal relationship between baseline frailty and short-term prognosis in discharged adult stroke patients. OBJECTIVE To examine the causal impact of frailty on non-elective readmission and major adverse cardiac and cerebral events, and investigate its associations with cognitive impairment and post-stroke disability. DESIGN A multicenter prospective cohort study. SETTING Two tertiary hospitals in Central and Northwest China. PARTICIPANTS 667 adult stroke patients in stroke units were included from January 2022 to June 2022. METHODS Baseline frailty was assessed by the Frailty Scale. Custom-designed questions were utilized to assess non-elective readmission and major adverse cardiac and cerebral events as primary outcomes. Cognitive impairment, assessed using the Mini-Mental State Examination Scale (MMSE), and post-stroke disability, measured with the Modified Rankin Scale (mRS), were considered secondary outcomes at a 3-month follow-up. The impact of baseline frailty on non-elective readmission and major adverse cardiac and cerebral events was examined using bivariate and multiple Cox regression analyses. Furthermore, associations between baseline frailty and cognitive impairment, or post-stroke disability, were investigated through generalized linear models. RESULTS A total of 5 participants died, 12 had major adverse cardiac and cerebral events, and 57 had non-selective readmission among 667 adult stroke patients. Frailty was an independent risk factor for non-selective readmission (hazard ratio [HR]: 2.71, 95 % confidence interval [CI]: 1.59, 4.62) and major adverse cardiac and cerebral events (HR: 3.77, 95 % CI: 1.07, 13.22) for stroke patients. Baseline frailty was correlated with cognitive impairment (regression coefficient [β]: -2.68, 95 % CI: -3.78, -1.58) adjusting for socio-demographic and clinical factors and follow-up interval. However, the relationship between frailty and cognitive impairment did not reach statistical significance when further adjusting for baseline MMSE (β: -0.39, 95 % CI: -1.43, 0.64). Moreover, baseline frailty was associated with post-stroke disability (β: 0.36, 95 % CI: 0.08, 0.65) adjusting for socio-demographic and clinical variables, follow-up interval, and baseline mRS. CONCLUSIONS The finding highlights the importance of assessing baseline frailty in discharged adult stroke patients, as it is significantly associated with non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability at 3 months. These results highlight the crucial role of screening and evaluating frailty status in improving short-term prognosis for adult stroke patients. Interventions should be developed to address baseline frailty and mitigate the short-term prognosis of stroke. TWEETABLE ABSTRACT Baseline frailty predicts non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability in adult stroke patients. @haiyanhexyyy.
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Affiliation(s)
- Haiyan He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha, Hunan, China; International Medical Centre, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Minhui Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
| | - Li Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yueping Zheng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuqin Nie
- Department of Nursing, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Yinglan Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
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Wei J, Wang J, Chen J, Yang K, Liu N. Stroke and frailty index: a two-sample Mendelian randomisation study. Aging Clin Exp Res 2024; 36:114. [PMID: 38775917 PMCID: PMC11111486 DOI: 10.1007/s40520-024-02777-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Previous observational studies have found an increased risk of frailty in patients with stroke. However, evidence of a causal relationship between stroke and frailty is scarce. The aim of this study was to investigate the potential causal relationship between stroke and frailty index (FI). METHODS Pooled data on stroke and debility were obtained from genome-wide association studies (GWAS).The MEGASTROKE Consortium provided data on stroke (N = 40,585), ischemic stroke (IS,N = 34,217), large-vessel atherosclerotic stroke (LAS,N = 4373), and cardioembolic stroke (CES,N = 7 193).Summary statistics for the FI were obtained from the most recent GWAS meta-analysis of UK BioBank participants and Swedish TwinGene participants of European ancestry (N = 175,226).Two-sample Mendelian randomization (MR) analyses were performed by inverse variance weighting (IVW), weighted median, MR-Egger regression, Simple mode, and Weighted mode, and heterogeneity and horizontal multiplicity of results were assessed using Cochran's Q test and MR-Egger regression intercept term test. RESULTS The results of the current MR study showed a significant correlation between stroke gene prediction and FI (odds ratio 1.104, 95% confidence interval 1.064 - 1.144, P < 0.001). In terms of stroke subtypes, IS (odds ratio 1.081, 95% confidence interval 1.044 - 1.120, P < 0.001) and LAS (odds ratio 1.037, 95% confidence interval 1.012 - 1.062, P = 0.005). There was no causal relationship between gene-predicted CES and FI. Horizontal multidimensionality was not found in the intercept test for MR Egger regression (P > 0.05), nor in the heterogeneity test (P > 0.05). CONCLUSIONS This study provides evidence for a causal relationship between stroke and FI and offers new insights into the genetic study of FI.
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Affiliation(s)
- Jiangnan Wei
- Department of Nursing, Zhuhai Campus of Zunyi Medical University, No. 368 Jinwan Road, Zhuhai, Guangdong, China
| | - Jiaxian Wang
- Department of Nursing, Zhuhai Campus of Zunyi Medical University, No. 368 Jinwan Road, Zhuhai, Guangdong, China
| | - Jiayin Chen
- Department of Nursing, Zhuhai Campus of Zunyi Medical University, No. 368 Jinwan Road, Zhuhai, Guangdong, China
| | - Kezhou Yang
- Department of Nursing, Zhuhai Campus of Zunyi Medical University, No. 368 Jinwan Road, Zhuhai, Guangdong, China
| | - Ning Liu
- Department of Fundamentals, Department of Basic Teaching and Research in General Medicine, Zunyi Medical University Zhuhai Campus, Zhuhai, Guangdong, China.
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Du J, Qu C, Xu Z, Liu Z, Lv M, Wang D, Wei W, Duan Y, Shen J. White matter hyperintensities mediate the association between frailty and cognitive impairment in moyamoya disease. Clin Neurol Neurosurg 2024; 240:108283. [PMID: 38608350 DOI: 10.1016/j.clineuro.2024.108283] [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: 12/09/2023] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES The relationship between cognitive function and frailty in moyamoya disease (MMD) remains unclear, and the underlying mechanism is poorly understood. This study aims to investigate whether white matter hyperintensities (WMHs) mediate the association between frailty and cognitive impairment in MMD. METHODS Patients with MMD were consecutively enrolled in our study from January 2021 to May 2023. Pre-admission frailty and cognition were assessed using the Clinical Frailty Scale (CFS) and cognitive tests, respectively. Regional deep WMH (DWMH) and periventricular WMH (PWMH) volumes were calculated using the Brain Anatomical Analysis using Diffeomorphic deformation toolbox based on SPM 12 software. Multivariate logistic regression analysis was conducted to evaluate the association between frailty and cognitive function in MMD. Mediation analysis was performed to assess whether WMHs explained the association between frailty and cognition. RESULTS A total of 85 patients with MMD were enrolled in this study. On the basis of the CFS scores, 24 patients were classified as frail, 38 as pre-frail, and 23 as robust. Significant differences were observed in learning, memory, processing speed, executive functions, and semantic memory among the three groups (p < 0.001). Frailty was independently associated with memory and executive functions (p < 0.05); even after controlling for WMH. Mediation analysis indicated that the associations of frailty with memory and executive functions were partially mediated by WMH, DWMH, and PWMH (p < 0.05). CONCLUSION Frailty is significantly correlated with a higher risk of cognitive impairment in MMD, even after adjusting for other covariates. WMHs partially mediate the association between frailty and cognitive impairment.
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Affiliation(s)
- Juan Du
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Changhua Qu
- Department of Neurology, Minda Hospital of Hubei Minzu University, Hubei, China
| | - Ziwei Xu
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Zhengxin Liu
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Mingxuan Lv
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Dan Wang
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wenshi Wei
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yu Duan
- Department of Neurosurgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
| | - Jun Shen
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
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Xue R, Chen B, Ma R, Zhang Y, Zhang K. Association of multidimensional frailty and quality of life in middle-aged and older people with stroke: A cross-sectional study. J Clin Nurs 2024; 33:1562-1570. [PMID: 38131358 DOI: 10.1111/jocn.16969] [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: 07/18/2023] [Revised: 11/08/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The aims of this study were to (i) compare the prevalence of multidimensional frailty in middle-aged and older people with stroke and to (ii) explore the relationship between multidimensional frailty and quality of life (QoL) in this patient population. BACKGROUND In recent years, stroke patients have become increasingly younger. As an important risk factor for stroke patients, frailty has gradually drawn research attention because of its multidimensional nature. DESIGN This study used a cross-sectional design. METHODS The study included 234 stroke patients aged 45 and older. Multidimensional frailty was defined as a holistic condition in which a person experiences losses in one or more domains of human functioning (physical, psychological and social) based on the Tilburg Frailty Indicator, and QoL was based on the short version of the Stroke-Specific Quality of Life Scale. Hierarchical regression was used to analyse the correlation factors of QoL. STROBE checklist guides the reporting of the manuscript. RESULTS A total of 128 (54.7%) participants had multidimensional frailty, 48 (44.5%) were middle aged and 80 (63.5%) were older adults. The overall QoL mean score of the participants was 47.86 ± 9.04. Multidimensional frailty was negatively correlated with QoL. Hierarchical regression analysis showed that multidimensional frailty could independently explain 14.6% of the variation in QoL in stroke patients. CONCLUSIONS Multidimensional frailty was prevalent in middle-aged and older people with stroke, and it was a significant factor associated with QoL in stroke patients. RELEVANCE TO CLINICAL PRACTICE This study emphasises the importance of the early identification of multidimensional frailty. And targeted interventions should be studied to prevent the occurrence of multidimensional frailty and thereby improve the QoL of patients. PATIENT OR PUBLIC CONTRIBUTION/S There are no patient or public contributions to this study.
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Affiliation(s)
- Rong Xue
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Baoyun Chen
- Department of Nursing, Xuzhou Central Hospital, Xuzhou, China
| | - Ronghui Ma
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, China
| | - Yuxin Zhang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Kaili Zhang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
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Zeng W, Zhou W, Pu J, Tong B, Li D, Yao Y, Shang S. Physical frailty trajectories in older stroke survivors: Findings from a national cohort study. J Clin Nurs 2024. [PMID: 38528345 DOI: 10.1111/jocn.17101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/26/2024] [Accepted: 02/28/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Physical frailty (PF) is highly prevalent and associated with undesirable outcomes in stroke survivors aged 65 years or older. However, the long-term trajectories of PF are understudied in those older stroke survivors. AIMS To identify PF trajectories and relative predictors associated with the PF trajectories in older stroke survivors. DESIGN This is a secondary analysis of a population-based cohort study in the United States. METHODS Six hundred and sixty-three older stroke survivors from the National Health and Ageing Trends Study from 2015 to 2021 were included. PF was operationally assessed based on the Fried Frailty Phenotype. Trajectories were identified by group-based trajectory modelling. The associations between sociodemographic characteristics, clinical factors, symptoms, cognitive factors and PF trajectories were examined using the design-based logistic regression method. RESULTS Most older stroke survivors were 75 and older (63.32%), female (53.99%), white (80.54%) and partnered (50.64%). Two PF trajectory groups were identified (Group 1: low risk, robust; 49.47%; Group 2: high risk, deteriorating; 50.53%). Individuals were at a higher risk to be assigned to Group 2 if they were 75-84 years (adjusted odds ratio [aOR]: 2.16, 95% CI: 1.23-3.80) or 85+ years (aOR: 2.77, 95% CI: 1.52-5.04), had fair self-reported health (aOR: 2.78, 95% CI: 1.53-5.07) or poor self-reported health (aOR: 3.37, 95% CI: 1.51-7.52), had comorbidities (aOR: 8.44, 95% CI: 1.31-54.42), had breathing problems (aOR: 2.18, 95% CI: 1.18-4.02) and had balance problems (aOR: 1.70, 95% CI: 1.06-2.73). CONCLUSION PF trajectories in older stroke survivors were heterogeneous and were associated with age, self-rated health status, comorbidities, breathing problems and balance problems. IMPLICATION TO CLINICAL PRACTICE Early, routine, dynamic screening for stroke-related physical frailty (PF) and relative predictors might be beneficial for identifying the most vulnerable individuals. Our findings might help develop strategies to manage PF progression. REPORTING METHOD The reporting followed the STROBE guideline.
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Affiliation(s)
- Wen Zeng
- Nursing School of Peking University Health Science Center, Beijing, China
- Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Weijiao Zhou
- Nursing School of Peking University Health Science Center, Beijing, China
| | - Junlan Pu
- Nursing School of Peking University Health Science Center, Beijing, China
| | - Beibei Tong
- Nursing School of Peking University Health Science Center, Beijing, China
| | - Dan Li
- Nursing School of Peking University Health Science Center, Beijing, China
| | - Yuanrong Yao
- Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Shaomei Shang
- Nursing School of Peking University Health Science Center, Beijing, China
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Ng YX, Cheng LJ, Quek YY, Yu R, Wu XV. The measurement properties and feasibility of FRAIL scale in older adults: A systematic review and meta-analysis. Ageing Res Rev 2024; 95:102243. [PMID: 38395198 DOI: 10.1016/j.arr.2024.102243] [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: 07/16/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
Frailty is a prevalent condition amongst older adults, significantly affecting their quality of life. The FRAIL tool has been purposefully designed for clinical application by assisting healthcare professionals in identifying and managing frailty-related issues in older adults, making it a preferred choice for assessing frailty across diverse older populations. This review aimed to synthesize the measurement properties and feasibility of FRAIL. Guided by COSMIN guidelines, seven databases were searched from inception to 31 Mar 2023. The measurement properties were extracted for quality appraisal of the populations in the studied samples. Where possible, random-effects meta-analysis and meta-regression were used for quantitative synthesis. Eighteen articles containing 273 tests were drawn from 14 different populations. We found that populations testing for criterion validity had high-quality ratings, while construct validity ratings varied based on health status and geographical region. Test-retest reliability had sufficient quality ratings, while scale agreement had sufficient ratings in only four out of 14 populations tested. Responsiveness ratings were insufficient in seven out of eight populations, with inconsistent ratings in one population. Our analysis of missing data across three articles showed a 16.3% rate, indicating good feasibility of the FRAIL. FRAIL is a feasible tool for assessing frailty of older adults in community settings, with good criterion validity and test-retest reliability. However, more research is needed on construct validity and responsiveness.
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Affiliation(s)
- Yu Xuan Ng
- Alexandra Hospital, National University Health System, Singapore
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yu Yi Quek
- Alexandra Hospital, National University Health System, Singapore
| | - Ruby Yu
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore.
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Shakya S, Silva SG, McConnell ES, McLaughlin SJ, Cary MP. Structural determinants and cardiometabolic typologies related to frailty in community-dwelling older adults. Arch Gerontol Geriatr 2024; 117:105171. [PMID: 37688920 DOI: 10.1016/j.archger.2023.105171] [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: 07/14/2023] [Revised: 08/20/2023] [Accepted: 08/26/2023] [Indexed: 09/11/2023]
Abstract
Frailty is a geriatric syndrome linked to adverse outcomes. Co-occurring cardiometabolic factors increase frailty risk; however, their distinct combinations (typologies) associated with frailty are unclear. We aimed to identify subgroups of older adults with distinct cardiometabolic typologies and characterize their relationship with structural determinants and frailty to inform tailored approaches to prevent and delay frailty. This study was cross-sectional design and included 7984 community-dwelling older adults (65+ years) enrolled in the Health and Retirement Study (2006 and 2008). Latent class analysis was performed using seven cardiometabolic indicators (abdominal obesity, obesity, low high-density lipoprotein; and elevated blood pressure, blood sugar, total cholesterol, C-reactive protein). Frailty was indicated by ≥3 features (weakness, slowness, fatigue, low physical activity, unintentional weight loss). Logistic regression was used to examine the relationship between structural determinants (gender, race/ethnicity, and education), cardiometabolic typologies, and frailty. Three cardiometabolic subgroups were identified: insulin-resistant (n = 3547), hypertensive dyslipidemia (n = 1246), and hypertensive (n = 3191). Insulin-resistant subgroup members were more likely to be female, non-Hispanic Black, and college non-graduates; hypertensive dyslipidemia subgroup members were more likely to be non-Hispanic Others and report high school education; and hypertensive subgroup members were more likely to be male and college educated (p≤.05). Frailty risk was higher for females, Hispanic or Non-Hispanic Black older adults, and those with lower education (p≤.001). Frailty risk was greater in the insulin-resistant compared to the other subgroups (both aOR=2.0, both p<.001). Findings highlight a need to design tailored interventions targeting cardiometabolic typologies to prevent and delay frailty.
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Affiliation(s)
- Shamatree Shakya
- College of Nursing, University of Illinois at Chicago, Chicago, IL, United States.
| | - Susan G Silva
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States
| | - Eleanor S McConnell
- Department of Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC), Durham, NC, United States
| | - Sara J McLaughlin
- Department of Sociology and Gerontology, Miami University, Oxford, OH, United States
| | - Michael P Cary
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States
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10
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Chaganti J. Editorial for "MRI Assessment of Brain Frailty and Clinical Outcome in Patients With Acute Posterior Perforating Artery Infarction". J Magn Reson Imaging 2024; 59:350-351. [PMID: 37158363 DOI: 10.1002/jmri.28767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Affiliation(s)
- Joga Chaganti
- Department of Radiology, St Vincent's Hospital, Sydney, New South Wales, Australia
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Cai H, Zhang H, Liang J, Liu Z, Huang G. Genetic liability to frailty in relation to functional outcome after ischemic stroke. Int J Stroke 2024; 19:50-57. [PMID: 37542426 DOI: 10.1177/17474930231194676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
BACKGROUND Frailty appears to be associated with unfavorable prognosis after stroke in observational studies, but the causality remains largely unknown. AIMS The aim of this study is to investigate the potential causal effect of frailty on functional outcome at 3 months after ischemic stroke using the Mendelian randomization (MR) framework. METHODS Genetic instruments for frailty index were identified in a genome-wide association study meta-analysis including 175,226 individuals of European descent. Corresponding genetic association estimates for functional outcome after ischemic stroke at 90 days were taken from the Genetic of Ischemic Stroke Functional Outcome (GISCOME) network of 6021 patients. We performed inverse-variance weighted MR as the main analyses, followed by several alternate methods and sensitivity analyses. RESULTS In univariable MR, we found evidence that genetically predicted higher frailty index (odds ratio (OR) = 5.12; 95% confidence interval (CI) = 1.31-20.09; p = 0.019) was associated with worse functional outcome (modified Rankin Scale score ⩾3) after ischemic stroke. In further multivariable MR adjusting for potential confounding traits including body mass index, C-reactive protein, inflammatory bowel disease, and smoking initiation, the overall patterns between genetic liability to frailty and poor functional outcome status remained. Sensitivity analyses with complementary methods and with model unadjusted for baseline stroke severity (OR = 4.19; 95% CI = 1.26-13.90; p = 0.019) yielded broadly concordant results. CONCLUSIONS The present MR study suggested a possible causal effect of frailty on poor functional outcome after ischemic stroke. Frailty might represent a potential target for intervention to improve recovery after ischemic stroke.
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Affiliation(s)
- Huan Cai
- Department of Rehabilitation Medicine, Zhongshan City People's Hospital, Zhongshan, China
| | - Hao Zhang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jialin Liang
- Department of Endocrinology and Metabolism, Zhongshan City People's Hospital, Zhongshan, China
| | - Zhonghua Liu
- Department of Rehabilitation Medicine, Zhongshan City People's Hospital, Zhongshan, China
| | - Guozhi Huang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
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12
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Hammant A, Chithiramohan T, Haunton V, Beishon L. Cognitive testing following transient ischaemic attack: A systematic review of clinical assessment tools. COGENT PSYCHOLOGY 2023; 10:2196005. [PMID: 37025393 PMCID: PMC10069374 DOI: 10.1080/23311908.2023.2196005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Cognitive deficits are prevalent after transient ischaemic attack (TIA) and result in loss of function, poorer quality of life and increased risks of dependency and mortality. This systematic review aimed to synthesise the available evidence on cognitive assessment in TIA patients to determine the prevalence of cognitive deficits, and the optimal tests for cognitive assessment. Medline, Embase, PsychINFO and CINAHL databases were searched for relevant articles. Articles were screened by title and abstract. Full-text analysis and quality assessment was performed using the National Institute of Health Tool. Data were extracted on study characteristics, prevalence of TIA deficits, and key study findings. Due to significant heterogeneity, meta-analysis was not possible. Twenty-five full-text articles met the review inclusion criteria. There was significant heterogeneity in terms of cognitive tests used, definitions of cognitive impairment and TIA, time points post-event, and analysis methods. The majority of studies used the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) (n = 23). Prevalence of cognitive impairment ranged from 2% to 100%, depending on the time-point and cognitive domain studied. The MoCA was more sensitive than the MMSE for identifying cognitive deficits. Deficits were common in executive function, attention, and language. No studies assessed diagnostic test accuracy against a reference standard diagnosis of cognitive impairment. Recommendations on cognitive testing after TIA are hampered by significant heterogeneity between studies, as well as a lack of diagnostic test accuracy studies. Future research should focus on harmonising tools, definitions, and time-points, and validating tools specifically for the TIA population.
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Affiliation(s)
- Alexander Hammant
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Victoria Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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13
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Zhang N, Jia Z, Gu T, Zheng Y, Zhang Y, Song W, Chen Z, Li G, Tse G, Liu T. Associations between modifiable risk factors and frailty: a Mendelian randomisation study. J Epidemiol Community Health 2023; 77:782-790. [PMID: 37604674 DOI: 10.1136/jech-2023-220882] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Early identification of modifiable risk factors is essential for the prevention of frailty. This study aimed to explore the causal relationships between a spectrum of genetically predicted risk factors and frailty. METHODS Univariable and multivariable Mendelian randomisation (MR) analyses were performed to explore the relationships between 22 potential risk factors and frailty, using summary genome-wide association statistics. Frailty was accessed by the frailty index. RESULTS Genetic liability to coronary artery disease (CAD), type 2 diabetes mellitus (T2DM), ischaemic stroke, atrial fibrillation and regular smoking history, as well as genetically predicted 1-SD increase in body mass index, systolic blood pressure, diastolic blood pressure, low-density lipoprotein cholesterol, triglycerides, alcohol intake frequency and sleeplessness were significantly associated with increased risk of frailty (all p<0.001). In addition, there was a significant inverse association between genetically predicted college or university degree with risk of frailty (beta -0.474; 95% CI (-0.561 to -0.388); p<0.001), and a suggestive inverse association between high-density lipoprotein cholesterol level with risk of frailty (beta -0.032; 95% CI (-0.055 to -0.010); p=0.004). However, no significant causal associations were observed between coffee consumption, tea consumption, serum level of total testosterone, oestradiol, 25-hydroxyvitamin D, C reactive protein or moderate to vigorous physical activity level with frailty (all p>0.05). Results of the reverse directional MR suggested bidirectional causal associations between T2DM and CAD with frailty. CONCLUSIONS This study provided genetic evidence for the causal associations between several modifiable risk factors with lifetime frailty risk. A multidimensional approach targeting these factors may hold a promising prospect for prevention frailty.
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Affiliation(s)
- Nan Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Ziheng Jia
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Tianshu Gu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yi Zheng
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yunpeng Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Wenhua Song
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Ziliang Chen
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, Kent, UK
- School of Nursing and Health Studies, Hong Kong, Metropolitan University, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
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14
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Kara N, Iweka CA, Blacher E. Chrono-Gerontology: Integrating Circadian Rhythms and Aging in Stroke Research. Adv Biol (Weinh) 2023; 7:e2300048. [PMID: 37409422 DOI: 10.1002/adbi.202300048] [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: 01/31/2023] [Revised: 05/14/2023] [Indexed: 07/07/2023]
Abstract
Stroke is a significant public health concern for elderly individuals. However, the majority of pre-clinical studies utilize young and healthy rodents, which may result in failure of candidate therapies in clinical trials. In this brief review/perspective, the complex link between circadian rhythms, aging, innate immunity, and the gut microbiome to ischemic injury onset, progression, and recovery is discussed. Short-chain fatty acids and nicotinamide adenine dinucleotide+ (NAD+ ) production by the gut microbiome are highlighted as key mechanisms with profound rhythmic behavior, and it is suggested to boost them as prophylactic/therapeutic approaches. Integrating aging, its associated comorbidities, and circadian regulation of physiological processes into stroke research may increase the translational value of pre-clinical studies and help to schedule the optimal time window for existing practices to improve stroke outcome and recovery.
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Affiliation(s)
- Nirit Kara
- Department of Biological Chemistry, The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Edmond J. Safra Campus Givat-Ram, Jerusalem, 9190401, Israel
| | - Chinyere Agbaegbu Iweka
- Department of Neurology & Neurological Sciences, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Eran Blacher
- Department of Biological Chemistry, The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Edmond J. Safra Campus Givat-Ram, Jerusalem, 9190401, Israel
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15
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Chu CS, Cheng SL, Bai YM, Su TP, Tsai SJ, Chen TJ, Yang FC, Chen MH, Liang CS. Multimorbidity Pattern and Risk for Mortality Among Patients With Dementia: A Nationwide Cohort Study Using Latent Class Analysis. Psychiatry Investig 2023; 20:861-869. [PMID: 37794668 PMCID: PMC10555512 DOI: 10.30773/pi.2023.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Individuals with dementia are at a substantially elevated risk for mortality; however, few studies have examined multimorbidity patterns and determined the inter-relationship between these comorbidities in predicting mortality risk. METHODS This is a prospective cohort study. Data from 6,556 patients who were diagnosed with dementia between 1997 and 2012 using the Taiwan National Health Insurance Research Database were analyzed. Latent class analysis was performed using 16 common chronic conditions to identify mortality risk among potentially different latent classes. Logistic regression was performed to determine the adjusted association of the determined latent classes with the 5-year mortality rate. RESULTS With adjustment for age, a three-class model was identified, with 42.7% of participants classified as "low comorbidity class (cluster 1)", 44.2% as "cardiometabolic multimorbidity class (cluster 2)", and 13.1% as "FRINGED class (cluster 3, characterized by FRacture, Infection, NasoGastric feeding, and bleEDing over upper gastrointestinal tract)." The incidence of 5-year mortality was 17.6% in cluster 1, 26.7% in cluster 2, and 59.6% in cluster 3. Compared with cluster 1, the odds ratio for mortality was 9.828 (95% confidence interval [CI]=6.708-14.401; p<0.001) in cluster 2 and 1.582 (95% CI=1.281-1.953; p<0.001) in cluster 3. CONCLUSION Among patients with dementia, the risk for 5-year mortality was highest in the subpopulation characterized by fracture, urinary and pulmonary infection, upper gastrointestinal bleeding, and nasogastric intubation, rather than cancer or cardiometabolic comorbidities. These findings may improve decision-making and advance care planning for patients with dementia.
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Affiliation(s)
- Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Non-Invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Li Cheng
- Department of Nursing, Mackay Medical College, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
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16
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Zhang Q, Gao X, Huang J, Xie Q, Zhang Y. Association of pre-stroke frailty and health-related factors with post-stroke functional independence among community-dwelling Chinese older adults. J Stroke Cerebrovasc Dis 2023; 32:107130. [PMID: 37058872 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107130] [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: 01/02/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023] Open
Abstract
OBJECTIVES Frailty is associated with a range of poor post-stroke outcomes. There is still a lack of comprehensive understanding of the temporal relationship between pre-stroke frailty status and other related factors with functional recovery after stroke. This study aims to evaluate pre-stroke frailty status and health-related factors associated with functional independence among community-dwelling Chinese older adults. MATERIALS AND METHODS The dataset based on the China Health and Retirement Longitudinal Study (CHARLS) conducted in 28 provinces across China was used. The pre-stroke frailty status was assessed using the Physical Frailty Phenotype (PFP) scale with the 2015 wave data. The PFP scale consisted of five criteria with a total score of 5, and categorized into non-frail (0 point), prefrail (1 and 2 points), and frail (3 or more points). Covariates included demographic factors (age, sex, marital status, residence, and education level) and health-related variables (comorbidities, self-reported health status and cognition). Activities of daily living (ADL) and instrumental activities of daily living (IADL) were assessed as the functional outcomes, with difficulties in at least one of the 6 ADL items and 5 IADL items defined as ADL/IADL limitation respectively. A logistic regression model was used to estimate the associations. RESULTS A total of 666 participants who were newly diagnosed with stroke during the 2018 wave were included. 234 (35.1%) participants were classified as non-frail, 380 (57.1%) participants were classified as prefrail, and 52 (7.8%) participants were classified as frail. Pre-stroke frailty was significantly associated with ADL and IADL limitations post stroke. Additional significant variables with ADL limitation were age, female and more comorbidities. Additional significant variables with IADL limitation were age, female, married or cohabitating, more comorbidities and pre-stroke lower global cognitive score. CONCLUSION Frailty status was associated with ADL and IADL limitations after stroke. A more comprehensive assessment of frailty in older people may help to identify those with most significant risk for declining functional capacities after stroke and to develop appropriate intervention strategies.
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Affiliation(s)
- Qi Zhang
- Doctor of Occupational Therapy (OTD), College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, China.
| | - Xi Gao
- Master of Education, Department of Exercise Sciences, The University of Auckland, New Zealand.
| | - Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, China.
| | - Qiurong Xie
- Master of Rehabilitation Science, College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, China.
| | - Yanxin Zhang
- Department of Exercise Sciences, The University of Auckland, Auckland 1142, New Zealand.
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17
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Taylor JA, Greenhaff PL, Bartlett DB, Jackson TA, Duggal NA, Lord JM. Multisystem physiological perspective of human frailty and its modulation by physical activity. Physiol Rev 2023; 103:1137-1191. [PMID: 36239451 PMCID: PMC9886361 DOI: 10.1152/physrev.00037.2021] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
"Frailty" is a term used to refer to a state characterized by enhanced vulnerability to, and impaired recovery from, stressors compared with a nonfrail state, which is increasingly viewed as a loss of resilience. With increasing life expectancy and the associated rise in years spent with physical frailty, there is a need to understand the clinical and physiological features of frailty and the factors driving it. We describe the clinical definitions of age-related frailty and their limitations in allowing us to understand the pathogenesis of this prevalent condition. Given that age-related frailty manifests in the form of functional declines such as poor balance, falls, and immobility, as an alternative we view frailty from a physiological viewpoint and describe what is known of the organ-based components of frailty, including adiposity, the brain, and neuromuscular, skeletal muscle, immune, and cardiovascular systems, as individual systems and as components in multisystem dysregulation. By doing so we aim to highlight current understanding of the physiological phenotype of frailty and reveal key knowledge gaps and potential mechanistic drivers of the trajectory to frailty. We also review the studies in humans that have intervened with exercise to reduce frailty. We conclude that more longitudinal and interventional clinical studies are required in older adults. Such observational studies should interrogate the progression from a nonfrail to a frail state, assessing individual elements of frailty to produce a deep physiological phenotype of the syndrome. The findings will identify mechanistic drivers of frailty and allow targeted interventions to diminish frailty progression.
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Affiliation(s)
- Joseph A Taylor
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - Paul L Greenhaff
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - David B Bartlett
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina.,Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Thomas A Jackson
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom
| | - Niharika A Duggal
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom
| | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
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18
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Ducca EL, Gomez GT, Palta P, Sullivan KJ, Jack CR, Knopman DS, Gottesman RF, Walston J, Windham BG, Walker KA. Physical Frailty and Brain White Matter Abnormalities: The Atherosclerosis Risk in Communities Study. J Gerontol A Biol Sci Med Sci 2023; 78:357-364. [PMID: 35596270 PMCID: PMC9951053 DOI: 10.1093/gerona/glac111] [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: 01/31/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical frailty is associated with increased risk for dementia and other neurologic sequelae. However, the neurobiological changes underlying frailty and frailty risk remain unknown. We examined the association of cerebral white matter structure with current and future frailty. METHODS Atherosclerosis Risk in Communities Study Neurocognitive Study participants who underwent 3T brain MRI were included. Frailty status was classified according to the Fried criteria. Cerebral white matter integrity was defined using white matter hyperintensity (WMH) volume and microstructure, measured using diffusion tensor imaging fractional anisotropy (FA) and mean diffusivity (MD). Multivariable linear regression was used to relate baseline frailty to white matter structure; multivariable logistic regression was used to relate baseline white matter to frailty risk among participants nonfrail at baseline. RESULTS In the cross-sectional analysis (N = 1 754; mean age: 76 years), frailty was associated with greater WMH volume, lower FA, and greater MD. These associations remained consistent after excluding participants with a history of stroke or dementia. Among participants nonfrail at baseline who completed follow-up frailty assessment (N = 1 379; 6.6-year follow-up period), each standard deviation increase in WMH volume was associated with 1.46 higher odds of frailty at follow-up. Composite FA and MD measures were not associated with future frailty; however, secondary analyses found several significant white matter tract-specific associations with frailty risk. CONCLUSION The current study demonstrates a robust association of WMH volume with current and future frailty. Although measures of white matter microstructure were altered in frail individuals, these measures were not generally associated with progression from nonfrail to frail status.
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Affiliation(s)
- Emma L Ducca
- Department of Psychology, St. John’s University, Jamaica, New York, USA
| | - Gabriela T Gomez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Priya Palta
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin J Sullivan
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca F Gottesman
- Stroke Branch, Intramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Center on Aging and Health, and Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - B Gwen Windham
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Keenan A Walker
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
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19
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Veronese N, Maniscalco L, Matranga D, Lacca G, Dominguez LJ, Barbagallo M. Association Between Pollution and Frailty in Older People: A Cross-Sectional Analysis of the UK Biobank. J Am Med Dir Assoc 2023; 24:475-481.e3. [PMID: 36774967 DOI: 10.1016/j.jamda.2022.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/22/2022] [Accepted: 12/31/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVES Frailty is a relevant issue in older people, being associated with several negative outcomes. Increasing literature is reporting that pollution (particularly air pollution) can increase the risk of frailty, but the research is still limited. We aimed to investigate the potential association of pollution (air, noise) with frailty and prefrailty among participants 60 years and older of the UK Biobank study. DESIGN Cross-sectional. SETTINGS AND PARTICIPANTS Older participants (age ≥ 60 years) participating to the UK Biobank. METHODS Frailty and prefrailty presence were ascertained using a model including 5 indicators (weakness, slowness, weight loss, low physical activity, and exhaustion). Air pollution was measured through residential exposures to nitrogen oxides (NOx) and particulate matter (PM2.5, PM2.5-10, PM10). The average residential sound level during the daytime, the evening, and night was used as an index for noise pollution. RESULTS A total of 220,079 subjects, aged 60 years and older, was included. The partial proportional odds model, adjusted for several confounders, showed that the increment in the exposure to NOx was associated with a higher probability of being in both the prefrail and frail category [odds ratio (OR) 1.003; 95% CI 1.001-1.004]. Similarly, the increase in the exposure to PM2.5-10 was associated with a higher probability of being prefrail and frail (OR 1.014; 95% CI 1.001-1.036), such as the increment in the exposure to PM2.5 that was associated with a higher probability of being frail (OR 1.018; 95% CI 1.001-1.037). CONCLUSIONS AND IMPLICATIONS Our study indicates that the exposure to air pollutants as PM2.5, PM2.5-10, or NOx might be associated with frailty and prefrailty, suggesting that air pollution can contribute to frailty and indicating that the frailty prevention and intervention strategies should take into account the dangerous impact of air pollutants.
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Affiliation(s)
- Nicola Veronese
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy.
| | - Laura Maniscalco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy
| | - Domenica Matranga
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy
| | - Guido Lacca
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy
| | - Ligia J Dominguez
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy; School of Medicine and Surgery, University Kore of Enna, Enna, Italy
| | - Mario Barbagallo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy
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20
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Dos Santos Mantovani M, Coelho de Carvalho N, Ferreira Minicucci M, Gustavo Modelli de Andrade L, de Souza Cavalcante R, Berg de Almeida G, Aline Costa N, de Fátima da Silva J, Augusto Monteiro de Barros Almeida R. Transitions in frailty state 12 months after kidney transplantation: a prospective cohort study. J Nephrol 2022; 35:2341-2349. [PMID: 36048368 DOI: 10.1007/s40620-022-01436-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frailty is associated with several unfavorable outcomes after kidney transplantation (KTx). However, limited information is available regarding the transitions in frailty state and its components after KTx. This study aimed to evaluate the transitions in physical frailty phenotype and its components over a period of 12 months after KTx. METHODS In this prospective single-center cohort study, we measured physical frailty phenotype (PFP) and its components at the time of admission for KTx and 12 months after KTx. The evaluation includes five components: weakness (grip strength analysed by sex and body mass index quartiles), physical activity (kcals/week based on the Minnesota Leisure Time Physical Activity questionnaire), exhaustion (self-report using the Center for Epidemiological Studies Depression Scale), gait speed (time taken to walk 15 feet based on sex and height-specific cutoff), and unintentional weight loss (self-report of unintentional weight loss > 10 lbs in the last year). The exhaustion and physical activity components are validated in the Brazilian population. Each component is scored as 0 or 1 according to its presence or absence, and a PFP score of 3-5 defines frailty, 2 is intermediate, and 0-1 is rated as non-frail. We used the McNemar and Wilcoxon test to compare physical frailty phenotype and its components between the two periods. RESULTS Among 87 patients included in the study, 16.1% were classified as frail, 20.7% as intermediately frail, and 63.2% as non-frail. Sixty-four patients were included in the analysis to evaluate transitions in frailty. At the time of admission for KTx, 15.6% of patients were defined as frail compared to 4.7% of patients at 12 months after KTx (p = 0.023). Among the physical frailty phenotype components, the proportion of patients who scored in the weight loss category 12 months after KTx was significantly lower than that at the time of KTx (6.3% vs 34.4%, p < 0.001). CONCLUSIONS There was a 69.9% reduction in the prevalence of frail patients at the end of the 12-month follow-up after KTx. Among the components of frailty, weight loss showed a significant improvement.
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Affiliation(s)
| | | | - Marcos Ferreira Minicucci
- Internal Medicine Department, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | | | - Ricardo de Souza Cavalcante
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Gabriel Berg de Almeida
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Nara Aline Costa
- Faculty of Nutrition, Universidade Federal de Goiás (UFG), Goiânia, Brazil
| | - Julhiany de Fátima da Silva
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
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21
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Miranda LA, Luvizutto GJ, Stephan BCM, Souza JTD, Silva TRD, Winckler FC, Ferreira NC, Antunes LCDO, Bessornia PAC, Bazan SGZ, Fukushima FB, Costa RDMD, Modolo GP, Minicucci MF, Bazan R, Vidal EIDO. Evaluating the performance of the PRISMA-7 frailty criteria for predicting disability and death after acute ischemic stroke. J Stroke Cerebrovasc Dis 2022; 31:106837. [PMID: 36283237 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
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22
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Pluta R, Jabłoński M, Januszewski S, Czuczwar SJ. Crosstalk between the aging intestinal microflora and the brain in ischemic stroke. Front Aging Neurosci 2022; 14:998049. [PMID: 36275012 PMCID: PMC9582537 DOI: 10.3389/fnagi.2022.998049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022] Open
Abstract
Aging is an inevitable phenomenon experienced by animals and humans, and its intensity varies from one individual to another. Aging has been identified as a risk factor for neurodegenerative disorders by influencing the composition of the gut microbiota, microglia activity and cognitive performance. The microbiota-gut-brain axis is a two-way communication path between the gut microbes and the host brain. The aging intestinal microbiota communicates with the brain through secreted metabolites (neurotransmitters), and this phenomenon leads to the destruction of neuronal cells. Numerous external factors, such as living conditions and internal factors related to the age of the host, affect the condition of the intestinal microflora in the form of dysbiosis. Dysbiosis is defined as changes in the composition and function of the gut microflora that affect the pathogenesis, progress, and response to treatment of a disease entity. Dysbiosis occurs when changes in the composition and function of the microbiota exceed the ability of the microflora and its host to restore equilibrium. Dysbiosis leading to dysfunction of the microbiota-gut-brain axis regulates the development and functioning of the host’s nervous, immune, and metabolic systems. Dysbiosis, which causes disturbances in the microbiota-gut-brain axis, is seen with age and with the onset of stroke, and is closely related to the development of risk factors for stroke. The review presents and summarizes the basic elements of the microbiota-gut-brain axis to better understand age-related changes in signaling along the microbiota-gut-brain axis and its dysfunction after stroke. We focused on the relationship between the microbiota-gut-brain axis and aging, emphasizing that all elements of the microbiota-gut-brain axis are subject to age-related changes. We also discuss the interaction between microbiota, microglia and neurons in the aged individuals in the brain after ischemic stroke. Finally, we presented preclinical and clinical studies on the role of the aged microbiota-gut-brain axis in the development of risk factors for stroke and changes in the post-stroke microflora.
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Affiliation(s)
- Ryszard Pluta
- Laboratory of Ischemic and Neurodegenerative Brain Research, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
- *Correspondence: Ryszard Pluta,
| | - Mirosław Jabłoński
- Department of Rehabilitation and Orthopedics, Medical University of Lublin, Lublin, Poland
| | - Sławomir Januszewski
- Laboratory of Ischemic and Neurodegenerative Brain Research, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
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23
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Kamimoto T, Kawakami M, Morita T, Miyazaki Y, Hijikata N, Akimoto T, Tsujikawa M, Honaga K, Suzuki K, Kondo K, Tsuji T. Effects of the COVID-19 Pandemic on Physical Function of Community-Dwelling People with Disabilities in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12599. [PMID: 36231898 PMCID: PMC9566647 DOI: 10.3390/ijerph191912599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
In 2020, COVID-19 spread throughout the world, and international measures such as travel bans, quarantines, and increased social distancing were implemented. In Japan, the number of infected people increased, and a state of emergency was declared from 16 April to 25 May 2020. Such a change in physical activity could lead to a decline in physical function in people with disabilities. A retrospective study was conducted to determine the impact of the pandemic on the physical function of disabled persons living in the community. Data were collected at four points in time: two points before the declaration of the state of emergency was issued and two points after the declaration period had ended. Time series data of physical function at four points in time were compared for 241 people with disabilities. The mean age was 72.39 years; 157 had stroke, 59 musculoskeletal disease, and 26 other diseases. Overall, there was a long-term decrease in walking speed (p < 0.001) and a worsening of the Timed Up-and-Go (TUG) score (p < 0.001) after the period of the state of emergency. The TUG score worsened only in the group with a walking speed of 1.0 m/s or less before the state of emergency (p = 0.064), suggesting that this group was more susceptible.
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Affiliation(s)
- Takayuki Kamimoto
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
| | - Towa Morita
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
| | - Yuta Miyazaki
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
- Department of Physical Rehabilitation, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Nanako Hijikata
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - Tomonori Akimoto
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
| | - Masahiro Tsujikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Kanjiro Suzuki
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
- Department of Rehabilitation Medicine, Waseda Clinic, Miyazaki 880-0933, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
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24
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Liu W, Zhang L, Fang H, Gao Y, Liu K, Li S, Liu H, Wang X, Liu C, Song B, Xia Z, Xu Y. Genetically predicted frailty index and risk of stroke and Alzheimer's disease. Eur J Neurol 2022; 29:1913-1921. [PMID: 35318774 DOI: 10.1111/ene.15332] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have reported the association between frailty and stroke or Alzheimer's disease (AD). However, the causality remains unclear. The aim of the present study was to evaluate whether genetically predicted frailty is associated with the risk of stroke or AD by a Mendelian randomization (MR) study. METHODS Genetic variants associated with the frailty index (FI) were obtained from a large genome-wide association study (GWAS). Summary-level data for stroke and AD were adopted from the corresponding large GWAS of individuals of European ancestry. The inverse variance weighted method was used for estimating causal effects. Multivariable analysis was performed for further adjustment. RESULTS The present MR study indicated a suggestive association between genetically predicted FI and a higher risk of any stroke (odds ratio 1.360, 95% confidence interval 1.006-1.838, p = 0.046). Regarding the subtypes of stroke, genetically predicted FI was associated with a higher risk of large artery atherosclerosis stroke (LAS) (odds ratio 2.487, 95% confidence interval 1.282-4.826, p = 0.007). No causal links were identified between genetically predicted FI and any ischaemic stroke, intracranial haemorrhage, cardioembolic stroke, small artery stroke, AD or AD-by-proxy. Multivariable MR analysis indicated that the association of genetically predicted FI with LAS was attenuated after adjustment for inflammatory bowel disease (p = 0.114). CONCLUSIONS The MR study suggested that genetically predicted FI may be associated with an increased risk of any stroke. Subgroup analysis indicated a suggestive association between genetically predicted FI and the risk of LAS. The underlying mechanisms need further investigation.
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Affiliation(s)
- Weishi Liu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Clinical Systems Biology Laboratories, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Luyang Zhang
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Fang
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Gao
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kai Liu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shen Li
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Clinical Systems Biology Laboratories, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongbing Liu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Clinical Systems Biology Laboratories, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Wang
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Clinical Systems Biology Laboratories, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chen Liu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Clinical Systems Biology Laboratories, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Song
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zongping Xia
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Clinical Systems Biology Laboratories, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuming Xu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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25
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Yang F, Li N, Yang L, Chang J, Yan A, Wei W. Association of Pre-stroke Frailty With Prognosis of Elderly Patients With Acute Cerebral Infarction: A Cohort Study. Front Neurol 2022; 13:855532. [PMID: 35711265 PMCID: PMC9196308 DOI: 10.3389/fneur.2022.855532] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Frailty is a state of cumulative degradation of physiological functions that leads to adverse outcomes such as disability or mortality. Currently, there is still little understanding of the prognosis of pre-stroke frailty status with acute cerebral infarction in the elderly. Objective We investigated the association between pre-stroke frailty status, 28-day and 1-year survival outcomes, and functional recovery after acute cerebral infarction. Methods Clinical data were collected from 314 patients with acute cerebral infarction aged 65–99 years. A total of 261 patients completed follow-up in the survival cohort analysis and 215 patients in the functional recovery cohort analysis. Pre-stroke frailty status was assessed using the FRAIL score, the prognosis was assessed using the modified Rankin Scale (mRS), and disease severity using the National Institutes of Health Stroke Scale (NIHSS). Results Frailty was independently associated with 28-day mortality in the survival analysis cohort [hazard ratio (HR) = 4.30, 95% CI 1.35–13.67, p = 0.014]. However, frailty had no independent effect on 1-year mortality (HR = 1.47, 95% CI 0.78–2.79, p = 0.237), but it was independently associated with advanced age, the severity of cerebral infarction, and combined infection during hospitalization. Logistic regression analysis after adjusting for potential confounders in the functional recovery cohort revealed frailty, and the NIHSS score was significantly associated with post-stroke severe disability (mRS > 2) at 28 days [pre-frailty adjusted odds ratio (aOR): 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.002] or 1 year (pre-frailty aOR: 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.003). Conclusions Pre-stroke frailty is an independent risk factor for 28-day mortality and 28-day or 1-year severe disability. Age, the NIHSS score, and co-infection are likewise independent risk factors for 1-year mortality.
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Affiliation(s)
- Fuxia Yang
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Nan Li
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Lu Yang
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jie Chang
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Aijuan Yan
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wenshi Wei
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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26
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Proietti M, Romiti GF, Raparelli V, Diemberger I, Boriani G, Dalla Vecchia LA, Bellelli G, Marzetti E, Lip GY, Cesari M. Frailty prevalence and impact on outcomes in patients with atrial fibrillation: A systematic review and meta-analysis of 1,187,000 patients. Ageing Res Rev 2022; 79:101652. [PMID: 35659945 DOI: 10.1016/j.arr.2022.101652] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/20/2022] [Accepted: 05/23/2022] [Indexed: 12/14/2022]
Abstract
Frailty is a clinical syndrome characterized by a reduced physiologic reserve, increased vulnerability to stressors and an increased risk of adverse outcomes. People with atrial fibrillation (AF) are often burdened by frailty due to biological, clinical, and social factors. The prevalence of frailty, its management and association with major outcomes in AF patients are still not well quantified. We systematically searched PubMed and EMBASE, from inception to September 13th, 2021, for studies reporting the prevalence of frailty in AF patients. The study was registered in PROSPERO (CRD42021235854). 33 studies were included in the systematic review (n = 1,187,651 patients). The frailty pooled prevalence was 39.7 % (95 %CI=29.9 %-50.5 %, I2 =100 %), while meta-regression analyses showed it is influenced by age, history of stroke, and geographical location. Meta-regression analyses showed that OAC prescription was influenced by study-level mean age, baseline thromboembolic risk, and study setting. Frail AF patients were associated with a higher risk of all-cause death (OR=5.56, 95 %CI=3.46-8.94), ischemic stroke (OR=1.59, 95 %CI=1.00-2.52), and bleeding (OR=1.64, 95 %CI=1.11-2.41), when compared to robust individuals. In this systematic review and meta-analysis, the prevalence of frailty was high in patients with AF. Frailty may influence the prognosis and management of AF patients, thus requiring person-tailored interventions in a holistic or integrated approach to AF care.
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Affiliation(s)
- Marco Proietti
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
| | | | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Italy; University Center for Studies on Gender Medicine, University of Ferrara, Italy; University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Italy
| | | | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Emanuele Marzetti
- Università Cattolica del Sacro Cuore, Department of Geriatrics and Orthopedics, Rome, Italy; Center for Geriatric Medicine (Ce.M.I.), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome,Italy
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
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27
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Shakya S, Bajracharya R, Ledbetter L, Cary MP. The Association between Cardiometabolic Risk Factors and Frailty in Older Adults: A Systematic Review. Innov Aging 2022; 6:igac032. [PMID: 35795135 PMCID: PMC9250659 DOI: 10.1093/geroni/igac032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Enhanced management and prevention of frailty depend on our understanding of the association between potentially modifiable risk factors and frailty. However, the associations between potentially modifiable cardiometabolic risk factors and frailty are not clear. The purpose of this review was to appraise and synthesize the current evidence examining the associations between the cardiometabolic risk factors and frailty. Research Design and Methods Multiple databases, including MEDLINE (via PubMed), Embase (via Elsevier), and Web of Science (via Clarivate), were searched extensively. Studies that examined cardiometabolic risk factors and frailty as main predictors and outcome of interest, respectively, among older adults (≥60 years) were included. The Joanna Briggs Institute critical appraisal tools were used to evaluate the quality of studies. PRISMA (2020) guided this review, and findings were synthesized without meta-analysis. This systematic review was registered in PROSPERO (CRD42021252565). Results Twelve studies met the eligibility criteria and were included in the review. Abdominal obesity, hyperglycemia, and multiple co-occurring cardiometabolic risk factors were associated with the increased likelihood of frailty in older adults. There was inconsistency across the studies regarding the associations between dyslipidemia, elevated blood pressure, and frailty. Discussion and Implications Understanding the association between cardiometabolic risk factors and frailty can have translational benefits in developing tailored interventions for the prevention and management of frailty. More studies are needed to validate predictive and clinically significant associations between single and specific combinations of co-occurring cardiometabolic risk factors and frailty.
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Affiliation(s)
| | | | - Leila Ledbetter
- School of Medicine, Medical Center Library & Archives, Duke University, Durham, NC, USA
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28
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Muir KW, Saposnik G. Current State and Future for Emerging Stroke Therapies: Reflections and Reactions. Stroke 2022; 53:2082-2084. [PMID: 35535598 DOI: 10.1161/strokeaha.122.039796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Keith W Muir
- School of Psychology and Neuroscience, Queen Elizabeth University Hospital, University of Glasgow, Scotland, United Kingdom (K.W.M.)
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Canada (G.S.).,Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada (G.S.)
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29
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Abstract
The microbiota-gut-brain-axis (MGBA) is a bidirectional communication network between gut microbes and their host. Many environmental and host-related factors affect the gut microbiota. Dysbiosis is defined as compositional and functional alterations of the gut microbiota that contribute to the pathogenesis, progression and treatment responses to disease. Dysbiosis occurs when perturbations of microbiota composition and function exceed the ability of microbiota and its host to restore a symbiotic state. Dysbiosis leads to dysfunctional signaling of the MGBA, which regulates the development and the function of the host's immune, metabolic, and nervous systems. Dysbiosis-induced dysfunction of the MGBA is seen with aging and stroke, and is linked to the development of common stroke risk factors such as obesity, diabetes, and atherosclerosis. Changes in the gut microbiota are also seen in response to stroke, and may impair recovery after injury. This review will begin with an overview of the tools used to study the MGBA with a discussion on limitations and potential experimental confounders. Relevant MGBA components are introduced and summarized for a better understanding of age-related changes in MGBA signaling and its dysfunction after stroke. We will then focus on the relationship between the MGBA and aging, highlighting that all components of the MGBA undergo age-related alterations that can be influenced by or even driven by the gut microbiota. In the final section, the current clinical and preclinical evidence for the role of MGBA signaling in the development of stroke risk factors such as obesity, diabetes, hypertension, and frailty are summarized, as well as microbiota changes with stroke in experimental and clinical populations. We conclude by describing the current understanding of microbiota-based therapies for stroke including the use of pre-/pro-biotics and supplementations with bacterial metabolites. Ongoing progress in this new frontier of biomedical sciences will lead to an improved understanding of the MGBA's impact on human health and disease.
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Affiliation(s)
- Pedram Honarpisheh
- Department of Neurology, University of Texas McGovern Medical School, Houston (P.H., L.D.M.)
| | - Robert M Bryan
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX (R.M.B.)
| | - Louise D McCullough
- Department of Neurology, University of Texas McGovern Medical School, Houston (P.H., L.D.M.)
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30
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Tan BYQ, Ho JSY, Leow AS, Chia MLJ, Sia CH, Koh YY, Seetharaman SK, Yang C, Gopinathan A, Teoh HL, Sharma VK, Seet RCS, Chan BPL, Yeo LLL, Tan LF. Effect of frailty on outcomes of endovascular treatment for acute ischaemic stroke in older patients. Age Ageing 2022; 51:6575882. [PMID: 35486669 DOI: 10.1093/ageing/afac096] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND frailty has been shown to be a better predictor of clinical outcomes than age alone across many diseases. Few studies have examined the relationship between frailty, stroke and stroke interventions such as endovascular thrombectomy (EVT). OBJECTIVE we aimed to investigate the impact of frailty measured by clinical frailty scale (CFS) on clinical outcomes after EVT for acute ischemic stroke (AIS) in older patients ≥70 years. METHODS in this retrospective cohort study, we included all consecutive AIS patients age ≥ 70 years receiving EVT at a single comprehensive stroke centre. Patients with CFS of 1-3 were defined as not frail, and CFS > 3 was defined as frail. The primary outcome was modified Rankin Score (mRS) at 90 days. The secondary outcomes included duration of hospitalisation, in-hospital mortality, carer requirement, successful reperfusion, symptomatic intracranial haemorrhage and haemorrhagic transformation. RESULTS a total of 198 patients were included. The mean age was 78.1 years and 52.0% were female. Frail patients were older, more likely to be female, had more co-morbidities. CFS was significantly associated with poor functional outcome after adjustment for age, NIHSS and time to intervention (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.04-2.28, P = 0.032). There was trend towards higher mortality rate in frail patients (frail: 18.3%; non-frail: 9.6%; P = 0.080). There were no significant differences in other secondary outcomes except increased carer requirement post discharge in frail patients (frail: 91.6%; non-frail: 72.8%; P = 0.002). CONCLUSIONS frailty was associated with poorer functional outcome at 90 days post-EVT in patients ≥ 70 years.
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Affiliation(s)
- Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jamie S Y Ho
- Academic Foundation Programme, Royal Free London NHS Foundation Trust, London, UK
| | - Aloysius S Leow
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Magdalene L J Chia
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Ching Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ying Ying Koh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Cunli Yang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Anil Gopinathan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Raymond C S Seet
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Li Feng Tan
- Healthy Ageing Programme, Department of Geriatric Medicine, Alexandra Hospital, Singapore, Singapore
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31
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Burton JK, Stewart J, Blair M, Oxley S, Wass A, Taylor-Rowan M, Quinn TJ. Prevalence and implications of frailty in acute stroke: systematic review & meta-analysis. Age Ageing 2022; 51:afac064. [PMID: 35352795 PMCID: PMC9037368 DOI: 10.1093/ageing/afac064] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND frailty is common in older adults and associated with poor outcomes following illness. Although stroke is predominantly a disease of older people, our knowledge of frailty in stroke is limited. We aimed to collate the literature on acute stroke and frailty to estimate the prevalence of pre-stroke frailty and its associations with outcomes. METHODS paired researchers searched multidisciplinary electronic databases for papers describing frailty and acute stroke. We assessed risk of bias using Newcastle-Ottawa tools appropriate to study design. We created summary estimates of pre-stroke frailty using random effects models. We collated whether studies reported significant positive associations between frailty and clinical outcomes in adjusted models. RESULTS we included 14 studies (n = 27,210 participants). Seven studies (n = 8,840) used a frailty index approach, four studies (n = 14,924) used Hospital Frailty Risk Scores. Pooled prevalence of pre-stroke frailty was 24.6% (95% confidence interval, CI: 16.2-33.1%; low quality evidence, downgraded due to heterogeneity, bias). Combining frailty and pre-frailty (nine studies, n = 23,827), prevalence of any frailty syndrome was 66.8% (95%CI: 49.9-83.7%). Seven studies were at risk of bias, from participant selection or method of frailty assessment. Pre-stroke frailty was associated with all adverse outcomes assessed, including longer-term mortality (positive association in 6 of 6 studies reporting this outcome; odds ratio: 3.75 [95%CI: 2.41-5.70]), length of admission (3 of 4 studies) and disability (4 of 6 studies). CONCLUSIONS despite substantial heterogeneity, whichever way it is measured, frailty is common in patients presenting with acute stroke and associated with poor outcomes. This has implications for the design of stroke services and pathways.
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Affiliation(s)
- Jennifer K Burton
- Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Glasgow, UK
| | - Jennifer Stewart
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde,
Glasgow, UK
| | - Mairi Blair
- Queen Elizabeth University Hospital, NHS Greater Glasgow and
Clyde, Glasgow, UK
| | - Sinead Oxley
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde,
Glasgow, UK
| | - Amy Wass
- Forth Valley Royal Hospital, NHS Forth Valley, Larbert,
UK
| | - Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Glasgow, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Glasgow, UK
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Munthe-Kaas R, Aam S, Saltvedt I, Wyller TB, Pendlebury ST, Lydersen S, Hagberg G, Schellhorn T, Rostoft S, Ihle-Hansen H. Is Frailty Index a better predictor than pre-stroke modified Rankin Scale for neurocognitive outcomes 3-months post-stroke? BMC Geriatr 2022; 22:139. [PMID: 35183106 PMCID: PMC8857811 DOI: 10.1186/s12877-022-02840-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The prognostic value of frailty measures for post-stroke neurocognitive disorder (NCD) remains to be evaluated.
Aims
The aim of this study was to compare the predictive value of pre-stroke FI with pre-stroke modified Rankin Scale (mRS) for post-stroke cognitive impairment. Further, we explored the added value of including FI in prediction models for cognitive prognosis post-stroke.
Methods
We generated a 36-item Frailty Index (FI), based on the Rockwood FI, to measure frailty based on pre-stroke medical conditions recorded in the Nor-COAST multicentre prospective study baseline assessments. Consecutive participants with a FI score and completed cognitive test battery at three months were included. We generated Odds Ratio (OR) with NCD as the dependent variable. The predictors of primary interest were pre-stroke frailty and mRS. We also measured the predictive values of mRS and FI by the area (AUC) under the receiver operating characteristic curve.
Results
598 participants (43.0% women, mean/SD age = 71.6/11.9, mean/SD education = 12.5/3.8, mean/SD pre-stroke mRS = 0.8/1.0, mean/SD GDS pre-stroke = 1.4/0.8, mean/SD NIHSS day 1 3/4), had a FI mean/SD score = 0.14/0.10. The logistic regression analyses showed that FI (OR 3.09), as well as the mRS (OR 2.21), were strong predictors of major NCD. When FI and mRS were entered as predictors simultaneously, the OR for mRS decreased relatively more than that for FI. AUC for NCD post-stroke was higher for FI than for mRS, both for major NCD (0.762 vs 0.677) and for any NCD (0.681 vs 0.638).
Conclusions
FI is a stronger predictor of post-stroke NCD than pre-stroke mRS and could be a part of the prediction models for cognitive prognosis post-stroke.
Trial Registration
ClinicalTrials.gov Identifier: NCT02650531.
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Bąk E, Młynarska A, Marcisz C, Kadłubowska M, Marcisz-Dyla E, Sternal D, Młynarski R, Krzemińska S. Kinesiophobia in Elderly Polish Patients After Ischemic Stroke, Including Frailty Syndrome. Neuropsychiatr Dis Treat 2022; 18:707-715. [PMID: 35387207 PMCID: PMC8979513 DOI: 10.2147/ndt.s352151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In patients after stroke, the relationship between the occurrence of kinesiophobia and the accompanying frailty syndrome, as well as the acceptance of the disease and the level of mood, has not been recognized so far. The aim of this study was to determine the prevalence of kinesiophobia in elderly Polish people after ischemic stroke, including the frailty syndrome and the associations between the prevalence of kinesiophobia and feelings of anxiety and degree of the illness acceptance. METHODS A cross-sectional study was used to achieve the study objectives. The study involved 152 hospitalized patients aged of minimum 60 (mean age 63), qualified for post-stroke rehabilitation, including 76 women and 76 men. The patients were divided into two groups, with kinesiophobia (119 persons) and without kinesiophobia (33 persons). The Tampa Scale of Kinesiophobia (TSK), the Tilburg Frailty Indicator (TFI), the Hospital Anxiety Depression Scale (HADS) and the Acceptance of Illness Scale (AIS) were used. Study results were calculated using MedCalc Software. RESULTS Kinesiophobia has been demonstrated in 78% of people after ischemic stroke. The values of TFI and HADS were higher in the patients with kinesiophobia (p<0.001). In patients with ischemic stroke, it was shown that the level of kinesiophobia increased with higher anxiety (p<0.001), higher total TFI score, (p<0.05), and a lower level of illness acceptance (p<0.001). CONCLUSION The occurrence of kinesiophobia in elderly Polish people after ischemic stroke is common and the determinants of its development are the coexistence of the frailty syndrome, anxiety and a low level of illness acceptance. In post-stroke patients, the presence of kinesiophobia should be considered, especially in the situation of comorbid frailty syndrome. The issue of kinesiophobia in patients after stroke requires further in-depth research, especially in the field of cognitive-behavioral prevention aimed at ways to reduce this phenomenon.
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Affiliation(s)
- Ewelina Bąk
- Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biala, Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Czesław Marcisz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Monika Kadłubowska
- Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biala, Poland
| | - Ewa Marcisz-Dyla
- Faculty of Management, Psychology, Katowice Business University, Katowice, Poland
| | - Danuta Sternal
- Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biala, Poland
| | - Rafał Młynarski
- Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Sylwia Krzemińska
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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Diaz-Toro F, Petermann-Rocha F, Parra-Soto S, Troncoso-Pantoja C, Concha-Cisternas Y, Lanuza F, Dreyer Arroyo E, Celis A, Celis-Morales C. Association between Poor Oral Health and Frailty in Middle-Aged and Older Individuals: A Cross-Sectional National Study. J Nutr Health Aging 2022; 26:987-993. [PMID: 36437766 DOI: 10.1007/s12603-022-1858-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Older adults with poor oral health may be at higher risk of being pre-frail or frail. However, very few studies have examined this association in Latin American countries and middle-aged individuals. Therefore, we aimed to investigate the association between oral health and frailty status among Chilean adults ≥40 years. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS We included 3,036 participants ≥40 years from the Chilean National Health Survey 2016-2017. METHODS Frailty status was assessed with a 49-item frailty index, while the number of teeth, self-reported oral health, tooth decay, use of prostheses, and oral pain were the oral health conditions included. To assess the association between oral health conditions and frailty, we used multinomial logistic regression models status adjusted for sociodemographic and lifestyle variables. RESULTS Overall, 40.6% and 11.8% of individuals were classified as pre-frail and frail, respectively. After adjusting for confounders, individuals with ≤20 teeth had a higher likelihood of being frail (odds ratio (OR): 1.94 [95% CI: 1.18-3.20]) than people with >20 teeth. Moreover, people with bad or very bad oral health, as well as oral pain, had a higher likelihood of being pre-frail (OR: 2.04 [95% CI: 1.40-2.97] and OR: 2.92 [95% CI: 1.58-5.39], respectively). Middle-aged individuals with fewer teeth and poor self-reported oral health had a higher likelihood of being pre-frail and frail than people ≥60. CONCLUSIONS AND IMPLICATIONS Individuals with poor global oral health were more likely to be pre-frail or frail. This association seems to be stronger in people <60 years old. Our results are consistent with previously published reports.
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Affiliation(s)
- F Diaz-Toro
- Fanny Petermann-Rocha, PhD, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile, , Phone: +56 2 26768968
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Predictors of Transition to Frailty in Middle-Aged and Older People With HIV: A Prospective Cohort Study. J Acquir Immune Defic Syndr 2021; 88:518-527. [PMID: 34757975 DOI: 10.1097/qai.0000000000002810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND People with HIV (PWH) have increased frailty risk at younger ages compared with the general population. Multimorbidity is associated with frailty, yet effects of specific comorbidities on transition to frailty in PWH are unknown. SETTING Prospective study of 219 PWH age 45 years or older in the National NeuroAIDS Tissue Consortium. METHODS Frailty status was categorized using Fried frailty phenotype criteria. Comorbidities [bone disease, cardiovascular disease, cerebrovascular disease, liver disease, renal disease, diabetes, chronic obstructive pulmonary disease (COPD), hypertension, obesity, cancers, neuropsychiatric conditions] were assessed from longitudinal data. Associations between baseline comorbidities and transition to frailty within 30 months were analyzed using Kaplan-Meier and Cox regression models. Grip strength was assessed using mixed-effects models. RESULTS At baseline, the median age was 61 years, 73% were male 98% were on antiretroviral therapy, 29% had ≥3 comorbidities, 27% were robust, and 73% were pre-frail. Cerebrovascular disease, diabetes, and COPD were independent predictors of transition to frailty within 30 months in models adjusted for age, sex, and multimorbidity (≥3 additional comorbidities) [hazard ratios (95% confidence intervals) 2.52 (1.29 to 4.93), 2.31 (1.12 to 4.76), and 1.82 (0.95 to 3.48), respectively]. Furthermore, cerebrovascular disease, diabetes, COPD, or liver disease co-occurring with multimorbidity was associated with substantially increased frailty hazards compared with multimorbidity alone (hazard ratios 4.75-7.46). Cerebrovascular disease was associated with decreased baseline grip strength (P = 0.0001), whereas multimorbidity, diabetes, and COPD were associated with declining grip strength (P < 0.10). CONCLUSIONS In older PWH, cerebrovascular disease, diabetes, COPD, or liver disease co-occurring with multimorbidity is associated with substantially increased risk of becoming frail within 30 months. Interventions targeting these comorbidities may ameliorate frailty and age-related functional decline in PWH.
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36
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Zhao Y, Lu Y, Zhao W, Wang Y, Ge M, Zhou L, Yue J, Dong B, Hao Q. Long sleep duration is associated with cognitive frailty among older community-dwelling adults: results from West China Health and Aging Trend study. BMC Geriatr 2021; 21:608. [PMID: 34706663 PMCID: PMC8555015 DOI: 10.1186/s12877-021-02455-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/03/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To investigate the association between sleep duration and cognitive frailty among older adults dwelling in western China. METHODS We used the baseline data from West China Health and Aging Trend (WCHAT) study. Sleep duration was classified as short sleep duration (< 6 h), normal sleep duration (6-8 h) and long sleep duration (≥ 9 h). Fried frailty criteria and Short Portable Mental Status Questionnaire were used to measure cognitive frailty. Multinomial logistic regression was conducted to estimate odds ratio (OR) and 95% confidence interval (CI). RESULTS A total of 4093 older adults (age = 67.8 ± 5.9 years, 1708 males and 2385 females) were included in the analysis. The prevalence of cognitive frailty was 11.8% among older adults in western China. Approximately 11.9% participants had short sleep duration (< 6 h); 22.2% had a long sleep duration (≥ 9 h). After adjusting for covariates, only long sleep duration was significantly associated with high risk of cognitive frailty (OR = 2.07, 95%CI = 1.60-2.68, P < 0.001) in western China older adults compared to normal sleep duration. CONCLUSIONS Long sleep duration was significantly related to cognitive frailty in older adults. Intervention for long sleep duration may be helpful to prevent cognitive frailty. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR1800018895 .
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Affiliation(s)
- Yunli Zhao
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, China.,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No.37 GuoXueXiang, Chengdu, 610041, Sichuan, China
| | - Ying Lu
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Wanyu Zhao
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, China.,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No.37 GuoXueXiang, Chengdu, 610041, Sichuan, China
| | - Yanyan Wang
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, China.,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No.37 GuoXueXiang, Chengdu, 610041, Sichuan, China
| | - Meiling Ge
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, China.,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No.37 GuoXueXiang, Chengdu, 610041, Sichuan, China
| | - Lixing Zhou
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, China.,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No.37 GuoXueXiang, Chengdu, 610041, Sichuan, China
| | - Jirong Yue
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, China.,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No.37 GuoXueXiang, Chengdu, 610041, Sichuan, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, China. .,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No.37 GuoXueXiang, Chengdu, 610041, Sichuan, China.
| | - Qiukui Hao
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, China.,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No.37 GuoXueXiang, Chengdu, 610041, Sichuan, China
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37
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Aminu AQ, Wondergem R, Van Zaalen Y, Pisters M. Self-Efficacy Is a Modifiable Factor Associated with Frailty in Those with Minor Stroke: Secondary Analysis of 200 Cohort Respondents. Cerebrovasc Dis Extra 2021; 11:99-105. [PMID: 34628411 PMCID: PMC8543288 DOI: 10.1159/000519311] [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: 05/22/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Owing to the improvement in acute care, there has been an increase in the number of people surviving stroke and living with its impairments. Frailty is common in people with stroke and has a significant impact on the prognosis after stroke. To reduce frailty progression, potentially modifiable factors should be identified. Increasing levels of self-efficacy influence both behaviour and physical functioning, and therefore it could be a potential target to prevent frailty. METHODS This is a prospective cohort study that involved the secondary analysis of the RISE data to examine the relationship between self-efficacy and frailty. The RISE study is a longitudinal study that consists of 200 adults aged 18+ years after their first stroke event. Data were collected from the respondents at 3 weeks, 6 months, 12 months, and 24 months after their discharge from the hospital. Frailty was assessed using the multidimensional frailty index with scores ranging from 0 to 1, and self-efficacy was assessed using the SESx scale, which was dichotomized as low/moderate or high. Frailty trajectories were examined using the repeated linear model. The generalized estimating equation was used to examine the relationship between self-efficacy and frailty at baseline and in the future (6-24 months). The B coefficients were reported at 95% CI before and after adjusting for potential confounders (age, gender, stroke severity, education, and social support). RESULTS A total of 200 responses were analysed, and the mean age of the respondents was 67.78 ± 11.53. Females made up 64% of the sample, and the mean frailty score at baseline was 0.17 ± 0.09. After adjusting for confounders, respondents with low self-efficacy had an approximately 5% increase in their frailty scores at baseline and in the 24-month follow-up period compared to those with high self-efficacy. CONCLUSION The result from this study showed that self-efficacy was significantly associated with frailty after stroke. Our findings suggest that self-efficacy may play a role in frailty progression among stroke survivors.
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Affiliation(s)
- Abodunrin Quadri Aminu
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, United Kingdom
| | - Roderick Wondergem
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,The Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne Van Zaalen
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Martijn Pisters
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,The Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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38
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Sawada N, Takeuchi N, Ekuni D, Morita M. Oral function, nutritional status and physical status in Japanese independent older adults. Gerodontology 2021; 39:359-365. [PMID: 34599786 DOI: 10.1111/ger.12593] [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: 06/25/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To clarify the associations among oral status, nutritional status and physical status in Japanese independent older adults. BACKGROUND It is important to focus on factors affecting physical status associated with life dysfunction, long-term care and mortality. However, there are very few reports of the associations among oral status, nutritional status and physical status. MATERIALS AND METHODS Patients who visited the Preventive Dentistry Clinic at Okayama University Hospital from November 2017 to January 2019 participated in this cross-sectional study. Number of teeth, periodontal condition and oral function were recorded. Bacteria counts in tongue dorsum, oral wettability, tongue pressure, tongue and lip movement function [oral diadochokinesis (ODK)], masticatory ability, bite force and swallowing function were measured. Nutritional status was assessed by the Mini Nutritional Assessment. Physical frailty status and Elderly Status Assessment Set were also evaluated. These variables were analysed by structural equation modelling (SEM). RESULTS Data from 203 patients were analysed (63 males and 140 females). Patients ranged in age from 60 to 93 years. The final model of the path diagram was completed by SEM. ODK was positively associated with nutritional status, and nutritional status was negatively associated with frailty. Age was associated with ODK, nutritional status and frailty. CONCLUSION Based on the associations among age, ODK, nutritional status and frailty, maintaining tongue movement function may contribute to good nutritional status and physical status in Japanese independent older adults.
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Affiliation(s)
- Nanami Sawada
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Noriko Takeuchi
- Department of Preventive Dentistry, Okayama University Hospital, Okayama, Japan
| | - Daisuke Ekuni
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Manabu Morita
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Potential Mechanisms of Acute Standing Balance Deficits After Concussions and Subconcussive Head Impacts: A Review. Ann Biomed Eng 2021; 49:2693-2715. [PMID: 34258718 DOI: 10.1007/s10439-021-02831-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023]
Abstract
Standing balance deficits are prevalent after concussions and have also been reported after subconcussive head impacts. However, the mechanisms underlying such deficits are not fully understood. The objective of this review is to consolidate evidence linking head impact biomechanics to standing balance deficits. Mechanical energy transferred to the head during impacts may deform neural and sensory components involved in the control of standing balance. From our review of acute balance-related changes, concussions frequently resulted in increased magnitude but reduced complexity of postural sway, while subconcussive studies showed inconsistent outcomes. Although vestibular and visual symptoms are common, potential injury to these sensors and their neural pathways are often neglected in biomechanics analyses. While current evidence implies a link between tissue deformations in deep brain regions including the brainstem and common post-concussion balance-related deficits, this link has not been adequately investigated. Key limitations in current studies include inadequate balance sampling duration, varying test time points, and lack of head impact biomechanics measurements. Future investigations should also employ targeted quantitative methods to probe the sensorimotor and neural components underlying balance control. A deeper understanding of the specific injury mechanisms will inform diagnosis and management of balance deficits after concussions and subconcussive head impact exposure.
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40
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Abreu P, Magalhães R, Baptista D, Azevedo E, Correia M. Admission and Readmission/Death Patterns in Hospitalized and Non-hospitalized First-Ever-in-a-Lifetime Stroke Patients During the First Year: A Population-Based Incidence Study. Front Neurol 2021; 12:685821. [PMID: 34566836 PMCID: PMC8455946 DOI: 10.3389/fneur.2021.685821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Hospitalization and readmission rates after a first-ever-in-a-lifetime stroke (FELS) are considered measures of quality of care and, importantly, may give valuable information to better allocate health-related resources. We aimed to investigate the hospitalization pattern and the unplanned readmissions or death of hospitalized (HospS) and non-hospitalized stroke (NHospS) patients 1 year after a FELS, based on a community register. Methods: Data about hospitalization and unplanned readmissions and case fatality 1 year after a FELS were retrieved from the population-based register undertaken in Northern Portugal (ACIN2), comprising all FELS in 2009–2011. We used the Kaplan–Meier method to estimate 1-year readmission/death-free survival and Cox proportional hazard models to identify independent factors for readmission/death. Results: Of the 720 FELS, 35.7% were not hospitalized. Unplanned readmission/death within 1 year occurred in 33.0 and 24.9% of HospS and NHospS patients, respectively. The leading causes of readmission were infections, recurrent stroke, and cardiovascular events. Stroke-related readmissions were observed in more than half of the patients in both groups. Male sex, age, pre- and post-stroke functional status, and diabetes were independent factors of readmission/death within 1 year. Conclusion: About one-third of stroke patients were not hospitalized, and the readmission/death rate was higher in HospS patients. Still, that readmission/death rate difference was likely due to other factors than hospitalization itself. Our research provides novel information that may help implement targeted health-related policies to reduce the burden of stroke and its complications.
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Affiliation(s)
- Pedro Abreu
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Diana Baptista
- Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Manuel Correia
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Department of Neurology, Hospital Santo António - Centro Hospitalar Universitário do Porto, Porto, Portugal
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Evans NR, Todd OM, Minhas JS, Fearon P, Harston GW, Mant J, Mead G, Hewitt J, Quinn TJ, Warburton EA. Frailty and cerebrovascular disease: Concepts and clinical implications for stroke medicine. Int J Stroke 2021; 17:251-259. [PMID: 34282986 PMCID: PMC8864332 DOI: 10.1177/17474930211034331] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Frailty is a distinctive health state in which the ability of older people to cope with
acute stressors is compromised by an increased vulnerability brought by age-associated
declines in physiological reserve and function across multiple organ systems. Although
closely associated with age, multimorbidity, and disability, frailty is a discrete
syndrome that is associated with poorer outcomes across a range of medical conditions.
However, its role in cerebrovascular disease and stroke has received limited attention.
The estimated rise in the prevalence of frailty associated with changing demographics over
the coming decades makes it an important issue for stroke practitioners, cerebrovascular
research, clinical service provision, and stroke survivors alike. This review will
consider the concept and models of frailty, how frailty is common in cerebrovascular
disease, the impact of frailty on stroke risk factors, acute treatments, and
rehabilitation, and considerations for future applications in both cerebrovascular
clinical and research settings.
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Affiliation(s)
| | - Oliver M Todd
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Jatinder S Minhas
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Patricia Fearon
- Department of Stroke Medicine, Royal Victoria Hospital, Belfast, UK
| | - George W Harston
- Acute Stroke Programme, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jonathan Mant
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jonathan Hewitt
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Piotrowicz K, Gryglewska B, Grodzicki T, Gąsowski J. Arterial stiffness and frailty - A systematic review and metaanalysis. Exp Gerontol 2021; 153:111480. [PMID: 34265411 DOI: 10.1016/j.exger.2021.111480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/24/2022]
Abstract
Frailty and cardiovascular disease share some of the pathophysiologic features. Our objective was to review and metaanalyse the available published evidence on the topic. We performed a comprehensive literature search for studies where pulse wave velocity (PWV) or carotid-ankle vascular index (CAVI) has been linked with frailty in older persons. Of the initial 362 abstracts, after the application of the PRISMA approach, 5 were analysed in detail. We calculated within-study and pooled standardised mean differences of aortic stiffness measures between frail and non-frail (0.62 [0.31-0.92], p < 0.0001, I2 = 88%), and pre-frail and non-frail (0.32 [0.14-0.51], p = 0.0006, I2 = 72%) groups. In two studies it was possible to extract directly or calculate based on published data the odds ratios for the concomitant frailty, associated in one case with CAVI greater by 1 m/s and in another with cfPWV >13 m/s, indicating greater probability of concomitant frailty given greater aortic stiffness. Across the studies, the prevalence of hypertension, diabetes mellitus, hyperlipidaemia, and smoking tended to increase from non-frail, to pre-frail, and frail groups, presenting a possibility of important confounding, but also a common pathophysiology. In conclusion, the pooled analysis of the published cross-sectional study results indicates a relation between aortic stiffness and frailty in older subjects. However, well designed prospective studies are needed to answer the questions of causality.
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Affiliation(s)
- Karolina Piotrowicz
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Kraków, Poland
| | - Barbara Gryglewska
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Kraków, Poland
| | - Tomasz Grodzicki
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Kraków, Poland
| | - Jerzy Gąsowski
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Kraków, Poland.
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Huberman MA, d'Adesky ND, Niazi QB, Perez-Pinzon MA, Bramlett HM, Raval AP. Irisin-Associated Neuroprotective and Rehabilitative Strategies for Stroke. Neuromolecular Med 2021; 24:62-73. [PMID: 34215971 DOI: 10.1007/s12017-021-08666-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/19/2021] [Indexed: 10/20/2022]
Abstract
Irisin, a newly discovered protein hormone that is secreted in response to low frequency whole body vibration (LFV), could be a promising post-stroke rehabilitation therapy for patients who are frail and cannot comply with regular rehabilitation therapy. Irisin is generated from a membrane-bound precursor protein fibronectin type III domain-containing protein 5 (FNDC5). Aside from being highly expressed in muscle, FNDC5 is highly expressed in the brain. The cleaved form of FNDC5 was found in the cerebrospinal fluid as well as in various regions of the brain. Numerous studies suggest that irisin plays a key role in brain metabolism and inflammation regulation. Both the metabolism and inflammation govern stroke outcome, and in a published study, we demonstrated that LFV therapy following middle cerebral artery occlusion significantly reduced innate immune response, improved motor function and infarct volume in reproductively senescent female rats. The observed effect of LFV therapy could be working via irisin, therefore, the current review focuses to understand various aspects of irisin including its mechanism of action on the brain.
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Affiliation(s)
- Melissa Ann Huberman
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Nathan D d'Adesky
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Qismat Bahar Niazi
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Miguel A Perez-Pinzon
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Helen M Bramlett
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, 33136, USA.,Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, 33136, USA
| | - Ami P Raval
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, 33136, USA.
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Analysis of Frailty in Geriatric Patients as a Prognostic Factor in Endovascular Treated Patients with Large Vessel Occlusion Strokes. J Clin Med 2021; 10:jcm10102171. [PMID: 34069797 PMCID: PMC8157268 DOI: 10.3390/jcm10102171] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/21/2022] Open
Abstract
Frailty is associated with an increased risk of adverse health-care outcomes in elderly patients. The Hospital Frailty Risk Score (HFRS) has been developed and proven to be capable of identifying patients which are at high risk of adverse outcomes. We aimed to investigate whether frail patients also face adverse outcomes after experiencing an endovascular treated large vessel occlusion stroke (LVOS). In this retrospective observational cohort study, we analyzed patients ≥ 65 years that were admitted during 2015-2019 with LVOS and endovascular treatment. Primary outcomes were mortality and the modified Rankin Scale (mRS) after three months. Regression models were used to determine the impact of frailty. A total of 318 patients were included in the cohort. The median HFRS was 1.6 (IQR 4.8). A total of 238 (75.1%) patients fulfilled the criteria for a low-frailty risk with a HFRS < 5.72 (22.7%) for moderate-frailty risk with an HFRS from 5-15 and 7 (2.2%) patients for a high-frailty risk. Multivariate regression analyses revealed that the HFRS was associated with an increased mortality after 90 days (CI (95%) 1.001 to 1.236; OR 1.112) and a worse mRS (CI (95%) 1.004 to 1.270; OR 1.129). We identified frailty as an impact factor on functional outcome and mortality in patients undergoing thrombectomy in LVOS.
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Kong LN, Lyu Q, Yao HY, Yang L, Chen SZ. The prevalence of frailty among community-dwelling older adults with diabetes: A meta-analysis. Int J Nurs Stud 2021; 119:103952. [PMID: 34022743 DOI: 10.1016/j.ijnurstu.2021.103952] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/17/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Coexistence of frailty and chronic diseases including diabetes is related to a higher risk of adverse health outcomes. There is an increasing interest in the intersection of diabetes and frailty. Understanding the prevalence of frailty in older adults with diabetes is of great importance. However, estimates of the prevalence of frailty among this population varied widely in the relevant literature. OBJECTIVES To conduct a systematic review and meta-analysis to estimate the overall prevalence of frailty and prefrailty among community-dwelling older adults with diabetes, and examine the risk factors associated with frailty in this population. METHODS PubMed, Web of Science, Embase, Wiley Cochrane Library, and Cumulative Index of Nursing and Allied Health were searched from inception to May 30th, 2020. Investigators assessed eligibility, extracted data and evaluated methodological quality. The pooled prevalence of frailty and prefrailty was calculated using the random-effects model. Meta-regression analysis and subgroup analysis were conducted to explore sources of heterogeneity. RESULTS A total of 32 studies met the inclusion criteria, involving 14,450 individuals. The pooled prevalence of frailty and prefrailty in older adults with diabetes was 20.1% (95% CI = 16.0-24.2%) and 49.1% (95%CI = 45.1-53.1%), respectively, with significant heterogeneity across the studies. Frailty was more prevalent in older adults with diabetes than those without diabetes (OR = 1.61, 95%CI = 1.47-1.77, p < 0.001). The pooled prevalence of frailty was lower in studies using Frailty Phenotype to define frailty (16.3%) and conducted in Asia (14.3%). Female gender and unmarried status were risk factors of frailty among this population. CONCLUSION Frailty and prefrailty are common in community-dwelling older adults with diabetes. Early screening of frailty and interventions should be integrated into diabetes care for older adults to prevent and reduce the negative effects of frailty at the community level. Better quality longitudinal research is required to examine the temporal relationship between diabetes and frailty.
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Affiliation(s)
- Ling-Na Kong
- School of Nursing, Chongqing Medical University, No. 1 Yixueyuan Road, Yu Zhong District, Chongqing 400016, PR China; School of Nursing, The first Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.
| | - Qiong Lyu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Hai-Yan Yao
- Library, The first Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Li Yang
- School of Nursing, Qingdao University, Qingdao, PR China
| | - Shuo-Zhen Chen
- Clinical Nursing Teaching and Research Section, Affiliated Hospital of Zunyi Medical University, Zunyi, PR China
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Wæhler IS, Saltvedt I, Lydersen S, Fure B, Askim T, Einstad MS, Thingstad P. Association between in-hospital frailty and health-related quality of life after stroke: the Nor-COAST study. BMC Neurol 2021; 21:100. [PMID: 33663430 PMCID: PMC7931593 DOI: 10.1186/s12883-021-02128-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/17/2021] [Indexed: 12/31/2022] Open
Abstract
Background Stroke survivors are known to have poorer health-related quality of life (HRQoL) than the general population, but less is known about characteristics associated with HRQoL decreasing through time following a stroke. This study aims to examine how in-hospital frailty is related to HRQoL from 3 to 18 months post stroke. Method Six hundred twenty-five participants hospitalised with stroke were included and followed up at 3 and/or 18 months post stroke. Stroke severity was assessed the day after admission with the National Institutes of Health Stroke Scale (NIHSS). A modified Fried phenotype was used to assess in-hospital frailty; measures of exhaustion, physical activity, and weight loss were based on pre-stroke status, while gait speed and grip strength were measured during hospital stay. HRQoL at 3- and 18-months follow-up were assessed using the five-level version of the EuroQol five-dimensional descriptive system (EQ-5D-5L) and the EuroQol visual analogue scale (EQ-5D VAS). We conducted linear mixed effect regression analyses unadjusted and adjusted for sex, age, and stroke severity to investigate the association between in-hospital frailty and post-stroke HRQoL. Results Mean (SD) age was 71.7 years (11.6); mean NIHSS score was 2.8 (4.0), and 263 (42.1%) were female. Frailty prevalence was 10.4%, while 58.6% were pre-frail. The robust group had EQ-5D-5L index and EQ-5D VAS scores at 3 and 18 months comparable to the general population. Also at 3 and 18 months, the pre-frail and frail groups had significantly lower EQ-5D-5L indices than the robust group (p < 0.001), and the frail group showed a larger decrease from 3 to 18 months in the EQ-5D-5L index score compared to the robust group (− 0.056; 95% CI − 0.104 to − 0.009; p = 0.021). There were no significant differences in change in EQ-5D VAS scores between the groups. Conclusion This study on participants mainly diagnosed with mild strokes suggests that robust stroke patients have fairly good and stable post-stroke HRQoL, while post-stroke HRQoL is impaired and continues to deteriorate among patients with in-hospital frailty. This emphasises the importance of a greater focus on frailty in stroke units. Trial registration ClinicalTrials.gov (NCT02650531).
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Affiliation(s)
- Idunn Snorresdatter Wæhler
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Brynjar Fure
- Department of Internal Medicine and Department of Neurology, Central Hospital Karlstad and School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Marte Stine Einstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
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Grande G, Qiu C, Fratiglioni L. Prevention of dementia in an ageing world: Evidence and biological rationale. Ageing Res Rev 2020; 64:101045. [PMID: 32171784 DOI: 10.1016/j.arr.2020.101045] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/21/2020] [Accepted: 03/10/2020] [Indexed: 12/31/2022]
Abstract
As the population ages, the number of people with dementia is expected to increase in the coming decades, with consequences at the societal and individual levels. In this narrative review, we provide a summary of the scientific evidence concerning dementia prevention, with a focus on the following three strategies: 1) Targeting the body to protect the brain, including prevention and treatment of cardiovascular morbidity; 2) Compensatory interventions to counteract brain ageing, including education and life-long engagement in cognitively and socially stimulating activities; and 3) Lifespan health promotion, such as a physically active lifestyle, smoking cessation, and a healthy and balanced diet. Next, we consider the biological mechanisms by which these strategies may act by taking into account the main pathways implicated in the development and progression of dementia: neurodegeneration, brain resilience, vascular damage, neuroinflammation, and oxidative stress. Based on the current evidence, and in line with the declining trends of dementia incidence in high-income countries, we conclude that timely multidomain preventive actions are promising strategies to reduce the dementia epidemic worldwide. There is still a considerable gap between the epidemiological evidence and its underlying biological mechanisms. Filling this gap will be crucial to move forward in dementia prevention worldwide.
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Cosarderelioglu C, Nidadavolu LS, George CJ, Oh ES, Bennett DA, Walston JD, Abadir PM. Brain Renin-Angiotensin System at the Intersect of Physical and Cognitive Frailty. Front Neurosci 2020; 14:586314. [PMID: 33117127 PMCID: PMC7561440 DOI: 10.3389/fnins.2020.586314] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022] Open
Abstract
The renin–angiotensin system (RAS) was initially considered to be part of the endocrine system regulating water and electrolyte balance, systemic vascular resistance, blood pressure, and cardiovascular homeostasis. It was later discovered that intracrine and local forms of RAS exist in the brain apart from the endocrine RAS. This brain-specific RAS plays essential roles in brain homeostasis by acting mainly through four angiotensin receptor subtypes; AT1R, AT2R, MasR, and AT4R. These receptors have opposing effects; AT1R promotes vasoconstriction, proliferation, inflammation, and oxidative stress while AT2R and MasR counteract the effects of AT1R. AT4R is critical for dopamine and acetylcholine release and mediates learning and memory consolidation. Consequently, aging-associated dysregulation of the angiotensin receptor subtypes may lead to adverse clinical outcomes such as Alzheimer’s disease and frailty via excessive oxidative stress, neuroinflammation, endothelial dysfunction, microglial polarization, and alterations in neurotransmitter secretion. In this article, we review the brain RAS from this standpoint. After discussing the functions of individual brain RAS components and their intracellular and intracranial locations, we focus on the relationships among brain RAS, aging, frailty, and specific neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, and vascular cognitive impairment, through oxidative stress, neuroinflammation, and vascular dysfunction. Finally, we discuss the effects of RAS-modulating drugs on the brain RAS and their use in novel treatment approaches.
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Affiliation(s)
- Caglar Cosarderelioglu
- Division of Geriatrics, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey.,Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lolita S Nidadavolu
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Claudene J George
- Division of Geriatrics, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States
| | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Peter M Abadir
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Jagadeesan V, Culver A, Raiker N, Halverson Q, Prasada S, Chen L, Welty LJ, Prabhakaran S, Maganti K. Left Atrial Dilation and Risk of One-Year Readmission after Embolic Stroke of Undetermined Source. J Stroke Cerebrovasc Dis 2020; 29:104975. [PMID: 32689607 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104975] [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: 04/01/2020] [Revised: 05/04/2020] [Accepted: 05/16/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Structural left atrial and ventricular abnormalities on the electrocardiogram (ECG) and transthoracic echocardiogram (TTE) at the time of ischemic stroke have been associated with morbidity and mortality. Yet, the prognostic impact of the same in embolic stroke of undetermined source (ESUS), a relevant subtype of ischemic stroke with a unique pathophysiology, has not been well studied to date. Our aim was to assess the predictive impact of left atrio-ventricular ECG and TTE abnormalities on one-year hospital readmission after ESUS from an ongoing single center prospective stroke registry in the U.S. METHODS We identified 369 ESUS patients who had at least 1 year of complete follow-up between 2013 and 2018. We examined the association of abnormal left atrio-ventricular findings on ECG and TTE, as well as basic demographic and clinical characteristics, measured at index admission with time to 1-year hospital readmission using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards regression. RESULTS Recurrent ischemic stroke and cardiovascular causes constituted 60% of all readmissions. Patients with left atrial dilation on TTE were more likely to readmitted within 1 year (HR 1.51; 95% CI, 1.04-2.21). Bundle branch block, pathologic Q-wave, and troponin elevation curves diverged, but were not significantly associated with readmission (log-rank p=0.34, p=0.08, p=0.42, respectively). CONCLUSIONS Following ESUS, left atrial dilation on TTE was associated with 1-year overall hospital readmission, of which cardiovascular and cerebrovascular ischemic events, and heart failure were a notable proportion. Our data support ongoing studies of atrial cardiopathy in ESUS patients.
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Affiliation(s)
- Vikrant Jagadeesan
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Austin Culver
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Nisha Raiker
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Quinn Halverson
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Sameer Prasada
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Liqi Chen
- Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Leah J Welty
- Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago Hospitals, Chicago, IL, USA.
| | - Kameswari Maganti
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Monaco A, Palmer K, Marengoni A, Maggi S, Hassan TA, Donde S. Integrated care for the management of ageing-related non-communicable diseases: current gaps and future directions. Aging Clin Exp Res 2020; 32:1353-1358. [PMID: 32277438 PMCID: PMC7316682 DOI: 10.1007/s40520-020-01533-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/10/2020] [Indexed: 11/04/2022]
Abstract
Due to the increase in the older population in Europe and associated rise in the absolute number of persons with Non-Communicable Diseases (NCDs), it is becoming increasingly important to find ways to promote healthy ageing, which is defined as the process of developing and maintaining the functional ability that enables well-being in older age. Older persons with NCDs can have complex care needs due to the increased risk of frailty, multimorbidity, and polypharmacy. However, current health systems in Europe often provide fragmented care for older people with NCDs; many receive disjointed care from numerous specialists or via different levels of care. In the current article, we discuss barriers and challenges in implementing integrated care models in European settings for older NCD patients. Specifically, we discuss the need for greater use of case managers in the care and treatment persons with complex care needs as well as the lack of training and education in healthcare professionals on topics related to multimorbidity, frailty, and polypharmacy. We discuss the limitations that arise from the current focus on disease-specific guidelines and care models that do not take comorbid conditions into account, and the lack of good quality evidence that evaluates the effectiveness of integrated care interventions, especially in European health settings. We highlight the importance of evaluating and monitoring mental health in conjunction with somatic symptoms in NCD patients and discuss the integral role of information and communication technology in healthcare to streamline integrated care processes and help to achieve better outcomes for patients.
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Affiliation(s)
| | - Katie Palmer
- Oliba, Via Federico Cesi 30, 00193, Rome, Italy.
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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