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Hu FH, Feng LP, Jia YJ, Ge MW, Shen LT, Liu P, Chen HL. Frailty and all-cause and cancer-related mortality in cancer patients: A prospective cohort study. Eur J Oncol Nurs 2024; 71:102667. [PMID: 39003843 DOI: 10.1016/j.ejon.2024.102667] [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: 05/30/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To evaluate the associations between frailty and all-cause and cancer-related mortality. Additionally, the objective is to compare the magnitude of these associations between older adults and younger adults. METHODS We gathered baseline data from NHANES (1999-2018) and developed a cumulative index consisting of 39 items to evaluate frailty. The National Death Index database was utilized to track the survival status of individuals. The Cox regression model was employed to estimate the associations between frailty status and all-cause and cancer-related mortality. RESULTS Ultimately, 3398 cancer patients were included in the analysis, comprising 910 younger adults and 2488 older adults. Compared to non-frail patients, the elevated all-cause and cancer-related mortality among pre-frail patients was not statistically significant (HRs = 1.312, 95%CI: 0.956-1.800, P = 0.092; HRs = 1.462, 0.811-2.635, P = 0.207). However, a significant elevation of both all-cause and cancer-related mortality risk was observed among frail patients (HRs = 2.213, 1.617-3.030, P < 0.001; HRs = 2.463, 95%CI = 1.370-4.429, P = 0.003). Frailty individuals demonstrated a more pronounced association with the prediction of all-cause mortality in younger (HRs = 2.230, 1.073-4.634, P = 0.032) than in older adults (HRs = 2.090, 1.475-2.960, P < 0.001). Sensitivity analysis consistently revealed robust results. RCS plots suggested a progressively escalating dose-response correlation between frailty and both all-cause and cancer-related mortality risk. CONCLUSIONS Pre-frailty did not result in an increase in mortality risks compared to non-frailty. However, frailty caused a higher all-cause and cancer-related mortality risk than non-frailty. Identifying those at risk and implementing targeted interventions may contribute to extending healthy life expectancy, regardless of age.
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Affiliation(s)
- Fei-Hong Hu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Li-Ping Feng
- Family-Centered Maternity Ward, Affiliated Hospital of Nantong University, Nantong University, Nantong, Jiangsu, China
| | - Yi-Jie Jia
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Meng-Wei Ge
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Lu-Ting Shen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Peng Liu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China.
| | - Hong-Lin Chen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China.
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Wingood M, Kiyoshi-Teo H, Scott AJ, Caulley JM, Wilson BS, Council SK, Vincenzo JL. Demographic Comparisons of Self-Reported Fall Risk Factors Among Older Adults Attending Outpatient Rehabilitation. Clin Interv Aging 2024; 19:1287-1300. [PMID: 39050519 PMCID: PMC11268720 DOI: 10.2147/cia.s456894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose Identify the prevalence and prevalence differences of fall risk factors by sex, clinic rurality, and race/ethnicity among older adults (≥65 years old) receiving outpatient rehabilitation. Patients and Methods Our secondary analysis used Electronic Health Record data of 108,751 older adults attending outpatient rehabilitation (2018-2022) within a large health system across 7 states and completed the Stay Independent Questionnaire. The mean age was 73.3 (±6.36), 58.1% were female, 84.3% were non-Hispanic White, and 88.8% attended an urban clinic. Fall risks were identified via the Centers for Disease Control and Prevention's Stay Independent Questionnaire. Results Older adults had a high prevalence of fall risks (44.3%), including history of falls (34.9%). The most prevalent fall-risk factors were impaired strength, gait, and balance. Compared to males, females had a higher prevalence of reporting a fall (4.3%), a fall with injury (9.9%), worrying about falling 9.1%), rushing to the toilet (8.5%), trouble stepping onto a curb (8.4%), taking medicine for sleep or mood (6.0%), feeling sad or depressed (5.3%), and feeling unsteady (4.6%). Males reported a higher prevalence of losing feeling in feet (9.4%), ≥1 fall in the past year (8.1%), and using hands to stand up (4.4%). Compared to White older adults, Native American/Alaska Natives had the highest prevalence of fall history (43.8%), Hispanics had the highest prevalence of falls with injury (56.1%), and Hispanics and Blacks had a higher prevalence of reporting 11/12 Stay Independent Questionnaire risk factors. Conclusion Older adults receiving outpatient rehabilitation have a high prevalence of fall risks, including falls and difficulties with strength, balance, or gait. Findings indicate that rehabilitation providers should perform screenings for these impairments, including incontinence and medication among females, loss of feeling in the feet among males, and all Stay Independent Questionnaire -related fall risk factors among Native American/Alaska Natives, Hispanics, and Blacks.
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Affiliation(s)
- Mariana Wingood
- Department of Implementation Science, Department of Internal Medicine/Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Hiroko Kiyoshi-Teo
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jamie M Caulley
- Rehabilitation Services, Providence St. Joseph Health, Portland, OR, USA
| | - Brian S Wilson
- Rehabilitation Services, Providence St. Joseph Health, Portland, OR, USA
| | - Sarah K Council
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jennifer L Vincenzo
- Department of Physical Therapy, College of Health Professions, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Collinge CW, Razzoli M, Mansk R, McGonigle S, Lamming DW, Pacak CA, van der Pluijm I, Niedernhofer L, Bartolomucci A. The mouse Social Frailty Index (mSFI): a novel behavioral assessment for impaired social functioning in aging mice. GeroScience 2024:10.1007/s11357-024-01263-4. [PMID: 38987495 DOI: 10.1007/s11357-024-01263-4] [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: 04/10/2024] [Accepted: 06/23/2024] [Indexed: 07/12/2024] Open
Abstract
Various approaches exist to quantify the aging process and estimate biological age on an individual level. Frailty indices based on an age-related accumulation of physical deficits have been developed for human use and translated into mouse models. However, declines observed in aging are not limited to physical functioning but also involve social capabilities. The concept of "social frailty" has been recently introduced into human literature, but no index of social frailty exists for laboratory mice yet. To fill this gap, we developed a mouse Social Frailty Index (mSFI) consisting of seven distinct assays designed to quantify social functioning which is relatively simple to execute and is minimally invasive. Application of the mSFI in group-housed male C57BL/6 mice demonstrated a progressively elevated levels of social frailty through the lifespan. Conversely, group-housed females C57BL/6 mice manifested social frailty only at a very old age. Female mice also showed significantly lower mSFI score from 10 months of age onward when compared to males. We also applied the mSFI in male C57BL/6 mice under chronic subordination stress and in chronic isolation, both of which induced larger increases in social frailty compared to age-matched group-housed males. Lastly, we show that the mSFI is enhanced in mouse models that show accelerated biological aging such as progeroid Ercc1-/Δ and Xpg-/- mice of both sexes compared to age matched littermate wild types. In summary, the mSFI represents a novel index to quantify trajectories of biological aging in mice and may help elucidate links between impaired social behavior and the aging process.
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Affiliation(s)
- Charles W Collinge
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Maria Razzoli
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Mansk
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Seth McGonigle
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Dudley W Lamming
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Christina A Pacak
- Greg Marzolf Jr. Muscular Dystrophy Center & Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Ingrid van der Pluijm
- Department of Molecular Genetics, and Department of Vascular Surgery, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Laura Niedernhofer
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
- Institute on the Biology of Aging and Metabolism, University of Minnesota, Minneapolis, MN, USA
| | - Alessandro Bartolomucci
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA.
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Gbessemehlan A, Cambois E, Brouard N, Letenneur L, Amieva H, Pérès K. Differences between subjective and disability health expectancies across ages in older adults. Sci Rep 2024; 14:14731. [PMID: 38926481 PMCID: PMC11208525 DOI: 10.1038/s41598-024-65416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
Health expectancies (HEs) have become a key indicator for monitoring healthy aging. So far, they have mainly been calculated based on functional rather than subjective health measures. Yet, by integrating several dimensions (medical, social, and cultural), subjective health is also an important measure of an older person's health status. In this study, we first estimated HEs using self-rated health (SRH), by age and sex. Second, we compared these results to those obtained when using a disability measure. We used pooled data from three prospective population-based cohorts including adults aged 65 years and over, living in Southwestern France (N = 4468). SRH was assessed using a single question and disability was measured using the Lawton scale. Healthy/Unhealthy Life Expectancies (HLE/UHLE) and Disability/Disability-Free Life Expectancies (DLE/DFLE) were estimated using the Interpolated Markov Chain program (IMaCh), separately in men and women. Women lived longer than men, with similar HLE but longer UHLE at all ages. The proportion of HLE in total LE decreased with age for both sexes and for women, it became smaller than the proportion of UHLE from age 73 onward. In both sexes, while the DLE was shorter than the UHLE in the youngest, a reversal was observed with advancing age. This change occurred earlier in women. Our study supports that SRH and disability showed different aging patterns, with sex and age differences. From a public health perspective, SRH and disability indicators appeared not interchangeable as they uncovered complementary but different information on the needs of aging people.
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Affiliation(s)
- Antoine Gbessemehlan
- University of Bordeaux, INSERM, UMR 1219, Bordeaux Population Health Research Center, 146 Rue Léo Saignat, 33076, Bordeaux, France.
| | | | - Nicolas Brouard
- National Institute of Demographic Studies (INED), Paris, France
| | - Luc Letenneur
- University of Bordeaux, INSERM, UMR 1219, Bordeaux Population Health Research Center, 146 Rue Léo Saignat, 33076, Bordeaux, France
| | - Hélène Amieva
- University of Bordeaux, INSERM, UMR 1219, Bordeaux Population Health Research Center, 146 Rue Léo Saignat, 33076, Bordeaux, France
| | - Karine Pérès
- University of Bordeaux, INSERM, UMR 1219, Bordeaux Population Health Research Center, 146 Rue Léo Saignat, 33076, Bordeaux, France
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Hao W, Wang Q, Yu R, Mishra SR, Virani SS, Shrestha N, Fu C, Zhu D. Reproductive factors and their association with physical and comprehensive frailty in middle-aged and older women: a large-scale population-based study. Hum Reprod Open 2024; 2024:hoae038. [PMID: 38948112 PMCID: PMC11211215 DOI: 10.1093/hropen/hoae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/03/2024] [Indexed: 07/02/2024] Open
Abstract
STUDY QUESTION Are women's reproductive factors associated with physical frailty and comprehensive frailty in middle-age and later life? SUMMARY ANSWER Early menarche at <13 years, age at menopause <45 years, surgical menopause, experiencing miscarriage and a shorter reproductive period of <35 years were associated with increased odds of frailty, while having two or three children was related to decreased likelihood of frailty. WHAT IS KNOWN ALREADY Evidence has shown that women are frailer than men in all age groups and across different populations, although women have longer lifespans. Female-specific reproductive factors may be related to risk of frailty in women. STUDY DESIGN SIZE DURATION A population-based cross-sectional study involved 189 898 women from the UK Biobank. PARTICIPANTS/MATERIALS SETTING METHODS Frailty phenotype and frailty index were used to assess physical frailty and comprehensive frailty (assessed using 38 health indicators for physical and mental wellbeing), respectively. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% CI between reproductive factors and likelihood of physical frailty and comprehensive frailty. Restricted cubic spline models were used to test the non-linear associations between them. In addition, we examined the combined effect of categorized age at menopause and menopause hormone therapy (MHT) on frailty. MAIN RESULTS AND THE ROLE OF CHANCE There was a J-shape relationship between age at menarche, reproductive period, and frailty; age at menarche <13 years and >16 years, and reproductive period <35 years or >40 years were all associated with increased odds of frailty. There was a negative linear relationship between menopausal age (either natural or surgical) and odds of frailty. Surgical menopause was associated with 30% higher odds of physical frailty (1.34, 1.27-1.43) and 30% higher odds of comprehensive frailty (1.30, 1.25-1.35). Having two or three children was linked to the lowest likelihood of physical frailty (0.48, 0.38-0.59) and comprehensive frailty (0.72, 0.64-0.81). Experiencing a miscarriage increased the odds of frailty. MHT use was linked to increased odds of physical frailty in women with normal age at natural menopause (after 45 years), while no elevated likelihood was observed in women with early natural menopause taking MHT. LIMITATIONS REASONS FOR CAUTION The reproductive factors were self-reported and the data might be subject to recall bias. We lacked information on the types and initiation time of MHT, could not identify infertile women who later became pregnant, and the number of infertile women may be underestimated. Individuals participating in the UK Biobank are not representative of the general UK population, limiting the generalization of our findings. WIDER IMPLICATION OF THE FINDINGS The reproductive factors experienced by women throughout their life course can potentially predict frailty in middle and old age. Identifying these reproductive factors as potential predictors of frailty can inform healthcare providers and policymakers about the importance of considering a woman's reproductive history when assessing their risk for frailty. STUDY FUNDING/COMPETING INTERESTS This work was supported by the National Key Research and Development Program of China (2022YFC2703800), National Natural Science Foundation of China (82273702), Science Fund Program for Excellent Young Scholars of Shandong Province (Overseas) (2022HWYQ-030), Taishan Scholars Project Special Fund (No. tsqnz20221103), and the Qilu Young Scholar (Tier-1) Program (202099000066). All authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Wenting Hao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Qi Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ruihong Yu
- Pingyin Center for Disease Control and Prevention, Pingyin, Jinan, China
| | - Shiva Raj Mishra
- NHMRC Clinical Trials Center, University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Westmead Applied Research Centre (WARC), University of Sydney, Sydney, NSW, Australia
| | - Salim S Virani
- Michael E DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
- The Aga Khan University, Karachi, Pakistan
| | - Nipun Shrestha
- Evidence Integration, University of Sydney, Sydney, NSW, Australia
| | - Chunying Fu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dongshan Zhu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Center for Clinical Epidemiology and Evidence-Based Medicine, Shandong University, Jinan, China
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Ma D, Sun Y, Chen G, Hao S, Jiang Z, Wang R, Hao S. The association between physical activity intensity and frailty risk among older adults across different age groups and genders: Evidence from four waves of the China Health and Retirement Longitudinal Survey. PLoS One 2024; 19:e0305346. [PMID: 38861565 PMCID: PMC11166314 DOI: 10.1371/journal.pone.0305346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024] Open
Abstract
"Exercise is the best medicine" is well known, but the optimal dose of physical activity (PA) for males and females across different age groups is still unknown. This study, using data from the four waves of CHARLS, aimed to determine the optimal PA dose that reduces frailty risks among older adults across various age groups and both sexes. We created a frailty index score using 63 health-related variables and used 0.21 as the frailty cut point. Binary logistic regression was used to compare the effect of vigorous, moderate, and light intensity PA under IPAQ criteria on frailty risk. The study found that regardless of whether males or females, the optimal effect of vigorous-intensity PA in reducing the risk of frailty is consistently observed throughout the entire old age career. Moreover, the age groups at which moderate-intensity PA reduces the risk of frailty were from age 70 for males and from age 80 for females. And light-intensity PA had no effect on reducing the risk of frailty. Moderate and vigorous intensity of PA in older adults should be promoted, but guidelines and recommendations must account for optimal associations with PA dose across genders and age groups.
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Affiliation(s)
- Di Ma
- Department of Sports Science, College of Sports & Arts, Hanyang University ERICA Campus, Ansan, South Korea
| | - Yulin Sun
- Department of Sports Science, College of Sports & Arts, Hanyang University ERICA Campus, Ansan, South Korea
| | - Guoyang Chen
- Department of Sports Science, College of Sports & Arts, Hanyang University ERICA Campus, Ansan, South Korea
| | - Siwei Hao
- Department of Sports Science, College of Sports & Arts, Hanyang University ERICA Campus, Ansan, South Korea
| | - Zhenping Jiang
- Department of Sports Science, College of Sports & Arts, Hanyang University ERICA Campus, Ansan, South Korea
| | - Rui Wang
- Department of Sports Science, College of Sports & Arts, Hanyang University ERICA Campus, Ansan, South Korea
| | - Shuaipeng Hao
- Department of Sports Science, College of Sports & Arts, Hanyang University ERICA Campus, Ansan, South Korea
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de Maio Nascimento M, Ihle A, Gouveia ÉR, Marques A. Dynamic associations between frailty and cognition over 4 years: A population-based study on adults aged ≥50 from 12 European countries. J Affect Disord 2024; 354:536-543. [PMID: 38484888 DOI: 10.1016/j.jad.2024.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/26/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE This study aimed (1) to investigate autoregressive and cross-lagged associations between frailty and cognition over 4 years in a large sample of European citizens aged ≥50 years, (2) to examine the 4-year temporal associations' differences between sex and between active and inactive physical behaviour, and (3) to explore in the years 2011, 2013, and 2015 associations between cognitive performance and the pre-frailty and frailty conditions. MATERIALS AND METHODS This longitudinal analysis was conducted with 20,857 individuals (11,540 women) from 12 countries aged ≥50 years who responded to waves 4, 5, and 6 of the SHARE project. The variables analysed were frailty (SHARE-FI) and a general cognition index (Cogindex) calculated for each wave from verbal fluency, immediate recall, and delayed recall. RESULTS A greater propensity for cognitive impairment was found in women, as well as in pre-frail and frail individuals. There were no significant differences between the sexes for the autoregressive effect of frailty and Cogindex over 4 years. On the other hand, sedentary and active individuals differed in frailty between Time 1-2. Cross-lagged analyses indicated a significant difference for the sexes between frailty and Cogindex Time 1-3 and between Cogindex and frailty of Time 2-3. Sedentary and active differed significantly in the path of frailty on Cogindex between Time 2-3. CONCLUSION Health policies should increase surveillance of frailty, cognition, and level of physical activity in the older European population, with a special focus on women.
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Affiliation(s)
| | - Andreas Ihle
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland; Department of Psychology, University of Geneva, Geneva, Switzerland; Swiss National Centre of Competence in Research LIVES-Overcoming Vulnerability: Life Course Perspectives, Lausanne, Switzerland
| | - Élvio Rúbio Gouveia
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland; Department of Physical Education and Sport, University of Madeira, Funchal, Portugal; Laboratory for Robotics and Engineering System (LARSYS), Interactive Technologies Institute, Funchal, Portugal
| | - Adilson Marques
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal; ISAMB, Universidade de Lisboa, Lisbon, Portugal.
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Fernández-Salido M, Alhambra-Borrás T, Garcés-Ferrer J. Implementation of a Comprehensive and Personalised Approach for Older People with Psychosocial Frailty in Valencia (Spain): Study Protocol for a Pre-Post Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:715. [PMID: 38928961 PMCID: PMC11203706 DOI: 10.3390/ijerph21060715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
With ageing, the risk of frailty increases, becoming a common condition that exposes older people to an increased risk of multiple adverse health outcomes. In Valencia (Spain), the ValueCare project develops and applies a value-based care approach that addresses the multidimensional nature of frailty by implementing integrated and personalized care to tackle psychosocial frailty. A pre-post controlled design with a baseline measurement at inclusion, at the end of implementation and a follow-up measurement after 6 months of intervention. In Valencia (Spain), 120 participants over 65 years of age are recruited from primary care centres to receive the ValueCare comprehensive and personalised care plan according to the results and are compared with 120 participants receiving "usual care". An assessment questionnaire is designed using validated instruments, and a personalised care plan is developed specifically for each participant based on the results obtained. The study protocol has been registered under the ISRCTN registration number ISRCTN25089186. Addressing frailty as a multidimensional and multifactorial risk condition requires the development and implementation of comprehensive assessments and care. In this context, this study will provide new insights into the feasibility and effectiveness of a value-based methodology for integrated care supported by ICT for older people experiencing frailty.
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Affiliation(s)
- Mirian Fernández-Salido
- Research Institute on Social Welfare Policy (POLIBIENESTAR), University of Valencia, 46022 Valencia, Spain; (T.A.-B.); (J.G.-F.)
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Fei Y, Niu S, Xi X, Tang W, Zhao Y, Zhang G, Yu X, Li C, Li X, Liu Y, Li Y, Yin Y, Cui Y, Li X. Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults especially for females: a cross-sectional study. BMC Geriatr 2024; 24:468. [PMID: 38811863 PMCID: PMC11134949 DOI: 10.1186/s12877-024-05056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Oral frailty is reported to increase the risk of new onset of mild cognitive impairment. Whereas, the association of oral frailty with cognition among older adults in both physical frail and non-physical frail status has not been sufficiently explored, and whether there are sex differences in the association is unclear. This study investigated the association of oral frailty and physical frailty with global cognitive function and executive function among older adults, as well as the sex differences in such association. METHODS This cross-sectional study included 307 participants aged ≥ 60 years old from communities between June 2023 and August 2023, in Nanjing, China. Global cognitive function and executive function were assessed by using the Montreal Cognitive Assessment (MoCA) and Trail Making Tests A (TMT-A), respectively. Oral frailty was identified by the combination of natural tooth, Oral Frailty Index-8 (OFI-8), and oral diadochokinesis. Physical frailty was measured by using Fried phenotype model which contained 5 criteria: unintentional weight loss, weakness, exhaustion, slowness, and low physical activity. Multiple linear regression analyses for overall participants and stratified by sex and presence or absence of physical frailty were performed, respectively, to examine the association between oral frailty and cognitive functions. RESULTS The median age of participants was 70 years old. The study included 158 (51.5%) females, 53 (17.3%) individuals with physical frailty, and 65 (21.2%) participants with oral frailty. After adjustment, the association between oral frailty and global cognitive function was observed in the physical frailty group (B = -2.67, 95% Confidence Interval [CI]: -5.27 to -0.07, p = 0.045) and the females with physical frailty (B = -4, 95% CI: -7.41 to -0.58, p = 0.024). Oral frailty was associated with executive function in overall participants (B = 0.12, 95% CI: 0.01 to 0.22, p = 0.037), physical frailty group (B = 23.68, 95% CI: 1.37 to 45.99, p = 0.038). In the adjusted models, oral frailty was significantly associated with executive function in all females (B = 0.21, 95% CI: 0.05 to 0.36, p = 0.009), in females without physical frailty (B = 0.19, 95% CI: 0.02 to 0.36, p = 0.027), and in females with physical frailty (B = 48.69, 95% CI: 7.17 to 90.21, p = 0.024). CONCLUSIONS Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults, particularly among females. It is ponderable to consider sex differences and facilitate the management of physical frailty when it comes to promoting cognitive health based on the perspective of oral health among older adults.
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Affiliation(s)
- Yang Fei
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Shuzhen Niu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Xueru Xi
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Wenping Tang
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yue Zhao
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Ge Zhang
- Department of Geriatrics (Geriatric Neurology), the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, China
| | - Xiaohong Yu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Cheng Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Xinru Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Ying Liu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yaxin Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yueheng Yin
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China.
| | - Yan Cui
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China.
| | - Xianwen Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
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10
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Ha B, Han M, So WY, Kim S. Sex differences in the association between sleep duration and frailty in older adults: evidence from the KNHANES study. BMC Geriatr 2024; 24:434. [PMID: 38755549 PMCID: PMC11100248 DOI: 10.1186/s12877-024-05004-2] [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: 12/10/2023] [Accepted: 04/23/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Frailty is a pervasive clinical syndrome among the older population. It is associated with an increased risk of diverse adverse health outcomes including death. The association between sleep duration and frailty remains unclear. Therefore, the aim of this study was to investigate the relationship between sleep duration and frailty in community-dwelling Korean older adults and to determine whether this relationship is sex-dependent. METHODS Data on 3,953 older adults aged ≥ 65 years were obtained from the 7th (2016-2018) Korea National Health and Nutrition Examination Survey (KNHANES). Frailty was defined using the Fried phenotype with criteria customized for the KNHANES dataset. Self-reported sleep duration was classified as short sleep duration (≤ 6 h), middle sleep duration (6.1-8.9 h), and long sleep duration (≥ 9 h). Complex samples multivariate logistic regression analysis was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The percentage of male participants with short, middle, and long sleep durations was 34.9%, 62.1%, and 16.8%, respectively, while that of female participants was 26.1%, 59.2%, and 14.7%. The prevalence of frailty in the middle sleep duration group was lower than that in the short and long sleep duration groups in both men (short, 14.7%; middle, 14.2%; long, 24.5%; p < 0.001) and women (short, 42.9%; middle, 27.6%; long, 48.6%; p < 0.001). Both short (OR = 2.61, 95% CI = 1.91 - 4.83) and long (OR = 2.57, 95% CI = 1.36 - 3.88) sleep duration groups had a significantly higher OR for frailty than the middle sleep duration group even after adjusting for confounding variables among women, but not among men. CONCLUSION Short and long sleep durations were independently associated with frailty in community-dwelling Korean older adult women. Managing sleep problems among women should be prioritized, and effective interventions to prevent frailty should be developed accordingly.
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Affiliation(s)
- Beomman Ha
- Armed Forces Medical Command, Seongnam-si, 13574, Republic of Korea
| | - Mijin Han
- Chungbuk National University Hospital, Cheongju-si, 28644, Republic of Korea
| | - Wi-Young So
- Department of Sports Medicine, College of Humanities, Korea National University of Transportation, 50 Daehak-ro, Chungbuk, Chungju-si, 27469, Republic of Korea.
| | - Seonho Kim
- Department of Nursing and Research Institute of Nursing Science, College of Medicine, Chungbuk National University, Cheongju-si, 28644, Republic of Korea.
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11
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Timm L, Guidetti S, Taloyan M. POSITIVE: experiences of an intervention aiming for reversing and preventing frailty using a home monitoring and communication platform within primary health care. BMC Geriatr 2024; 24:382. [PMID: 38689226 PMCID: PMC11061984 DOI: 10.1186/s12877-024-04990-7] [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: 01/15/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Frailty is increasing worldwide as the population ages. Physical activity is one component that has been shown to hinder and even reverse the process. The POSITIVE system (i.e., maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) is a prevention program that consists of home-monitoring equipment and a communication platform to support the initial treatment of frailty symptoms in primary health care. The participants, older aged (+ 70) frail persons and those at risk for frailty, took part in the program that promoted physical activity at home for six months. The aim was to explore and describe older persons' experiences of participating in a new prevention program using the POSITIVE system including technological tools intended to prevent the development of frailty. METHODS Nine interviews were conducted about experiences of participating in an intervention including use of technological tools to support physical activity. Qualitative content analysis was applied. RESULTS Two themes revealed: (1) Perceptions of being old are seldom positive, and (2) A rewarding and fruitful participation in the project with suggestions for improvement. Becoming older was related to physical pain and tiredness reducing the performance of former meaningful activities as well as an increase in mental stress. There was also a tendency to postpone the start of everyday activities, and in general, fewer activities were planned for one day than at younger ages. Participating in a physical activity intervention, including the use of technical tools, was considered meaningful and added motivation for engaging in other physical activities, this despite some difficulties with technical tools provided by the program. The contact with health care and the research team was appreciated. In addition, contact with other participants was requested and reported to be highly valued if added to the intervention, which could have been an expression of loneliness. CONCLUSION Participation in a prevention program motivated activities and social interaction. Adding opportunities for participants to meet each other is suggested for improving the intervention in terms of increasing the social dimensions. Our findings conclude that despite difficulties with handling the technical tools for the home-monitoring and communication platform, participation in the POSITIVE intervention was in general a positive experience.
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Affiliation(s)
- Linda Timm
- Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Alfred Nobels Alle 23, B4, Huddinge, Stockholm 141 83, Stockholm, Sweden.
| | - Susanne Guidetti
- Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Alfred Nobels Alle 23, B4, Huddinge, Stockholm 141 83, Stockholm, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, Women´s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marina Taloyan
- Division of Family Medicine and Primary Care, Department of Neurobiology Care Sciences and Society, Academic Primary Healthcare Centre, Karolinska Institutet, Region Stockholm, Sweden
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12
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Liu J, Zhu Y, Tan JK, Ismail AH, Ibrahim R, Hassan NH. Factors Associated with Frailty in Older Adults in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis. J Clin Med 2024; 13:2382. [PMID: 38673654 PMCID: PMC11050860 DOI: 10.3390/jcm13082382] [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: 02/06/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Frailty is a globally recognized issue. However, there is a lack of evidence exploring factors associated with frailty among older residents in community and nursing-home settings. Methods: To explore the prevalence and factors associated with frailty among older adults in community and nursing-home settings, we conducted a systematic search following the PRISMA guidelines across Web of Science, MEDLINE, EMBASE, PubMed, and Cochrane databases up until January 2024, selecting 38 studies which encompassed 150,642 participants. Results: Our findings showed higher frailty prevalence in nursing homes compared to communities. Frailty was significantly associated with sociodemographic (living alone, poor self-reported health), physiological (poor sleep, low activity of daily living), behavioral (physical inactivity) and disease (chronic conditions, depression) factors in both community and nursing-home settings. Conclusions: There are numerous factors associated with frailty in older adults in nursing-home and community settings. These factors underscore the significance of promptly identifying high-risk individuals and devising appropriate interventions to mitigate frailty among them.
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Affiliation(s)
- Jia Liu
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
| | - Yuezhi Zhu
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (Y.Z.); (J.K.T.)
| | - Jen Kit Tan
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (Y.Z.); (J.K.T.)
| | - Azera Hasra Ismail
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
| | - Roszita Ibrahim
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Nor Haty Hassan
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
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13
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Aguilar-Iglesias L, Perez-Asensio A, Vilches-Miguel L, Jimenez-Mendez C, Diez-Villanueva P, Perez-Rivera JA. Impact of Frailty on Heart Failure Prognosis: Is Sex Relevant? Curr Heart Fail Rep 2024; 21:131-138. [PMID: 38363515 DOI: 10.1007/s11897-024-00650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is one of the most frequent causes of hospital admission in elderly patients, especially in women, who present a high prevalence of geriatric syndromes like frailty. Studies have suggested that frailty and its impact may also differ between males and females. Understanding how frailty may differently affect HF patients depending on sex is therefore imperative for providing personalized care. The aim of this review is to summarize the role of sex in the prognostic impact of frailty in HF patients. RECENT FINDINGS Numerous studies have identified frailty as a significant predictor of all-cause mortality and hospital readmissions. A recent study of elderly HF out-patients demonstrated that while women had a higher prevalence of frailty, it was an independent predictor of mortality and readmission only in men. Moreover, another study revealed that physical frailty was associated with time to first clinical event among men but not among women. These results raise the question about why frailty affects differently HF prognosis in men and women. Women with HF present a higher prevalence of frailty, especially when it is considered as physical decline. Nevertheless, frailty affects differently HF prognosis in men and women. Women with HF present lower mortality than men and frailty is related with prognosis only in men. The different severity of HF between men and women and other hormonal, psychosocial, and clinical factors might be involved in this fact.
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Affiliation(s)
- Lara Aguilar-Iglesias
- Department of Cardiology, Hospital Universitario de Burgos, Avda. Islas Baleares, 3. 09005, Burgos, Spain
| | - Ana Perez-Asensio
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | | | | | - Jose-Angel Perez-Rivera
- Department of Cardiology, Hospital Universitario de Burgos, Avda. Islas Baleares, 3. 09005, Burgos, Spain.
- Facultad de Ciencias de La Salud, Universidad Isabel I, Burgos, Spain.
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14
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Tsuji T, Kanamori S, Watanabe R, Yokoyama M, Miyaguni Y, Saito M, Kondo K. Do changes in the frailty score differ by the type of group sports and exercises participated in? A 3-year longitudinal study. Eur Rev Aging Phys Act 2024; 21:8. [PMID: 38504171 PMCID: PMC10953207 DOI: 10.1186/s11556-024-00342-x] [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: 10/15/2023] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Older adults who engage in group sports and exercises achieve greater health benefits than those who exercise by themselves. The benefits of group participation may vary depending on the type of sports/exercise they engage in. The present study aimed to identify the association between specific sports and exercise types performed in groups and evaluate the longitudinal changes in multidimensional frailty scores among community-dwelling older adults in Japan. METHODS We used 3-year follow-up data from the Japan Gerontological Evaluation Study and analyzed 33,746 men and 36,799 women aged ≥ 65 years. To elucidate the relationship between participation in 20 types of group sports/exercises in 2016 (baseline) and the change in frailty score (using the Kihon Checklist, KCL) from 2016 to 2019, we performed linear regression analyses through multivariate adjustments for age group, self-rated health, marital status, living alone, occupational status, years of education, alcohol drinking status, smoking status, equivalent income, and disease status using an inverse probability weighting method. P < 0.05 was considered statistically significant. RESULTS The mean change in KCL scores over 3 years was + 0.62 and + 0.61 points in men and women, respectively, implying the degree of frailty worsened. The sports/exercise types that significantly prevented increments in KCL scores for both sexes compared to non-participants were hiking (men: B, - 0.36; women: B, - 0.29), walking (men: B, - 0.26; women: B, - 0.24), tennis (men: B, - 0.23; women: B, - 0.24), ground golf (men: B, - 0.21; women: B, - 0.19), and weight exercises (men: B, - 0.19; women: B, - 0.16). CONCLUSION Participation in specific sports and exercise groups offer significant physical and psychological benefits for frailty prevention among older adults in Japan. The results of this study may offer substantive evidence to encourage older adults to participate in group activities for the prevention of multidimensional frailty. It will also help public health stakeholders to decide which type of sports and exercise groups to promote in a community.
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Affiliation(s)
- Taishi Tsuji
- Institute of Health and Sport Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo City, Tokyo, 112-0012, Japan.
- Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-Cho, Inage Ward, Chiba City, Chiba, 263-8522, Japan.
| | - Satoru Kanamori
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi City, Tokyo, 173-8605, Japan
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku City, Tokyo, 160-8402, Japan
| | - Ryota Watanabe
- Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-Cho, Inage Ward, Chiba City, Chiba, 263-8522, Japan
- Center for Well-Being and Society, Nihon Fukushi University, 5-22-35 Chiyoda, Naka Ward, Nagoya City, Aichi, 460-0012, Japan
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430 Morioka-Cho, Obu City, Aichi, 474-8511, Japan
| | - Meiko Yokoyama
- Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-Cho, Inage Ward, Chiba City, Chiba, 263-8522, Japan
| | - Yasuhiro Miyaguni
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430 Morioka-Cho, Obu City, Aichi, 474-8511, Japan
- Department of Social Welfare, Nihon Fukushi University, Okuda, Mihama-Cho, Aichi, Chita-Gun, 470-3295, Japan
| | - Masashige Saito
- Center for Well-Being and Society, Nihon Fukushi University, 5-22-35 Chiyoda, Naka Ward, Nagoya City, Aichi, 460-0012, Japan
- Department of Social Welfare, Nihon Fukushi University, Okuda, Mihama-Cho, Aichi, Chita-Gun, 470-3295, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-Cho, Inage Ward, Chiba City, Chiba, 263-8522, Japan
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430 Morioka-Cho, Obu City, Aichi, 474-8511, Japan
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15
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Bisset ES, Howlett SE. Sex-specific effects of frailty on cardiac structure and function: insights from preclinical models. Can J Physiol Pharmacol 2024. [PMID: 38489788 DOI: 10.1139/cjpp-2024-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Advanced age is an independent risk factor for cardiovascular diseases in both sexes. This is thought to be due, in part, to age-dependent cellular, structural, and functional changes in the heart, a process known as cardiac aging. An emerging view is that cardiac aging leads to the accumulation of cellular and subcellular deficits that increase susceptibility to cardiovascular diseases. Still, people age at different rates, with those aging rapidly considered frail. Evidence suggests that frailty, rather than simply age, is a major risk factor for cardiovascular disease and predicts adverse outcomes in those affected. Recent studies in mouse models of frailty show that many adverse changes associated with cardiac aging are more prominent in mice with a high degree of frailty. This suggests that frailty sets the stage for late life cardiovascular diseases to flourish and raises the possibility that treating frailty may treat cardiovascular diseases. These studies show that ventricular dysfunction increases with frailty in males only, whereas atrial dysfunction increases with frailty in both sexes. These results may shed light on the reasons that men and women can be susceptible to different cardiovascular diseases as they age, and why frail individuals are especially vulnerable to these disorders.
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Affiliation(s)
- Elise S Bisset
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS B3H 4R2, Canada
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16
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Valsecchi N, Alhambra-Borrás T, Doñate-Martínez A, Korenhof SA, Raat H, Garcés-Ferrer J. Self-efficacy as a mediator between frailty and falls among community-dwelling older citizens. J Health Psychol 2024; 29:347-357. [PMID: 38279556 DOI: 10.1177/13591053231223879] [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: 01/28/2024] Open
Abstract
Frailty is one of the most challenging issues among older adults, and the relationship between frailty and falls has already been assessed numerous times in literature. In the present study, we explored the mediating role of self-efficacy related to falls (FSe) in the relationship between frailty and fall risk. In a cross-sectional design, 1080 community-dwelling older adults from Rotterdam (Netherlands) and Valencia (Spain) completed a questionnaire and data were then analyzed via mediation analysis using a bootstrapping approach. Results show that higher frailty is associated with higher fall incidence, and higher FSe is a partial mediator of this association, with a confidence interval for the indirect effect of 0.131-0.247. Moreover, results showed gender differences in FSe levels; women had lower FSe scores. Deepening research on the construct of FSe may give potential explanations that account for the emerged gender differences, and it could be more targeted in fall prevention programs.
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Affiliation(s)
| | | | | | | | - Hein Raat
- Erasmus Medical Center, The Netherlands
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17
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Pasquet R, Xu M, Sylvestre MP, Keezer MR. Comparison of three frailty measures for predicting hospitalization and mortality in the Canadian Longitudinal Study on Aging. Aging Clin Exp Res 2024; 36:48. [PMID: 38418612 PMCID: PMC10902012 DOI: 10.1007/s40520-024-02706-w] [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: 08/14/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Few studies have compared different measures of frailty for predicting adverse outcomes. It remains unknown which frailty measurement approach best predicts healthcare utilization such as hospitalization and mortality. AIMS This study aims to compare three approaches to measuring frailty-grip strength, frailty phenotype, and frailty index-in predicting hospitalization and mortality among middle-aged and older Canadians. METHODS We analyzed baseline and the first 3-year follow-up data for 30,097 participants aged 45 to 85 years from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA). Using separate logistic regression models adjusted for multimorbidity, age and biological sex, we predicted participants' risks for overnight hospitalization in the past 12 months and mortality, at the first 3-year follow-up, using each of the three frailty measurements at baseline. Model discrimination was assessed using Harrell's c-statistic and calibration assessed using calibration plots. RESULTS The predictive performance of all three measures of frailty were roughly similar when predicting overnight hospitalization and mortality risk among CLSA participants. Model discrimination measured using c-statistics ranged from 0.67 to 0.69 for hospitalization and 0.79 to 0.80 for mortality. All measures of frailty yielded strong model calibration. DISCUSSION AND CONCLUSION All three measures of frailty had similar predictive performance. Discrimination was modest for predicting hospitalization and superior in predicting mortality. This likely reflects the objective nature of mortality as an outcome and the challenges in reducing the complex concept of healthcare utilization to a single variable such as any overnight hospitalization.
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Affiliation(s)
- Romain Pasquet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 1000, Rue Saint-Denis, Montréal, QC, H2X 0C1, Canada
| | - Mengting Xu
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 1000, Rue Saint-Denis, Montréal, QC, H2X 0C1, Canada
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 1000, Rue Saint-Denis, Montréal, QC, H2X 0C1, Canada
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Mark R Keezer
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 1000, Rue Saint-Denis, Montréal, QC, H2X 0C1, Canada.
- School of Public Health, Université de Montréal, Montreal, QC, Canada.
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada.
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18
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Zhu X, Ding L, Zhang X, Wang H, Chen N. Association between physical frailty, circadian syndrome and cardiovascular disease among middle-aged and older adults: a longitudinal study. BMC Geriatr 2024; 24:199. [PMID: 38413861 PMCID: PMC10900721 DOI: 10.1186/s12877-024-04787-8] [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: 06/07/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Physical frailty (PF) and circadian syndrome (CircS) are proposed as novel risks for cardiovascular disease (CVD), but little attention is paid to their combined impact on CVD. This study aimed to investigate the association of PF, CircS and CVD in middle-aged and older adults. METHODS The sample comprised 8512 participants aged at least 45 years from the China Health and Retirement Longitudinal Study (CHARLS) 2011. PF was examined by the physical frailty phenotype scale. CircS was assessed by the components of the International Diabetes Federation (IDF) MetS plus short sleep duration and depression. The cut-off for CircS was set as ≥ 4. CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. A total of 6176 participants without CVD recruited from CHARLS 2011 and were followed up in 2018. RESULTS The prevalence of CVD in total populations, neither CircS or PF, PF alone, CircS alone and both CircS and PF were 13.0%, 7.4%, 15.5%, 17.4%, and 30.2%, respectively. CircS was more likely to be PF [OR (95%CI): 2.070 (1.732 ∼ 2.472)] than those without CircS. Both CircS alone [OR (95% CI): 1.954 (1.663 ∼ 2.296)], and coexisting CircS and PF [3.508 (2.739 ∼ 4.494)] were associated with CVD. Longitudinal analysis showed that individuals with both CircS and PF (HR: 1.716, 95%CI: 1.314 ∼ 2.240) and CircS alone [1.520 (1.331 ∼ 1.737)] were more likely to have new onset CVD than neither CircS or PF peers. CONCLUSION PF and CircS together are associated with higher CVD risk, which provided new evidence for a strong relation that warrants attention to assessing PF and CircS and in community to promote healthy aging.
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Affiliation(s)
- Xinhong Zhu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China.
- Hubei Shizhen Laboratory, Wuhan, China.
| | - Linlin Ding
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Xiaona Zhang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Heqing Wang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Ningbo Chen
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
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19
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Gompers A, Rossi A, Harding JL. Intersectional race and gender disparities in kidney transplant access in the United States: a scoping review. BMC Nephrol 2024; 25:36. [PMID: 38273245 PMCID: PMC10811805 DOI: 10.1186/s12882-023-03453-2] [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: 11/17/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Gender and racial disparities in kidney transplant access are well established, however how gender and race interact to shape access to kidney transplant is less clear. Therefore, we examined existing literature to assess what is known about the potential interaction of gender and race and the impact on access to kidney transplantation in the US. METHODS Following PRISMA guidelines, we conducted a scoping review and included quantitative and qualitative studies published in English between 1990 and May 31, 2023 among adult end-stage kidney disease patients in the US. All studies reported on access to specific transplant steps or perceived barriers to transplant access in gender and race subgroups, and the intersection between the two. We narratively synthesized findings across studies. RESULTS Fourteen studies met inclusion criteria and included outcomes of referral (n = 4, 29%), evaluation (n = 2, 14%), waitlisting (n = 4, 29%), transplantation (n = 5, 36%), provider perceptions of patient transplant candidacy (n = 3, 21%), and patient preferences and requests for a living donor (n = 5, 36%). Overall, we found that White men have the greatest access at all steps of the transplant process, from referral to eventual living or deceased donor transplantation. In contrast, women from racial or ethnic minorities tend to have the lowest access to kidney transplant, in particular living donor transplant, though this was not consistent across all studies. CONCLUSIONS Examining how racism and sexism interact to shape kidney transplant access should be investigated in future research, in order to ultimately shape policies and interventions to improve equity.
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Affiliation(s)
- Annika Gompers
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Ana Rossi
- Piedmont Transplant Institute, 1968 Peachtree Rd NW Building 77, Atlanta, GA, 30309, USA
| | - Jessica L Harding
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
- Department of Surgery, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
- Health Services Research Center, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
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20
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Khalil AH, Gobbens RJJ. What If the Clinical and Older Adults' Perspectives about Frailty Converge? A Call for a Mixed Conceptual Model of Frailty: A Traditional Literature Review. Healthcare (Basel) 2023; 11:3174. [PMID: 38132064 PMCID: PMC10742490 DOI: 10.3390/healthcare11243174] [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: 10/04/2023] [Revised: 11/01/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
Existing frailty models have enhanced research and practice; however, none of the models accounts for the perspective of older adults upon defining and operationalizing frailty. We aim to propose a mixed conceptual model that builds on the integral model while accounting for older adults' perceptions and lived experiences of frailty. We conducted a traditional literature review to address frailty attributes, risk factors, consequences, perceptions, and lived experiences of older adults with frailty. Frailty attributes are vulnerability/susceptibility, aging, dynamic, complex, physical, psychological, and social. Frailty perceptions and lived experience themes/subthemes are refusing frailty labeling, being labeled "by others" as compared to "self-labeling", from the perception of being frail towards acting as being frail, positive self-image, skepticism about frailty screening, communicating the term "frail", and negative and positive impacts and experiences of frailty. Frailty risk factors are classified into socio-demographic, biological, physical, psychological/cognitive, behavioral, and situational/environmental factors. The consequences of frailty affect the individual, the caregiver/family, the healthcare sector, and society. The mixed conceptual model of frailty consists of interacting risk factors, interacting attributes surrounded by the older adult's perception and lived experience, and interacting consequences at multiple levels. The mixed conceptual model provides a lens to qualify frailty in addition to quantifying it.
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Affiliation(s)
- Asya Hani Khalil
- Hariri School of Nursing, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
- Tranzo, Tilburg University, 5037 DB Tilburg, The Netherlands
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21
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Misquitta K, Reid N, Hubbard RE, Gordon EH. Factors associated with entry to residential care in frail older inpatients. Australas J Ageing 2023; 42:720-727. [PMID: 37573545 DOI: 10.1111/ajag.13231] [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: 04/27/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To examine factors that may influence the risk of discharge to a residential aged care facility (RACF) in a population of frail older inpatients. METHODS We analysed data from 5846 inpatients aged over 60 years from 27 hospitals in Queensland, Australia, admitted from independent living and referred for geriatric consultation. Patients underwent an interRAI Acute Care Comprehensive Geriatric Assessment by trained nurses. Frailty was assessed using a 52-item frailty index (FI). Risk/protective factors were determined a priori. Logistic regression assessed the relationship between factors and discharge destination, adjusted for FI, age, sex and hospital. Frailty × risk/protective factor interactions were performed. RESULTS Patients had a mean (SD) age of 79.7 (8.2) years and a mean (SD) FI of 0.44 (0.14). Twenty-nine per cent (n = 1678) of patients were discharged to an RACF. Each 0.1 increment in FI increased the risk of discharge to an RACF by 54% (OR 1.54, 95% CI 1.40-1.68, p < 0.01). Being married or in a de facto relationship had protective effects up to an FI of 0.7, whereas behavioural and psychological symptoms of dementia (BPSD) increased the risk of RACF discharge up to an FI of 0.7. Female sex, faecal incontinence and living alone did not influence the relationship between frailty and discharge destination. CONCLUSIONS The association between frailty and discharge to RACF has previously been recognised but here we found that risk and protective factors can influence this association. Whether early identification and management of mutable factors can reduce discharge to RACF should be addressed in future studies.
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Affiliation(s)
- Karen Misquitta
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Emily H Gordon
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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22
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Deore HS, Taranikanti M, Gaur A, Varatharajan S, John NA, Katta R, Taranikanti SS, Umesh M, Ganji V, Medala K. Comprehensive, continuous, and compulsory monitoring of frailty in elderly. J Family Med Prim Care 2023; 12:3194-3199. [PMID: 38361887 PMCID: PMC10866276 DOI: 10.4103/jfmpc.jfmpc_233_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 02/17/2024] Open
Abstract
Background The increasing elderly population makes frailty an increasing concern in society with vulnerability to stress and functional decline. Unrecognised comorbidities are common among the elderly due to lack of mention by the patients. Physicians should be equipped with effective interviewing skills along with the use of screening tools to assess any impairments in activities of daily living, cognition and signs of depression. Objectives To measure the degree of independence or dependence using scales and stratify patients based on Clinical Frailty Scale (CFS) so as to recommend it as a routinely usable tool. Materials and Methods In total, 191 elderly subjects above the age of 65 years were recruited for geriatric assessment. Tools that assess performance in daily living activities and cognition were used. The prevalidated CFS was used to score frailty to stratify patients into frail and non-frail groups, and the parameters were compared. Results Mean age of the study population was 69.54 years with 53.4% males and 46.6% females. Mean Katz index and mean Lawton score were >5. The mean Global Deterioration Scale (GDS) score was 1.5, and the mean clinical frailty score was 3.55. Significantly high number of male individuals were found in the frailty group. Hypertension was significantly higher in the frail group. The mean Katz scores were significantly lower, and mean GDS scores were significantly higher in the frailty group. Multivariable logistic regression has shown gender to be an important determinant of frailty with an odds ratio of 0.05 (CI-0.01-0.20). The higher Lawton score and GDS scores were significantly associated with frailty with an odds ratio of 0.33 (CI: 0.21-0.52) and 2.62 (CI: 1.14-6.02), respectively. Conclusion Men are more frail than women and co-morbidities like hypertension and coronary artery disease contribute to frailty with cognitive decline and decreased autonomy. A comprehensive assessment to identify frailty will provide a holistic view of well being among the elderly.
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Affiliation(s)
- Hiranya S. Deore
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Madhuri Taranikanti
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Sakthivadivel Varatharajan
- Department of General Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Nitin A. John
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Roja Katta
- Department of Physiology, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Sai Shriya Taranikanti
- Department of General Medicine, Agartala Government Medical College and GB Pant Hospital, Agartala, Tripura, India
| | - Madhusudhan Umesh
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Vidya Ganji
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Kalpana Medala
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
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23
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Passarelli JL, Al Hamad H. Geriatric frailty determinants in India. Aging Med (Milton) 2023; 6:450-451. [PMID: 38239712 PMCID: PMC10792337 DOI: 10.1002/agm2.12275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 01/22/2024] Open
Affiliation(s)
- Jorge Luis Passarelli
- Geriatrics and Long‐Term Care DepartmentRumailah Hospital, Hamad Medical CorporationDohaQatar
| | - Hanadi Al Hamad
- Geriatrics and Long‐Term Care DepartmentRumailah Hospital, Hamad Medical CorporationDohaQatar
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24
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Chou YY, Lee YS, Lin CS, Chen JP, Kuo FH, Lin CF, Chen YM, Lin SY. Gender-specific linkages: frailty, polypharmacy, anti-cholinergic burden, and 5-year mortality risk-a real-world analysis. PeerJ 2023; 11:e16262. [PMID: 38025730 PMCID: PMC10668851 DOI: 10.7717/peerj.16262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background With higher age, frailty escalates the risk of falls, unexpected physical dysfunction, hospitalization, and mortality. Polypharmacy in the older population is a major challenge that not only increases medical costs, but also may worsen the risk of hospitalization and death. More importantly, the properties of anti-cholinergic drugs contribute various negative effects. This study aimed to investigate the sex difference in the association of polypharmacy, anticholinergic burden, and frailty with mortality. Methods Participants older than 65 years who attended the geriatric outpatient clinic of the study center between January 2015 and July 2020 were invited to participate in this retrospective study. Comprehensive geriatric assessment data were collected and the phenotype of frailty was determined by Fried's criteria. Cox regression and the Kaplan-Meier curve were used to identify risk factors of 5-year survival along with intergroup differences in the risks. Results Of the 2,077 participants, 47.5% were female. The prevalence of frailty and the rate of polypharmacy were 44.7% and 60.6%, respectively. Higher age, male sex, low body mass index, low Mini-Mental State Examination scores, low activities of daily living, frailty status, polypharmacy, and a high Charlson Comorbidity Index score, and greater anticholinergic burden were significant risk factors that were associated with the 5-year all-cause mortality. Male patients with frailty exhibited the highest risks of mortality compared with male patients without frailty and female patients with or without frailty. Polypharmacy was significantly associated with a higher 5-year mortality rate in the frail male group compared with the non-frail male. In frail female group, individuals with a higher anticholinergic burden (as indicated by the Anticholinergic Cognitive Burden Scale) from drug usage exhibited an elevated 5-year mortality rate. Conclusions Polypharmacy and greater anticholinergic burden, synergistically interacted with frailty and intensified the 5-year mortality risk in a gender-specific manner. To mitigate mortality risks, clinicians should prudently identify polypharmacy and anticholinergic burden in the older population.
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Affiliation(s)
- Yin Yi Chou
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu Shan Lee
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chu Sheng Lin
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun Peng Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Fu-Hsuan Kuo
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Fu Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Occupational Medicine, Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Yi Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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25
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Lee T, Chung J, Song K, Ji Y. Prevalence and associated factors of cognitive frailty in community-dwelling older adults: Results from the Korean longitudinal study of aging. Int J Older People Nurs 2023; 18:e12576. [PMID: 37776018 DOI: 10.1111/opn.12576] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/13/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Cognitive frailty, a condition characterized by physical frailty with cognitive impairment, is emerging as a determinant of adverse health outcomes in older adults. However, its prevalence and correlation with associated factors are unknown in the aging population of Korea. OBJECTIVES To estimate the prevalence of cognitive frailty and identify factors associated with it among older Korean adults. METHODS A secondary analysis was performed using the Korean Longitudinal Study of Aging seventh survey dataset collected in 2018. Multinomial logistic regression analyses were conducted to examine the association between cognitive frailty and demographic, psychosocial, oral health and physical function factors. Individuals aged ≥65 years and without dementia were included (N = 1024). Participants were classified into four groups based on the presence or absence of physical frailty and mild cognitive impairment. This article is executed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. RESULTS The prevalence of cognitive frailty in the study sample was 11.2%. The results of multinomial logistic regression showed that advanced age, being female, lower education levels, heart disease, arthritis or rheumatoid arthritis, underweight, depression, non-social activity, poor oral health and functional limitation were significantly associated with cognitive frailty. CONCLUSIONS Cognitive frailty is prevalent among community-dwelling older adults in Korea. The findings provide primary care providers with insights about effective strategies for identifying at-risk individuals and will guide the development of population-level interventions to prevent or delay the onset of physical frailty and cognitive impairment in older adults. IMPLICATIONS FOR PRACTICE The findings provide practical information to healthcare providers for identifying cognitive frailty in older adults. The risk factors of cognitive frailty, such as psychosocial, oral health, and physical function factors, should be thoroughly monitored for older adults. Health personnel working in primary care have a critical role in identifying risk and beneficial factors and promoting preventative strategies that enhance health outcomes.
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Affiliation(s)
- Taewha Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Jane Chung
- Virginia Commonwealth University School of Nursing, Richmond, Virginia, USA
| | - Kijun Song
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Yoonjung Ji
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul, South Korea
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26
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Wong CN, Wilczek MP, Smith LH, Bosse JD, Richard EL, Cavanaugh R, Manjourides J, Orkaby AR, Olivieri-Mui B. Frailty Among Sexual and Gender Minority Older Adults: The All of Us Database. J Gerontol A Biol Sci Med Sci 2023; 78:2111-2118. [PMID: 37485864 PMCID: PMC10613018 DOI: 10.1093/gerona/glad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Despite known disparities in health status among older sexual and gender minority adults (OSGM), the prevalence of frailty is unknown. The aim of this study was to develop and validate a deficit-accumulation frailty index (AoU-FI) for the All of Us database to describe and compare frailty between OSGM and non-OSGM participants. METHODS Developed using a standardized approach, the AoU-FI consists of 33 deficits from baseline survey responses of adults aged 50+. OSGM were self-reported as "not straight" or as having discordant gender and sex assigned at birth. Descriptive statistics characterized the AoU-FI. Regression was used to assess the association between frailty, age, and gender. Validation of the AoU-FI used Cox proportional hazard models to test the association between frailty categories (robust <0.15, 0.15 ≤ pre-frail ≤ 0.25, frail >0.25) and mortality. RESULTS There were 9 110 OSGM and 67 420 non-OSGM with sufficient data to calculate AoU-FI; 41% OSGM versus 50% non-OSGM were robust, whereas 34% versus 32% were pre-frail, and 26% versus 19% were frail. Mean AoU-FI was 0.19 (95% confidence interval [CI]: 0.187, 0.191) for OSGM and 0.168 (95% CI: 0.167, 0.169) for non-OSGM. Compared to robust, odds of mortality were higher among frail OSGM (odds ratio [OR] 6.40; 95% CI: 1.84, 22.23) and non-OSGM (OR 3.96; 95% CI: 2.96, 5.29). CONCLUSIONS The AoU-FI identified a higher burden of frailty, increased risk of mortality, and an attenuated impact of age on frailty among OSGM compared to non-OSGM. Future work is needed to understand how frailty affects the OSGM population.
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Affiliation(s)
- Chelsea N Wong
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Louisa H Smith
- Roux Institute, Northeastern University, Portland, Maine, USA
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Jordon D Bosse
- School of Nursing, Northeastern University, Boston, Massachusetts, USA
| | - Erin L Richard
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California, USA
| | | | - Justin Manjourides
- Roux Institute, Northeastern University, Portland, Maine, USA
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Ariela R Orkaby
- New England Geriatric Research, Education, and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Division of Aging, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brianne Olivieri-Mui
- Roux Institute, Northeastern University, Portland, Maine, USA
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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27
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Jeong HN, Chang SJ, Kim JR, Choi GW. Similarities and Differences of Interventions to Promote Physical and Psychological Health Between Prefrail and Frail Older Women: A Systematic Review. J Gerontol Nurs 2023; 49:20-28. [PMID: 37768583 DOI: 10.3928/00989134-20230915-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
The current review aimed to explore similarities and differences in the properties of interventions that promote physical and psychological health between prefrail and frail older women. Ten databases were searched for studies published from database inception to May 2023. Two Cochrane tools were used to assess the risk of bias in experimental and quasi-experimental studies. Twenty-three studies were selected, including 11 studies on prefrailty and 12 studies on frailty. Exercise interventions were predominant, but the contents and standards of exercise intensity were inconsistent between prefrail and frail women. For the main outcomes of the interventions, balance ability and biochemical factors were measured more frequently for frail older women than prefrail older women. Psychological health was less measured for prefrail and frail older women compared to physical health. Future research needs to consider balance training, as well as the evaluation of biochemical factors and psychological health among prefrail or frail older women. [Journal of Gerontological Nursing, 49(10), 20-28.].
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Chang CH, Lien WC, Chiu TP, Yang TH, Wei CC, Kuo YL, Yeh CH, Liu B, Chen PJ, Lin YC. A novel smart somatosensory wearable assistive device for older adults' home rehabilitation during the COVID-19 pandemic. Front Public Health 2023; 11:1026662. [PMID: 37790724 PMCID: PMC10544986 DOI: 10.3389/fpubh.2023.1026662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Background Due to the Coronavirus disease 19 (COVID-19) related social distancing measures and health service suspension, physical activity has declined, leading to increased falling risk and disability, and consequently, compromising the older adult health. How to improve the quality of older adult life has become a crucial social issue. Objective In traditional rehabilitation, manual and repetitive muscle training cannot identify the patient's rehabilitation effect, and increasing the willingness to use it is not easy. Therefore, based on the usability perspective, this study aims to develop a novel smart somatosensory wearable assistive device (called SSWAD) combined with wireless surface electromyography (sEMG) and exergame software and hardware technology. The older adult can do knee extension, ankle dorsiflexion, and ankle plantar flexion rehabilitation exercises at home. Meanwhile, sEMG values can be digitally recorded to assist physicians (or professionals) in judgment, treatment, or diagnosis. Methods To explore whether the novel SSWAD could improve the older adult willingness to use and motivation for home rehabilitation, 25 frail older adult (12 males and 13 females with an average age of 69.3) perform the rehabilitation program with the SSWAD, followed by completing the system usability scale (SUS) questionnaire and the semi-structured interview for the quantitative and qualitative analyses. In addition, we further investigate whether the factor of gender or prior rehabilitation experience would affect the home rehabilitation willingness or not. Results According to the overall SUS score, the novel SSWAD has good overall usability performance (77.70), meaning that the SSWAD makes older adult feel interested and improves their willingness for continuous rehabilitation at home. In addition, the individual item scores of SUS are shown that female older adult with prior rehabilitation experience perform better in "Learnability" (t = 2.35, p = 0.03) and "Confidence" (t = -3.24, p = 0.01). On the contrary, male older adult without rehabilitation experience are more willing to adopt new technologies (t = -2.73, p = 0.02), and perform better in "Learnability" (t = 2.18, p = 0.04) and "Confidence" (t = -3.75, p < 0.001) with the SSWAD. In addition, the result of the semi-structured interview shows that the operation of the SSWAD is highly flexible, thus reducing older adult burden during the rehabilitation exercise and using them long-term. Conclusion This novel SSWAD receives consistently positive feedback regardless of the gender or prior rehabilitation experience of elders. The SSWAD could be used as a novel way of home rehabilitation for elders, especially during the COVID-19 pandemic. Older adult can do rehabilitation exercises at home, and physicians could make proper judgments or adjust suitable treatments online according to the sEMG data, which older adult can know their rehabilitation progress at the same time. Most importantly, older adult do not have to go to the hospital every time for rehabilitation, which significantly reduces time and the risk of infection.
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Affiliation(s)
- Chien-Hsiang Chang
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tseng-Ping Chiu
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Tai-Hua Yang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taipei, Taiwan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Chun Wei
- Department of Digital Multimedia Design, National Taipei University of Business, Taipei, Taiwan
| | - Yu-Liang Kuo
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Hsing Yeh
- Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Bo Liu
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Pin-Jun Chen
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Yang-Cheng Lin
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
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29
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Coffman EM, Smitherman AB, Willis EA, Ward DS, Tate DF, Valle CG. Frailty and comorbidities among young adult cancer survivors enrolled in an mHealth physical activity intervention trial. J Cancer Surviv 2023:10.1007/s11764-023-01448-4. [PMID: 37610479 PMCID: PMC10884352 DOI: 10.1007/s11764-023-01448-4] [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: 06/26/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE The physical frailty phenotype identifies individuals at risk for adverse health outcomes but has rarely been assessed among young adult cancer survivors (YACS). This study describes frailty status among YACS participating in a physical activity (PA) intervention trial. METHODS YACS were categorized at baseline using the 5-item FRAIL scale: fatigue; weight loss; illness; ambulation; resistance. Chi-square tests compared frailty and non-cancer comorbidities by characteristics. Prevalence rates (PRs) for the independent associations between characteristics, frailty, and comorbidities were estimated using modified Poisson regression models. RESULTS Among 280 YACS (82% female; mean (M) age = 33.4 ± 4.8 years, M=3.7 ± 2.4 years post-diagnosis), 11% frail, 17% prefrail; the most frequent criteria were fatigue (41%), resistance (38%), and ambulation (14%). Compared to BMI < 25, higher BMI was associated with increased likelihood of frailty (BMI 25-30, PR: 2.40, 95% CI: 1.38-4.17; BMI > 30, PR: 2.95, 95% CI: 1.71-5.08). Compared to 0, ≥ 30 min/week of moderate-to-vigorous PA was associated with reduced frailty (PR: 0.39, 95% CI: 0.25-0.60). Most YACS (55%) reported ≥ 1 comorbidity, most frequently depression (38%), thyroid condition (19%), and hypertension (10%). Comorbidities were more common for women (59% vs. 37%) and current/former smokers (PR: 1.71, 95% CI: 1.29-2.28). CONCLUSION Prevalence of frailty and comorbidities in this sample was similar to other YACS cohorts and older adults without cancer and may be an indicator of accelerated aging and increased risk for poor outcomes. IMPLICATIONS FOR CANCER SURVIVORS Assessment of frailty may help identify YACS at increased risk for adverse health outcomes.
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Affiliation(s)
- Erin M Coffman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Suite 136, Chapel Hill, NC, 27514, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Andrew B Smitherman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Erik A Willis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Suite 136, Chapel Hill, NC, 27514, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Suite 136, Chapel Hill, NC, 27514, USA
| | - Deborah F Tate
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Suite 136, Chapel Hill, NC, 27514, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Carmina G Valle
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Suite 136, Chapel Hill, NC, 27514, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Coffman EM, Smitherman AB, Willis EA, Ward DS, Tate DF, Valle CG. Frailty and Comorbidities Among Young Adult Cancer Survivors Enrolled in an mHealth Physical Activity Intervention Trial. RESEARCH SQUARE 2023:rs.3.rs-3111745. [PMID: 37461600 PMCID: PMC10350202 DOI: 10.21203/rs.3.rs-3111745/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Purpose: The physical frailty phenotype identifies individuals at risk for adverse health outcomes but has rarely been assessed among young adult cancer survivors (YACS). This study describes frailty status among YACS participating in a PA intervention trial. Methods: YACS were categorized by frailty status at baseline using the 5-item FRAIL index: fatigue; weight loss; illness; ambulation; resistance. Chi-square tests compared frailty and comorbidities by characteristics. Prevalence rates (PRs) for the independent associations between characteristics, frailty, and comorbidities were estimated using modified Poisson regression models. Results: Among 280 YACS (82% female, M=33.4±4.8 years, M=3.7±2.4 years post-diagnosis), 14% had frailty, and 24% prefrailty; the most frequent criteria were fatigue (70%), resistance (38%), and ambulation (14%). Compared to BMI <25, higher BMI (BMI 25-30, PR: 1.65, 95% CI: 1.02-2.65; BMI > 30, PR: 2.36, 95% CI: 1.46-3.81) was associated with increased frailty status. Compared to 0, 1-50 minutes/week of moderate-to-vigorous PA was associated with reduced frailty (PR: 0.62, 95% CI: 0.43-0.90). Most YACS (55%) reported > 1 comorbidity, most frequently depression (38%), thyroid condition (19%), and hypertension (10%). Men were less likely to report comorbidities (PR: 0.63, 95% CI: 0.42-0.93). Current/former smokers (PR: 1.29, 95% CI: 1.01-1.64) were more likely to have comorbidities. Conclusion: Prevalence of frailty and comorbidities in this sample was similar to other YACS cohorts and may be an indicator of accelerated aging and increased risk for poor outcomes. Implications for Cancer Survivors: Assessment of frailty may help identify YACS at risk for adverse health outcomes.
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Isernia S, Cazzoli M, Baglio G, Cabinio M, Rossetto F, Giunco F, Baglio F, Blasi V. Differential Roles of Neural Integrity, Physical Activity and Depression in Frailty: Sex-Related Differences. Brain Sci 2023; 13:950. [PMID: 37371428 DOI: 10.3390/brainsci13060950] [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: 04/17/2023] [Revised: 05/15/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
The frailty sex paradox has recently gained attention. At all ages, females are more likely to be frail and show a more severe phenotype but have a higher survival rate compared to males. The main aim was to test sex-specific differences in frailty syndrome using a multimodal evaluation from clinical and imaging data to deepen the understanding of different underlying mechanisms involved in the two sexes, and thus understand the association with different risk factors. Ninety-six community-dwelling older adults were characterized by clinical underpinnings (Fried's frailty indicators: comorbidity, depression, global cognitive level, physical activity, autonomy), and neural integrity (T1-weighted brain 3T MRI). The frailty × sex interaction in clinical and neural profiles was tested. Additionally, frailty risk factors were identified in the two sexes separately. Results showed that fragility was associated with an increment of depressive symptomatology in females, while a decrement in physical activity was observed already in the pre-frail stage in males. Finally, different risk factors were observed in the two groups: significant frailty predictors were neural integrity and physical activity in males, and age and depression in females. These data support the starting hypothesis of at least partially different mechanisms involved in the frailty phenotype between men and women.
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Affiliation(s)
- Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Marta Cazzoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Gisella Baglio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | | | - Fabrizio Giunco
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | | | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
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Mangalesh S, Daniel KV, Dudani S, Joshi A. Combined nutritional and frailty screening improves assessment of short-term prognosis in older adults following percutaneous coronary intervention. Coron Artery Dis 2023; 34:185-194. [PMID: 36762656 DOI: 10.1097/mca.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Frailty and malnutrition are well-known factors influencing outcomes of myocardial infarction (MI) in older adults. Due to considerable overlap between both entities, whether the simultaneous assessment of frailty and nutrition adds nonredundant value to risk assessment is unknown. METHODS We performed a prospective cohort study on 402 patients aged at least 65 years diagnosed with ST-elevation MI that underwent percutaneous coronary intervention. Nutritional status was assessed by Controlling Nutritional Status score (CONUT), Prognostic Nutritional Index, and Geriatric Nutritional Response Index. Frailty was assessed by Clinical Frailty Scale (CFS), Derby frailty index, and acute frailty network. Primary outcome was major adverse cardiac events (MACE), comprising all-cause mortality, non-fatal MI, and unplanned repeat revascularization during 28-day follow-up. Increment in Global Registry of Acute Coronary Events (GRACE) score performance following the addition of nutrition and frailty was assessed. RESULTS The incidence of MACE was 8.02 (6.38-9.95) per 1000 person-days. The CONUT score and CFS were the best predictors of MACE and independent predictors in the multivariate Cox-regression models [hazard ratios, 2.80 (1.54-5.09) and 2.54 (1.50-4.29)]. CONUT score classified 151 (37.6%) patients as malnourished, and CFS classified 131 (32.6%) as frail. The addition of both CONUT and CFS to the GRACE score led to better model discrimination and calibration through improved c-statistic (+0.165) ( P < 0.0001) and Akaike and Bayesian information criteria. CONCLUSION Combining CONUT and CFS provides nonredundant prognostic value despite their overlapping nature. Combined nutritional and frailty screening may improve risk prognostication in older adults following MI.
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Affiliation(s)
| | | | | | - Ajay Joshi
- Cardiology, Army College of Medical Sciences, New Delhi, India
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Matos LL, Sanabria A, Robbins KT, Halmos GB, Strojan P, Ng WT, Takes RP, Angelos P, Piazza C, de Bree R, Ronen O, Guntinas-Lichius O, Eisbruch A, Zafereo M, Mäkitie AA, Shaha AR, Coca-Pelaz A, Rinaldo A, Saba NF, Cohen O, Lopez F, Rodrigo JP, Silver CE, Strandberg TE, Kowalski LP, Ferlito A. Management of Older Patients with Head and Neck Cancer: A Comprehensive Review. Adv Ther 2023; 40:1957-1974. [PMID: 36920746 DOI: 10.1007/s12325-023-02460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/10/2023] [Indexed: 03/16/2023]
Abstract
The projected increase in life expectancy over the next few decades is expected to result in a rise in age-related diseases, including cancer. Head and neck cancer (HNC) is a worldwide health problem with high rates of morbidity and mortality. In this report, we have critically reviewed the literature reporting the management of older patients with HNC. Older adults are more prone to complications and toxicities secondary to HNC treatment, especially those patients who are frail or have comorbidities. Thus, this population should be screened prior to treatment for such predispositions to maximize medical management of comorbidities. Chronologic age itself is not a reason for choosing less intensive treatment for older HNC patients. Whenever possible, also older patients should be treated according to the best standard of care, as nonstandard approaches may result in increased treatment failure rates and mortality. The treatment plan is best established by a multidisciplinary tumor board with shared decision-making with patients and family. Treatment modifications should be considered for those patients who have severe comorbidities, evidence of frailty (low performance status), or low performance status or those who refuse the recommendations of the tumor board.
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Affiliation(s)
- Leandro L Matos
- Department of Head and Neck Surgery, Instituto do Cancer do Estado de São Paulo (ICESP), University of São Paulo Medical School, and Faculdade Israelita de Ciências da Saúde Albert Einstein Medical School, São Paulo, Brazil
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - K Thomas Robbins
- Division of Otolaryngology, Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Gyorgy B Halmos
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Wai Tong Ng
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Robert P Takes
- Department of Otolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Cesare Piazza
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ohad Ronen
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andres Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | | | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Israel, Affiliated with Ben-Gurion University of the Negev, Sheva, Israel
| | - Fernando Lopez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Department of Otolaryngology, Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Timo E Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Center for Life-Course Health Research, University of Oulu, Oulu, Finland
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, 8th Floor, Room 8174, São Paulo, SP, CEP: 05403-000, Brazil.
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil.
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Ellis RJ, Moffatt CR, Aaron LT, Beaverson G, Chaw K, Curtis C, Freeman-Lamb R, Judd D, Khatry K, Li YS, Nash T, Macfarlane B, Slater K, Soonarane Y, Stickley M, Anuradha S. Factors associated with hospitalisations and deaths of residential aged care residents with COVID-19 during the Omicron (BA.1) wave in Queensland. Med J Aust 2023; 218:174-179. [PMID: 36524321 PMCID: PMC9877866 DOI: 10.5694/mja2.51813] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To identify characteristics associated with the hospitalisation and death of people with COVID-19 living in residential aged care facilities (RACFs). DESIGN Retrospective cohort study. SETTING, PARTICIPANTS All confirmed (polymerase chain reaction testing) or probable SARS-CoV-2 infections (rapid antigen tests) in residents of the 86 RACFs in the Metro South Hospital and Health Service area (southeast Queensland), 13 December 2021 - 24 January 2022. MAIN OUTCOME MEASURES Hospitalisation within 14 days or death within 28 days of COVID-19 diagnosis. RESULTS Of 1071 RACF residents with COVID-19, 151 were hospitalised within 14 days and 126 died within 28 days of diagnosis. Likelihood of death increased with age (per five years: adjusted odds ratio [aOR], 1.38; 95% confidence interval [CI], 1.21-1.57), but not that of hospitalisation. Men were more likely to be hospitalised (aOR, 1.7; 95% CI, 1.2-2.4) or die (aOR, 2.5; 95% CI, 1.7-3.6) than women. The likelihood of hospitalisation was greater for those with dementia (aOR, 1.9; 95% CI, 1.2-3.0), heart failure (aOR, 1.7; 95% CI, 1.1-2.7), chronic kidney disease (aOR, 1.7; 95% CI, 1.1-2.5), or asthma (aOR, 2.2; 95% CI, 1.2-3.8). The likelihood of death was greater for residents with dementia (aOR, 2.2; 95% CI, 1.3-3.7), diabetes mellitus (aOR, 1.9; 95% CI, 1.3-3.0), heart failure (aOR, 2.0; 95% CI, 1.1-3.3), or chronic lung disease (aOR, 1.7; 95% CI, 1.1-2.7). The likelihood of hospitalisation and death were each higher for residents who had received two or fewer vaccine doses than for those who had received three doses. CONCLUSIONS Most characteristics that influenced the likelihood of hospitalisation or death of RACF residents with COVID-19 were non-modifiable factors linked with frailty and general health status. Having received three COVID-19 vaccine doses was associated with much lower likelihood of hospitalisation or death.
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Affiliation(s)
- Robert J Ellis
- Metro South Public Health Unit, Brisbane, QLD.,The University of Queensland, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
| | | | | | | | - Khin Chaw
- Metro South Public Health Unit, Brisbane, QLD.,Australian Red Cross Lifeblood, Brisbane, QLD
| | | | | | | | - Khadija Khatry
- Metro South Public Health Unit, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
| | - Yee Sum Li
- Metro South Public Health Unit, Brisbane, QLD.,The University of Queensland, Brisbane, QLD
| | - Terry Nash
- Metro South Public Health Unit, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
| | | | - Karen Slater
- Metro South Public Health Unit, Brisbane, QLD.,Griffith University, Brisbane, QLD
| | | | - Mark Stickley
- Metro South Public Health Unit, Brisbane, QLD.,The University of Queensland, Brisbane, QLD
| | - Satyamurthy Anuradha
- Metro South Public Health Unit, Brisbane, QLD.,The University of Queensland, Brisbane, QLD
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Hana D, Miller T, Chaker Z, Chobufo MD, Khan A, Patel B, Ghobrial J, Kawsara A, Thompson J, Raybuck B, Badhwar V, Daggubatti R, Mills J, Hamirani YS. Evaluating Gender-based Differences in Clinical Outcomes for Patients Undergoing Left Atrial Appendage Occlusion: A Single Centre Experience. Curr Probl Cardiol 2023; 48:101532. [PMID: 36509198 DOI: 10.1016/j.cpcardiol.2022.101532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
There is emerging recent data that has shown women to be more prone to in-hospital major adverse events after trans catheter left atrial appendage occlusion. Institutional LAAO registry at West Virginia University (WVU) was reviewed from January 2016 to October 2021 to identify 271 women and 293 men who underwent successful LAAO device implantation. Patients were evaluated for gender-based differences in baseline characteristics, CHA₂DS₂-VASc Score, HAS-BLED score, procedural data, in-hospital, and follow-up outcomes. Compared to men, women had lower baseline comorbidities including coronary artery disease (135 (49.6%) vs 172 (58.7%), P = 0.03), myocardial infarction (MI) (56 (20.5%) vs 85 (29%), P = 0.02) and coronary artery bypass surgery (10 (3.6%) vs 27 (9.2%), P = 0.008). Women were noted to have a higher CHA₂DS₂-VASc Score (5.3 ± 1.4 vs 4.4 ± 1.4, P < 0.001), and left ventricular ejection fraction (57.9 ± 7.7 vs 52.7 ± 12.4, P < 0.001). Women were noted to have a significantly higher rate of in-hospital composite adverse events (74 (27.2%) vs 58 (19.8%), P = 0.03); bleeding events (38 (10.2%) vs 19 (6.4%), P = 0.003) and associated blood transfusion (6 vs 0, P = 0.001) compared with men. No statistically significant differences were noted between both genders regarding the follow-up outcome. Our single center study shows women to have higher in-hospital composite adverse events as well as higher bleeding events during the index hospital admission.
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Affiliation(s)
- David Hana
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Tyler Miller
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Zakeih Chaker
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - Muchi D Chobufo
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - Arsalan Khan
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Bansari Patel
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Jonathan Ghobrial
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Akram Kawsara
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - Jesse Thompson
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Bryan Raybuck
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Ramesh Daggubatti
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - James Mills
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - Yasmin S Hamirani
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV.
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de Oliveira DC, Máximo RDO, Ramírez PC, de Souza AF, Luiz MM, Delinocente MLB, Steptoe A, de Oliveira C, Alexandre TDS. Does the incidence of frailty differ between men and women over time? Arch Gerontol Geriatr 2023; 106:104880. [PMID: 36493577 PMCID: PMC9868103 DOI: 10.1016/j.archger.2022.104880] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND/OBJECTIVE The mechanisms, risk factors and influence of sex on the incidence of frailty components are not fully understood. The aim of this study was to analyse sex differences in factors associated with the increase in the number of frailty components. METHODS A 12-year follow-up analysis was conducted with 1,747 participants aged ≥ 60 of the ELSA Study with no frailty at baseline. Generalised linear mixed models were used to analyse the increase in the number of frailty components stratified by sex, considering socioeconomic, behavioural, clinical and biochemical characteristics as exposure variables. RESULTS The increase in the number of frailty components in both sexes was associated with an advanced age (70 to 79 years and 80 years or older), low educational level, sedentary lifestyle, elevated depressive symptoms, joint disease, high C-reactive protein levels, perception of poor vision and uncontrolled diabetes (p < 0.05). Osteoporosis, low weight, heart disease, living with one or more people and perception of poor hearing were associated with an increase in the number of frailty components in men. High fibrinogen concentration, controlled diabetes, stroke and perception of fair vision were associated with the outcome in women (p < 0.05). Obese women and men and overweight women had a lower increase in the number of frailty components compared to those in the ideal weight range. CONCLUSIONS Socioeconomic factors, musculoskeletal disorders, heart disease and low weight seem to sustain the frailty process in men, whereas cardiovascular and neuroendocrine disorders seem to sustain the frailty process in women.
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Affiliation(s)
- Dayane Capra de Oliveira
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil
| | - Roberta de Oliveira Máximo
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil
| | - Paula Camila Ramírez
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil; Escuela de Fisioterapia, Universidad Industrial de Santander. Carrera 32 Nº 29-31, Bucaramanga 680006, Colômbia
| | - Aline Fernanda de Souza
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil
| | - Mariane Marques Luiz
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil
| | - Maicon Luis Bicigo Delinocente
- Postgraduate Programme in Gerontology, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310, Sao Carlos, Sao Paulo 13565-905, Brazil
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College of London (UCL). Gower Street, London WC1E 6BT, United Kingdom
| | - Cesar de Oliveira
- Department of Epidemiology and Public Health, University College of London (UCL). Gower Street, London WC1E 6BT, United Kingdom
| | - Tiago da Silva Alexandre
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil; Postgraduate Programme in Gerontology, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310, Sao Carlos, Sao Paulo 13565-905, Brazil; Department of Epidemiology and Public Health, University College of London (UCL). Gower Street, London WC1E 6BT, United Kingdom; Gerontology Department, Federal University of Sao Carlos, Rodovia Washington Luís, km 235, SP-310, Sao Carlos, Sao Paulo 13565-905, Brazil.
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van der Ploeg T, Gobbens RJJ, Salem BE. Bayesian Techniques in Predicting Frailty among Community-Dwelling Older Adults in the Netherlands. Arch Gerontol Geriatr 2023; 105:104836. [PMID: 36343439 DOI: 10.1016/j.archger.2022.104836] [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: 09/10/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
Background Frailty is a syndrome that is defined as an accumulation of deficits in physical, psychological, and social domains. On a global scale, there is an urgent need to create frailty-ready healthcare systems due to the healthcare burden that frailty confers on systems and the increased risk of falls, healthcare utilization, disability, and premature mortality. Several studies have been conducted to develop prediction models for predicting frailty. Most studies used logistic regression as a technique to develop a prediction model. One area that has experienced significant growth is the application of Bayesian techniques, partly due to an increasing number of practitioners valuing the Bayesian paradigm as matching that of scientific discovery. Objective We compared ten different Bayesian networks as proposed by ten experts in the field of frail elderly people to predict frailty with a choice from ten dichotomized determinants for frailty. Methods We used the opinion of ten experts who could indicate, using an empty Bayesian network graph, the important predictors for frailty and the interactions between the different predictors. The candidate predictors were age, sex, marital status, ethnicity, education, income, lifestyle, multimorbidity, life events, and home living environment. The ten Bayesian network models were evaluated in terms of their ability to predict frailty. For the evaluation, we used the data of 479 participants that filled in the Tilburg Frailty indicator (TFI) questionnaire for assessing frailty among community-dwelling older people. The data set contained the aforementioned variables and the outcome "frail". The model fit of each model was measured using the Akaike information criterion (AIC) and the predictive performance of the models was measured using the area under the curve (AUC) of the receiver operator characteristic (ROC). The AUCs of the models were validated using bootstrapping with 100 repetitions. The relative importance of the predictors in the models was calculated using the permutation feature importance algorithm (PFI). Results The ten Bayesian networks of the ten experts differed considerably regarding the predictors and the connections between the predictors and the outcome. However, all ten networks had corrected AUCs >0.700. Evaluating the importance of the predictors in each model, "diseases or chronic disorders" was the most important predictor in all models (10 times). The predictors "lifestyle" and "monthly income" were also often present in the models (both 6 times). One or more diseases or chronic disorders, an unhealthy lifestyle, and a monthly income below 1800 euro increased the likelihood of frailty. Conclusions Although the ten experts all made different graphs, the predictive performance was always satisfying (AUCs >0.700). While it is true that the predictor importance varied all the time, the top three of the predictor importance consisted of "diseases or chronic disorders", "lifestyle" and "monthly income". All in all, asking for the opinion of experts in the field of frail elderly to predict frailty with Bayesian networks may be more rewarding than a data-driven forecast with Bayesian networks because they have expert knowledge regarding interactions between the different predictors.
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Affiliation(s)
- Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, the Netherlands
| | - Benissa E Salem
- School of Nursing, University of California, Los Angeles, USA
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Chin M, Kendzerska T, Inoue J, Aw M, Mardiros L, Pease C, Andrew MK, Pakhale S, Forster AJ, Mulpuru S. Comparing the Hospital Frailty Risk Score and the Clinical Frailty Scale Among Older Adults With Chronic Obstructive Pulmonary Disease Exacerbation. JAMA Netw Open 2023; 6:e2253692. [PMID: 36729458 PMCID: PMC9896302 DOI: 10.1001/jamanetworkopen.2022.53692] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
IMPORTANCE Frailty is associated with severe morbidity and mortality among people with chronic obstructive pulmonary disease (COPD). Interventions such as pulmonary rehabilitation can treat and reverse frailty, yet frailty is not routinely measured in pulmonary clinical practice. It is unclear how population-based administrative data tools to screen for frailty compare with standard bedside assessments in this population. OBJECTIVE To determine the agreement between the Hospital Frailty Risk Score (HFRS) and the Clinical Frailty Scale (CFS) among hospitalized individuals with COPD and to determine the sensitivity and specificity of the HFRS (vs CFS) to detect frailty. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study was conducted among hospitalized patients with COPD exacerbation. The study was conducted in the respiratory ward of a single tertiary care academic hospital (The Ottawa Hospital, Ottawa, Ontario, Canada). Participants included consenting adult inpatients who were admitted with a diagnosis of acute COPD exacerbation from December 2016 to June 2019 and who used a clinical care pathway for COPD. There were no specific exclusion criteria. Data analysis was performed in March 2022. EXPOSURE Degree of frailty measured by the CFS. MAIN OUTCOMES AND MEASURES The HFRS was calculated using hospital administrative data. Primary outcomes were the sensitivity and specificity of the HFRS to detect frail and nonfrail individuals according to CFS assessments of frailty, and the secondary outcome was the optimal probability threshold of the HFRS to discriminate frail and nonfrail individuals. RESULTS Among 99 patients with COPD exacerbation (mean [SD] age, 70.6 [9.5] years; 56 women [57%]), 14 (14%) were not frail, 33 (33%) were vulnerable, 18 (18%) were mildly frail, and 34 (34%) were moderately to severely frail by the CFS. The HFRS (vs CFS) had a sensitivity of 27% and specificity of 93% to detect frail vs nonfrail individuals. The optimal probability threshold for the HFRS was 1.4 points or higher. The corresponding sensitivity to detect frailty was 69%, and the specificity was 57%. CONCLUSIONS AND RELEVANCE In this cross-sectional study, using the population-based HFRS to screen for frailty yielded poor detection of frailty among hospitalized patients with COPD compared with the bedside CFS. These findings suggest that use of the HFRS in this population may result in important missed opportunities to identify and provide early intervention for frailty, such as pulmonary rehabilitation.
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Affiliation(s)
- Melanie Chin
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Tetyana Kendzerska
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jiro Inoue
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michael Aw
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda Mardiros
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Pease
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Melissa K. Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Smita Pakhale
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alan J. Forster
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
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Farrelly C. Longevity Science and Women's Health and Wellbeing. JOURNAL OF POPULATION AGEING 2023:1-20. [PMID: 36741335 PMCID: PMC9885070 DOI: 10.1007/s12062-023-09411-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
In most areas of the world women comprise the majority of older persons (especially at the most advanced ages), but the additional longevity (globally it is 4.8 years) women have often comes with poorer health status compared to age-matched men. This article draws attention to four distinct ways an applied gerontological intervention designed to increase the human healthspan via "rate (of ageing) control" could positively impact the health and wellbeing of women in today's ageing world. The four benefits examined are: (1) improving women's health in late life; (2) increasing reproductive longevity and improving maternal health, (3) reducing the financial vulnerability many women experience at advanced ages (especially in the developing world); and (4) reducing the caring burdens which typically fall, at least disproportionately, on daughters to care for their ageing parents. Highlighting these factors is important as is helps focus geroscience advocacy not only on the potential health dividend age retardation could confer on those in late life, but also the distributional effects on health throughout the lifespan (e.g. improving maternal health) and on helping to ameliorate other important inequalities (e.g. reducing the financial vulnerabilities of late life and easing the burdens on the care givers for ageing parents). By making vivid the benefits "rate (of ageing) control" could confer on women, especially in the developing world, the goal of retarding biological ageing can be rightly construed as a pressing public health priority for the 21st century.
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Affiliation(s)
- Colin Farrelly
- Department of Political Studies, Queen’s University, Kingston, Canada
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5-Hydroxymethylfurfural induces mice frailty through cell senescence-associated sarcopenia caused by chronic inflammation. Heliyon 2023; 9:e13217. [PMID: 36793951 PMCID: PMC9922977 DOI: 10.1016/j.heliyon.2023.e13217] [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: 10/20/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 01/23/2023] Open
Abstract
Objective 5-Hydroxymethylfurfural (5-HMF) is an important component of air pollution, confirmed to be a risk factor for pulmonary inflammation. However, its association with general health is unknown. This article aimed to clarify the effect and mechanism of 5-HMF in the occurrence and aggravation of frailty in mice by investigating whether exposure to 5-HMF was linked to the occurrence and aggravation of mice frailty. Methods Twelve male C57BL/6 mice (12-month-old, 38 ± 1 g) were randomly divided into the control group and the 5-HMF group. The 5-HMF group was treated with 5-HMF (1 mg/kg/day, respiratory exposure) for 12 months, whereas the control group was treated with equal amounts of sterile water. After the intervention, the ELISA method was used to detect the serum inflammation level of the mice, and the physical performance and frail status were evaluated using a Fried physical phenotype-based assessment tool. The differences in the body compositions were calculated from their MRI images, and the pathological changes in their gastrocnemius muscle were revealed using the H&E staining. Furthermore, the senescence of skeletal muscle cells was evaluated by measuring the expression levels of senescence-related proteins by the western blotting. Results In the 5-HMF group, serum inflammatory factors IL-6, TNF-α, and CRP levels were significantly raised (p < 0.01). Mice in this group had higher frailty scores and significantly reduced grip strength (p < 0.001), slower weight gains, less WVgastrocnemius muscle masses, and lower sarcopenia indices (SI). In addition, the cross-sectional areas of their skeletal muscles were reduced, and the levels of their cell senescence-related proteins (p53, p21, p16, SOD1, SOD2, SIRT1, SIRT3) were considerably altered (p < 0.01). Conclusion 5-HMF may induce chronic and systemic inflammation, which in turn accelerates the progression of the frailty of mice through cell senescence.
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Sapp DG, Cormier BM, Rockwood K, Howlett SE, Heinze SS. The frailty index based on laboratory test data as a tool to investigate the impact of frailty on health outcomes: a systematic review and meta-analysis. Age Ageing 2023; 52:afac309. [PMID: 36626319 PMCID: PMC9831271 DOI: 10.1093/ageing/afac309] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 01/11/2023] Open
Abstract
The frailty index (FI) quantifies frailty as deficit accumulation. It has been adapted to employ laboratory test data (FI-Lab). Our objective was to systematically review and meta-analyse the FI-Lab's ability to predict mortality. Secondary objectives were to review the FI-Lab's association with adverse health outcomes and whether FI-Lab scores differed between the sexes. A systematic literature search was carried out using six online databases to identify studies that measured the FI-Lab in humans. Hazard ratios (HRs) were combined in a meta-analysis to create a pooled risk estimate for mortality. Of the 1,201 papers identified, spanning January 2010 until 11 July 2022, 38 were included. FI-Lab scores per 0.01 unit increase predicted mortality overall (HR = 1.04; 95% confidence interval (CI) = 1.03-1.05) and for studies with a mean age of 81+ years (HR = 1.04; 95% CI = 1.03-1.05). The quality of evidence for these meta-analyses are moderate and high, respectively. Further, higher FI-Lab scores were associated with more frequent adverse health outcomes. Sex differences in FI-Lab scores varied, with no consistent indication of a sex effect. The FI-Lab is associated with mortality and with a variety of adverse health outcomes. No consistent sex differences in FI-Lab scores were observed, with several studies in disagreement. Notably, these conclusions were most relevant to older (65+ years old) individuals; further evidence in younger people is needed in both clinical and population representative studies.
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Affiliation(s)
- David G Sapp
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Brianna M Cormier
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Kenneth Rockwood
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Stefan S Heinze
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
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Krivoshapova KE, Galimova NA, Bazdyrev ED, Barbarash OL. Sex differences in frailty manifestations in patients with coronary artery disease. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2023-3378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Aim. To analyze the differences in detection rate of prefrailty and frailty syndrome (FS) in male and female patients with multivessel coronary artery disease (CAD) undergoing elective coronary artery bypass grafting (CABG).Material and methods. The study included 387 patients admitted for elective primary CABG. Screening for prefrailty and FS in patients before surgery was performed using the questionnaire "Age is not a drawback".Results. In the age group of 45 to 59 years, 25% of females and only 6% of males had signs of FS, while 25% of women and 34% of men did not present with signs of frailty and prefrailty. Half of middle-aged women and 60% of middle-aged men had prefrailty. Between the ages of 60 and 74, only 14% of women and 24% of men were not frail. Elderly women are more likely than elderly men to present with signs of FS (p=0,040). The symptoms of prefrailty in elderly patients were detected at equal rate in men and women (59% and 60%, respectively). All senile-aged patients presented with the signs of prefrailty or FS.Conclusion. Patients with multivessel CAD present with manifestation of frailty in senile, elderly, and middle age. At the same time, middle-aged and elderly women with the higher rates of comorbid disorders require special attention.
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Affiliation(s)
| | - N. A. Galimova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - E. D. Bazdyrev
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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Resciniti NV, Farina MP, Merchant AT, Lohman MC. Depressive Symptoms Partially Mediate the Association of Frailty Phenotype Symptoms and Cognition for Females but Not Males. J Aging Health 2023; 35:42-49. [PMID: 35527693 PMCID: PMC9640765 DOI: 10.1177/08982643221100688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We aimed to evaluate whether depressive symptoms mediated the relationship between frailty phenotype and cognitive function by sex. METHODS Data came from the Health and Retirement Study from 2012-2016. The outcome was measured by Fried's frailty criteria, our outcome was continuous global cognition, and mediator was depressive symptoms. We used mediation analysis, stratified by sex, to estimate the direct and indirect effects of frailty symptoms on cognition mediated by depressive symptoms. RESULTS Males had a larger total effect (β= -0.43; 95% CI: -0.66, -0.02) for lower cognitive score for each increase in frailty symptom compared to females (β= -0.28; 95% CI: -0.47, -0.08). A significant indirect effect from frailty phenotype to cognition was found through depressive symptoms for females but not males. CONCLUSION These results highlight the importance of identifying individuals with frailty and depressive symptoms to monitor and provide interventions to preserve cognitive function.
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Affiliation(s)
- Nicholas V. Resciniti
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Mateo P. Farina
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Anwar T. Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Matthew C. Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Farrell S, Kane AE, Bisset E, Howlett SE, Rutenberg AD. Measurements of damage and repair of binary health attributes in aging mice and humans reveal that robustness and resilience decrease with age, operate over broad timescales, and are affected differently by interventions. eLife 2022; 11:e77632. [PMID: 36409200 PMCID: PMC9725749 DOI: 10.7554/elife.77632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
As an organism ages, its health-state is determined by a balance between the processes of damage and repair. Measuring these processes requires longitudinal data. We extract damage and repair transition rates from repeated observations of binary health attributes in mice and humans to explore robustness and resilience, which respectively represent resisting or recovering from damage. We assess differences in robustness and resilience using changes in damage rates and repair rates of binary health attributes. We find a conserved decline with age in robustness and resilience in mice and humans, implying that both contribute to worsening aging health - as assessed by the frailty index (FI). A decline in robustness, however, has a greater effect than a decline in resilience on the accelerated increase of the FI with age, and a greater association with reduced survival. We also find that deficits are damaged and repaired over a wide range of timescales ranging from the shortest measurement scales toward organismal lifetime timescales. We explore the effect of systemic interventions that have been shown to improve health, including the angiotensin-converting enzyme inhibitor enalapril and voluntary exercise for mice. We have also explored the correlations with household wealth for humans. We find that these interventions and factors affect both damage and repair rates, and hence robustness and resilience, in age and sex-dependent manners.
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Affiliation(s)
| | - Alice E Kane
- Blavatnik Institute, Department of Genetics, Paul F. Glenn Center for Biology of Aging Research at Harvard Medical SchoolBostonUnited States
| | - Elise Bisset
- Department of Pharmacology, Dalhousie UniversityHalifaxCanada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie UniversityHalifaxCanada
- Department of Medicine (GeriatricMedicine), Dalhousie UniversityHalifaxCanada
| | - Andrew D Rutenberg
- Department of Physics and Atmospheric Science, Dalhousie UniversityHalifaxCanada
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De Miguel-Yanes JM, Jimenez-Garcia R, De Miguel-Diez J, Hernández-Barrera V, Carabantes-Alarcon D, Zamorano-Leon JJ, Noriega C, Lopez-de-Andres A. Differences in Sex and the Incidence and In-Hospital Mortality among People Admitted for Infective Endocarditis in Spain, 2016-2020. J Clin Med 2022; 11:jcm11226847. [PMID: 36431324 PMCID: PMC9698698 DOI: 10.3390/jcm11226847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: A description of the trends and outcomes during hospitalization for infective endocarditis (IE) according to sex. (2) Methods: Using Spanish national hospital discharge data (2016−2020), we built Poisson regression models to compare the age-adjusted time trends for the incidence rate. We used propensity score matching (PSM) to compare the clinical characteristics and the in-hospital mortality (IHM) between men and women hospitalized with IE. (3) Results: We identified 10,459 hospitalizations for IE (33.26% women). The incidence of IE remained stable during this five-year period. The age-adjusted incidence of IE was two-fold higher among men vs. women (IRR = 2.08; 95%CI 2.0−2.17). Before PSM, women with IE were significantly older than men (70.25 vs. 66.24 years; p < 0.001) and had lower comorbidity according to the Charlson comorbidity index (mean 1.38 vs. 1.43; p = 0.019). After PSM, the IHM among women admitted for IE remained >3 points higher than that among men (19.52% vs. 15.98%; p < 0.001). (4) Conclusions: The incidence of IE was two-fold higher among men than among women. IHM was significantly higher among women after accounting for the potential confounders.
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Affiliation(s)
- Jose M. De Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Correspondence:
| | - Javier De Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
| | - Valentin Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - David Carabantes-Alarcon
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jose J. Zamorano-Leon
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Concepción Noriega
- Department of Nursery and Physiotherapy, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
| | - Ana Lopez-de-Andres
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Marconcin P, Barak S, Ferrari G, Gouveia ÉR, de Maio Nascimento M, Willig R, Varela M, Marques A. Prevalence of Frailty and Its Association with Depressive Symptoms among European Older Adults from 17 Countries: A 5-Year Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114055. [PMID: 36360934 PMCID: PMC9655131 DOI: 10.3390/ijerph192114055] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND This study aimed to examine the association between frailty and depressive symptoms. METHODS Cross-sectional and five-year longitudinal study. Data were from the population-based Survey of Health, Aging, and Retirement in Europe (SHARE) waves six (2015) and eight (2020). Frailty was assessed using the SHARE-Frailty Instrument. Fatigue, appetite, walking difficulties, and physical activity were self-reported, and grip strength was measured using a handgrip dynamometer. The EURO-D 12-item scale was used to measure depressive symptoms. RESULTS The sample comprised 25,771 older adults (56.2% female) with a mean age of 66.5 (95% CI 66.4, 66.6) years. The prevalence of frailty was 4.2% (95% CI 3.9, 4.4) in 2015 and 6.7% (95% CI 13.5, 14.3) in 2020. Among frail participants, 72.5% and 69.6% had depression in 2015 and 2020, respectively. Frailty was associated with depression over the 5 years. Those with pre-frailty and those with frailty in 2015 had 1.86 (95% CI 1.71, 2.01) and 2.46 (95% CI 2.14, 2.83) greater odds of having depressive symptoms in 2020. CONCLUSIONS Frailty is a predictor of depression in older adults, and frail participants had greater odds of presenting depressive symptoms.
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Affiliation(s)
- Priscila Marconcin
- CIPER-Interdisciplinary Centre for the Study of Human Performance Faculty of Human Kinetics, University of Lisbon, 1495-751 Lisbon, Portugal
- KinesioLab, Research Unit in Human Movement Analysis, Piaget Institute, 2805-059 Almada, Portugal
| | - Sharon Barak
- Department of Nursing, School of Health Sciences, Ariel University, Ariel 4076414, Israel
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Ramat-Gan 5290002, Israel
| | - Gerson Ferrari
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Santiago 9170022, Chile
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Providencia 7500912, Chile
| | - Élvio R. Gouveia
- Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal
- LARSYS-Laboratory for Robotics and Engineering System, Interactive Technologies Institute, 9020-105 Funchal, Portugal
| | - Marcelo de Maio Nascimento
- Department of Physical Education, Federal University of Vale do São Francisco, Petrolina 56304-917, Brazil
| | - Renata Willig
- KinesioLab, Research Unit in Human Movement Analysis, Piaget Institute, 2805-059 Almada, Portugal
| | - Margarida Varela
- RECI—Research Unit in Education and Community Intervention, Piaget Institute, 2805-059 Almada, Portugal
| | - Adilson Marques
- CIPER-Interdisciplinary Centre for the Study of Human Performance Faculty of Human Kinetics, University of Lisbon, 1495-751 Lisbon, Portugal
- ISAMB-Environmental Health Institute, Faculty of Medicine, University of Lisbon, 1649-020 Lisbon, Portugal
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Perez-Rojo G, López J, Noriega C, Velasco C, Carretero I, López-Frutos P, Galarraga L. A multidimensional approach to the resilience in older adults despite COVID-19. BMC Geriatr 2022; 22:793. [PMID: 36221056 PMCID: PMC9553300 DOI: 10.1186/s12877-022-03472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/22/2022] [Indexed: 11/21/2022] Open
Abstract
Researchers have mainly focused on aging risk factors and COVID-19 consequences. However, older adults have proved their ability to overcome adversities along their life. Resilience is a protective variable that dampens the impact of stress. Based on MacLeod’s et al. (2016) approach, we aimed to analyze the relationship between older adults’ resilience and COVID-19 related-stressors as well as their physical, mental, and social characteristics. Eight hundred eighty-nine people aged 60 and over participated in this study. Older participants, women, having better perceived health and not losing a loved one because of the virus were associated with more resilience. Moreover, higher levels of gratitude, personal growth, life purpose and lower levels of depression were associated with greater scores in resilience. This study offers a change of perspective in which aging is perceived from a positive viewpoint by focusing on easily accessible resources that may help older adults to cope with adverse situations.
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Affiliation(s)
- G Perez-Rojo
- Department of Psychology and Pedagogy, School of Medicine, Universidad San Pablo-CEU, CEU Universities, 28925, Madrid, Spain. .,Departamento de Psicología y Pedagogía, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Campus de Montepríncipe, 28925, Alcorcón, Madrid, Spain.
| | - J López
- Department of Psychology and Pedagogy, School of Medicine, Universidad San Pablo-CEU, CEU Universities, 28925, Madrid, Spain
| | - C Noriega
- Department of Psychology and Pedagogy, School of Medicine, Universidad San Pablo-CEU, CEU Universities, 28925, Madrid, Spain
| | - C Velasco
- Department of Psychology and Pedagogy, School of Medicine, Universidad San Pablo-CEU, CEU Universities, 28925, Madrid, Spain
| | - I Carretero
- Department of Psychology and Pedagogy, School of Medicine, Universidad San Pablo-CEU, CEU Universities, 28925, Madrid, Spain
| | - P López-Frutos
- Department of Psychology and Pedagogy, School of Medicine, Universidad San Pablo-CEU, CEU Universities, 28925, Madrid, Spain.,Universidad Francisco de Vitoria, Universidad Francisco de Vitoria, 28223, Madrid, Spain
| | - L Galarraga
- Department of Psychology and Pedagogy, School of Medicine, Universidad San Pablo-CEU, CEU Universities, 28925, Madrid, Spain
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Reid N, Young A, Shafiee Hanjani L, Hubbard RE, Gordon EH. Sex-specific interventions to prevent and manage frailty. Maturitas 2022; 164:23-30. [PMID: 35780633 DOI: 10.1016/j.maturitas.2022.05.012] [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: 03/20/2022] [Revised: 05/20/2022] [Accepted: 05/28/2022] [Indexed: 12/15/2022]
Abstract
There is growing interest in interventions that delay, slow, and even reverse frailty. In this narrative review, we explore the evidence on exercise, nutrition, medication optimisation and social support interventions for frailty and consider how these relate to underlying frailty pathophysiology. We also consider pathophysiological mechanisms underpinning sex differences in frailty before evaluating the limited evidence for sex-specific frailty interventions that is currently available. Through this review of the literature, we generate a list of potential sex-specific interventions for frailty. While individual-level recommendations are certainly important, future work should turn the focus towards population-level interventions that take into account sex differences in frailty, including changes to healthcare and socioeconomic systems, as well as changes to the built environment to promote healthy behaviours.
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Affiliation(s)
- Natasha Reid
- Faculty of Medicine, The University of Queensland, Queensland, Australia.
| | - Adrienne Young
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Royal Brisbane and Women's Hospital, Metro North Health, Queensland, Australia
| | | | - Ruth E Hubbard
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health, Queensland, Australia
| | - Emily H Gordon
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health, Queensland, Australia
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Beier F, Löffler M, Nees F, Hausner L, Frölich L, Flor H. Sensory and motor correlates of frailty: dissociation between frailty phenotype and frailty index. BMC Geriatr 2022; 22:755. [PMID: 36109693 PMCID: PMC9479302 DOI: 10.1186/s12877-022-03416-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Frailty has been associated with a decline in sensory and motor function. However, given that different frailty measures were shown to overlap but also differ in their diagnostic properties, sensory and motor correlates of frailty might be different depending on the operationalization of frailty. Our objective was to identify sensory and motor determinants of frailty and compare the results between frailty phenotype (FP) and frailty index (FI).
Methods
Data from 44 pre-frail and frail subjects aged 65 and above were used. Frailty was measured using the FP and the FI. Sensory function in the visual, auditory, and tactile domain was assessed using visual acuity, absolute hearing threshold and mechanical detection threshold. Upper extremity motor performance was evaluated by the Purdue Pegboard Test and the Short Physical Performance Battery was used to assess lower extremity motor function. Multiple logistic regression models were employed to determine associations of sensory and motor function with frailty vs. pre-frailty for both frailty measures.
Results
The frailty measures were moderately correlated (0.497, p ≤ 0.01) and had a Kappa agreement of 0.467 (p = 0.002). Using the FP, frailty was significantly associated with reduced upper extremity motor function only (OR = 0.50, 95% CI 0.29–0.87, p = 0.014). Frailty as assessed by the FI was significantly related to higher hearing thresholds (OR = 1.21, 95% CI 1.02–1.43, p = 0.027) and reduced lower extremity performance (OR = 0.32, 95% CI 0.13–0.77, p = 0.012).
Conclusion
Frailty is related to reduced performance in measures of sensory and motor function. However, traditional measures of frailty might be differentially sensitive to capture sensory and motor decline, possibly contributing to the much-observed discordance between the diagnostic instruments. This should be taken into account by researchers and clinicians when planning and evaluating therapeutic interventions for frailty.
Trial registration
ClinicalTrials.gov NCT03666039. Registered 11 September 2018 – Retrospectively registered.
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Andrew MK, Matthews S, Kim JH, Riley ME, Curran D. An Easy-to-Implement Clinical-Trial Frailty Index Based on Accumulation of Deficits: Validation in Zoster Vaccine Clinical Trials. Clin Interv Aging 2022; 17:1261-1274. [PMID: 36017192 PMCID: PMC9397533 DOI: 10.2147/cia.s364997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Despite being among those most in need of protection, frail older adults are often not well represented in clinical trials. Although frailty likely influences responses to treatments and vaccines, frailty may not be explicitly considered in trials even when frail participants are enrolled due to the perception that frailty is difficult to measure effectively and efficiently without adding to participant or data collection burden. We developed an easy-to-implement frailty index, the Clinical Trial-Frailty Index (CT-FI), based on baseline medical history and standard patient-reported outcomes using data from clinical trials of recombinant Zoster vaccine (the ZOE-50 and ZOE-70 studies). Our objective was to demonstrate that the CT-FI is a robust measure that may be used retrospectively or prospectively in clinical trials where sufficient patient data have been collected. Methods The CT-FI was based on baseline medical history and Quality of Life questionnaires (SF-36 and EQ-5D). Items meeting criteria for inclusion were scored from 0 to 1, then summed for each participant and divided by the total number of deficits considered. Validation analyses included descriptive verification of distribution and age- and sex-associations in relation to usual patterns of the frailty index, regressions in relation to outcomes hypothesized to be related to frailty, and resampling methods within the index. Results The CT-FI distribution was well represented by a gamma distribution with a range of 0–0.70. Deficit accumulation increased with chronological age and was higher for females. Multivariate Cox regression survival analysis showed that the CT-FI, age, and sex were significant predictors of mortality. Jackknife and Bootstrap resampling methods highlighted the robustness of the CT-FI, which was not sensitive to inclusion/exclusion of specific individual or groups of variables. Conclusion We have developed a reliable, robust and easy-to-implement CT-FI with potential retrospective or prospective application in other clinical trials. ![]()
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Affiliation(s)
- Melissa K Andrew
- Department of Medicine (Division of Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada
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