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Abstract
BACKGROUND Frailty has been associated with cognitive markers of dementia but its relationship with behavioral markers of dementia are poorly understood. OBJECTIVES To investigate the association between frailty and mild behavioral impairment (MBI), and whether this association is moderated by sex. DESIGN Cross-sectional observational study. PARTICIPANTS/SETTING 219 non-dementia participants (cognitively normal and mild cognitive impairment) from the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) study. MEASUREMENTS Frailty was measured using the frailty index (FI) with higher scores indicating more health deficits/greater frailty. MBI symptoms were derived from Neuropsychiatric Inventory Questionnaire scores using a published algorithm with a cut-off of >0 indicating MBI symptom presence and higher scores indicating greater severity. Multivariable logistic and linear regressions adjusted for age, sex, education, and cognitive diagnosis were used to test the association between FI and MBI symptom presence and severity, respectively, with MBI as the outcome variable. An FI-by-sex interaction term was included to test for sex-dependent effects. RESULTS The FI mean and SD across the entire cohort was 0.14 ± 0.06 (median = 0.14, IQR = 0.09-0.17, range = 0.02-0.38). Higher FI scores were associated with the presence of MBI symptoms both globally and in the domains of decreased motivation, affective dysregulation, and psychosis. Higher FI scores were also associated with more severe MBI symptoms in a sex-dependent manner: both sexes reported similarly low MBI symptom severity at low (-1 SD) levels of FI but males reported 1.9x higher MBI symptom severity relative to females at high (+1 SD) levels of FI. CONCLUSIONS The FI is associated with both the presence and severity of MBI, especially for males. This suggests that screening for early dementia risk should incorporate assessments of MBI for patients with frailty, and assessments of frailty for patients with MBI.
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Affiliation(s)
- D X Guan
- Zahinoor Ismail, 3280 Hospital Dr. NW Calgary AB, Canada T2N 4Z6, 403-210-6900, , @11thCCD
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Muscedere J, Afilalo J, Araujo de Carvalho I, Cesari M, Clegg A, Eriksen HE, Evans KR, Heckman G, Hirdes JP, Kim PM, Laffon B, Lynn J, Martin F, Prorok JC, Rockwood K, Rodrigues Mañas L, Rolfson D, Shaw G, Shea B, Sinha S, Theou O, Tugwell P, Valdiglesias V, Vellas B, Veronese N, Wallace LMK, Williamson PR. Moving Towards Common Data Elements and Core Outcome Measures in Frailty Research. J Frailty Aging 2020; 9:14-22. [PMID: 32150209 DOI: 10.14283/jfa.2019.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With aging populations around the world, frailty is becoming more prevalent increasing the need for health systems and social systems to deliver optimal evidence based care. However, in spite of the growing number of frailty publications, high-quality evidence for decision making is often lacking. Inadequate descriptions of the populations enrolled including frailty severity and frailty conceptualization, lack of use of validated frailty assessment tools, utilization of different frailty instruments between studies, and variation in reported outcomes impairs the ability to interpret, generalize and implement the research findings. The utilization of common data elements (CDEs) and core outcome measures (COMs) in clinical trials is increasingly being adopted to address such concerns. To catalyze the development and use of CDEs and COMs for future frailty studies, the Canadian Frailty Network (www.cfn-nce.ca; CFN), a not-for-profit pan-Canadian nationally-funded research network, convened an international group of experts to examine the issue and plan the path forward. The meeting was structured to allow for an examination of current frailty evidence, ability to learn from other COMs and CDEs initiatives, discussions about specific considerations for frailty COMs and CDEs and finally the identification of the necessary steps for a COMs and CDEs consensus initiative going forward. It was agreed at the onset of the meeting that a statement based on the meeting would be published and herein we report the statement.
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Affiliation(s)
- J Muscedere
- John Muscedere, Queen's University and Kingston General Hospital, Canada, E-Mail:
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Starkman R, Alibhai S, Wells RA, Geddes M, Zhu N, Keating MM, Leber B, Chodirker L, Sabloff M, Christou G, Leitch HA, St-Hilaire E, Finn N, Shamy A, Yee K, Storring J, Nevill T, Delage R, Elemary M, Banerji V, Lenis M, Kirubananthaan A, Mamedov A, Zhang L, Rockwood K, Buckstein R. An MDS-specific frailty index based on cumulative deficits adds independent prognostic information to clinical prognostic scoring. Leukemia 2019; 34:1394-1406. [PMID: 31811236 DOI: 10.1038/s41375-019-0666-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/30/2019] [Accepted: 11/17/2019] [Indexed: 12/21/2022]
Abstract
The frailty index (FI) is based on the principle that the more deficits an individual has, the greater their risk of adverse outcomes. It is expressed as a ratio of the number of deficits present to the total number of deficits considered. We developed an MDS-specific FI using a prospective MDS registry and assessed its ability to add prognostic power to conventional prognostic scores in MDS. The 42 deficits included in this FI included measurements of physical performance, comorbidities, laboratory values, instrumental activities of daily living, quality of life and performance status. Of 644 patients, 440 were eligible for FI calculation. The median FI score was 0.25 (range 0.05-0.67), correlated with age and IPSS/IPSS-R risk scores and discriminated overall survival. With a follow-up of 20 months, survival was 27 months (95% CI 24-30.4). By multivariate analysis, age >70, FI, transfusion dependence, and IPSS were significant covariates associated with OS. The incremental discrimination improvement of the frailty index was 37%. We derived a prognostic score with five risk groups and distinct survivals ranging from 7.4 months to not yet reached. If externally validated, the MDS-FI could be used as a tool to refine the risk stratification of current clinical prognostication models.
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Affiliation(s)
- R Starkman
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S Alibhai
- Geriatric Medicine/Oncology, University Health Network, Toronto, ON, Canada
| | - R A Wells
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Geddes
- Hematology/Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - N Zhu
- Hematology/Oncology, University of Alberta Hospital, Edmonton, AB, Canada
| | - M M Keating
- Hematology/Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - B Leber
- Hematology/Oncology, Juravinski Cancer Center, Hamilton, ON, Canada
| | - L Chodirker
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Sabloff
- Hematology/Oncology, University of Ottawa, Ottawa, ON, Canada
| | - G Christou
- Hematology/Oncology, University of Ottawa, Ottawa, ON, Canada
| | - H A Leitch
- Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - E St-Hilaire
- Hematology/Oncology, Dr. Georges-L-Dumont University Centre, Moncton, NB, Canada
| | - N Finn
- Hematology/Oncology, Dr. Georges-L-Dumont University Centre, Moncton, NB, Canada
| | - A Shamy
- Hematology/Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - K Yee
- Hematology/Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - J Storring
- Hematology/Oncology, McGill University Health Centre-Royal Victoria Hospital, Montreal, QC, Canada
| | - T Nevill
- Hematology/Oncology, Vancouver General Hospital, Vancouver, BC, Canada
| | - R Delage
- Hematology/Oncology, Centre de recherche du CHU de Quebec-Universite Laval, Quebec City, QC, Canada
| | - M Elemary
- Hematology, Saskatoon Cancer Centre, Saskatoon, SK, Canada
| | - V Banerji
- Hematology/Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - M Lenis
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Kirubananthaan
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Mamedov
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Zhang
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - K Rockwood
- Geriatric Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - R Buckstein
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Theou O, Jayanama K, Fernández-Garrido J, Buigues C, Pruimboom L, Hoogland AJ, Navarro-Martínez R, Rockwood K, Cauli O. Can a Prebiotic Formulation Reduce Frailty Levels in Older People? J Frailty Aging 2019; 8:48-52. [PMID: 30734832 DOI: 10.14283/jfa.2018.39] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to examine whether a prebiotic formulation reduces frailty index (FI) levels in older people. DESIGN We conducted secondary analysis of a placebo-controlled, randomized, double-blind design study. SETTING/PARTICIPANTS The study included non-demented people over the age of 65 who were living in nursing homes and were able to walk. Fifty participants completed the study (75.3±7.3 years, 70% females). INTERVENTION Participants were randomly assigned to either a group who received daily Darmocare Pre® (inulin and fructooligosaccharides) for 13 weeks or a placebo group (maltodextrin). MEASUREMENT The primary outcome in this secondary analysis was change in level of a 62-item FI compared to baseline. RESULTS At the 13-week follow-up, the placebo group had higher FI levels (preFI 0.23±0.11, postFI 0.24±0.12, p=0.012) and the intervention group had lower FI levels (preFI 0.22±0.09, postFI 0.20±0.08, p<0.001). There was an average increase of 0.01±0.01 in the FI score in the placebo group (0.4 deficits; Cohen's d 0.61; standardized response mean 0.59) and an average reduction of 0.02±0.02 in the intervention group (1.1 deficits; Cohen's d -1.35; standardized response mean -1.16). Among the 28 participants in the intervention group, FI levels were reduced for 25 people; five of them had an FI reduction greater than 0.03. The moderately/severely frail participants (FI >0.3, N=5) had the greatest reduction in their FI (0.04±0.01). CONCLUSION A prebiotic intervention can reduce frailty levels in nursing home residents especially in those with higher levels of frailty.
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Affiliation(s)
- O Theou
- Olga Theou, Rm 1313, Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H2E1, Canada. , Tel: +1 (902) 473-4846, Fax: +1 (902) 473-1050
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Kehler DS, Theou O, Rockwood K. Bed rest and accelerated aging in relation to the musculoskeletal and cardiovascular systems and frailty biomarkers: A review. Exp Gerontol 2019; 124:110643. [PMID: 31255732 DOI: 10.1016/j.exger.2019.110643] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 12/27/2022]
Abstract
Prolonged bed rest and lifelong physical inactivity cause deleterious effects to multiple physiological systems that appear to hasten aging processes. Many such changes are similar to those seen with microgravity in space, but at a much faster rate. Head down tilt bed rest models are used to study whole-body changes that occur with spaceflight. We propose that bed rest can be used to quantify accelerated human aging in relation to frailty. In particular, frailty as a measure of the accumulation of deficits estimates the variability in aging across systems, and moves away from the traditional single-system approach. Here, we provide an overview of the impact of bed rest on the musculoskeletal and cardiovascular systems as well as frailty-related biological markers and inflammatory cytokines. We also propose future inquiries to study the accumulation of deficits with head down bed rest and bed rest in the clinical setting, specifically to understand how unrepaired and unremoved subclinical and subcellular damage give rise to clinically observable health problems.
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Affiliation(s)
- D S Kehler
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - O Theou
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - K Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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Andrew MK, Dupuis-Blanchard S, Maxwell C, Giguere A, Keefe J, Rockwood K, St John P. Social and societal implications of frailty, including impact on Canadian healthcare systems. J Frailty Aging 2019; 7:217-223. [PMID: 30298169 DOI: 10.14283/jfa.2018.30] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Frailty has many social and societal implications. Social circumstances are key both as contributors to frail older adults' health outcomes and as practical facilitators or barriers to intervention and supports. Frailty also has important societal implications for health systems and social care policy. In this discussion paper, we use a social ecology framework to consider the social and societal implications and impact of frailty at each level, from the individual, through relationships with family and friend caregivers, institutions, health systems, neighborhoods and communities, to society at large. We conclude by arguing that attention to these issues at a policy level is critical. We identify three target actions: 1) Social dimensions of frailty should be systematically considered when frailty is assessed. 2) Action is needed at the level of policies and programs to improve support for caregivers. 3) Policy review across all portfolios will benefit from a social frailty lens.
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Affiliation(s)
- M K Andrew
- Melissa K Andrew, Division of Geriatric Medicine, Dalhousie University, Veterans' Memorial Building, 5155 Veterans' Memorial Lane, Halifax NS, B3H 2E1, , phone: (902) 473-4995, fax: (902) 473-1050
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Peters R, Beckett N, Antikainen R, Rockwood K, Bulpitt CJ, Anstey KJ. Subjective memory complaints and incident dementia in a high risk older adult hypertensive population. Age Ageing 2019; 48:253-259. [PMID: 30615065 DOI: 10.1093/ageing/afy193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/07/2018] [Accepted: 12/02/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND there is a growing body of evidence demonstrating an association between subjective memory complaints (SMC) and an increased risk of incident cognitive decline or dementia. To date this has not been examined in hypertensive older adults, a prevalent and growing population group at high risk of cognitive decline. METHODS using data from participants in the Hypertension in the Very Elderly Trial cohort the association between baseline SMC and incident cognitive decline and dementia was examined using Cox proportional hazard regression. Cognitive function was assessed using the Mini-Mental State Exam and diagnoses of dementia were made using standard diagnostic criteria. SMC was assessed by the question 'do you feel that you have more problems with memory than most?' Analyses were rerun to examine the associations by level of baseline cognitive function, to evaluate the role of SMC by dementia type and by sex. RESULTS baseline SMC were associated with an increased risk of developing any dementia (hazard ratio (HR)1.63 (95% confidence intervals (CI): 1.18:2.25)), Alzheimer's disease (HR1.59 (95% CI: 1.08:2.34)) and vascular dementia (HR2.05 (95% CI: 1.19:3.54)). Similar patterns were seen across all levels of baseline MMSE but were strongest in those with scores of 25-27. There were no clear differences by sex. DISCUSSION a positive report of SMC assessed by a single question in an older adult with hypertension raises the possibility of increased risk of incident dementia. As such its use may be a useful addition to the repertoire of the general practitioner and geriatrician when assessing older adults.
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Affiliation(s)
- R Peters
- Neuroscience Research Australia, Sydney, Australia
| | - N Beckett
- Guys and St Thomas’ NHS Foundation Trust, London, UK
| | | | | | | | - K J Anstey
- Neuroscience Research Australia, Sydney, Australia
- University of New South Wales, Sydney, Australia
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Muscedere J, Kim P, Afilalo J, Balion C, Baracos5 V, Bowdish D, Cesari M, Erusalimsky JD, Fülöp T, Heckman G, Howlett S, Khadaroo R, Kirkland J, Rodriguez Mañas L, Marzetti E, Paré G, Raina1 P, Rockwood K, Sinclair A, Skappak C, Verschoor C, Walter S. PROCEEDINGS OF THE CANADIAN FRAILTY NETWORK WORKSHOP: IDENTIFYING BIOMARKERS OF FRAILTY TO SUPPORT FRAILTY RISK ASSESSMENT, DIAGNOSIS AND PROGNOSIS. TORONTO, JANUARY 15, 2018. J Frailty Aging 2019; 8:106-116. [DOI: 10.14283/jfa.2019.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Canadian Frailty Network (CFN), a pan-Canadian not-for-profit organization funded by the Government of Canada through the Networks of Centres of Excellence Program, is dedicated to improving the care of older Canadians living with frailty. The CFN has partnered with the Canadian Longitudinal Study on Aging (CLSA) to measure potential frailty biomarkers in biological samples (whole blood, plasma, urine) collected in over 30,000 CLSA participants. CFN hosted a workshop in Toronto on January 15 2018, bringing together experts in the field of biomarkers, aging and frailty. The overall objectives of the workshop were to start building a consensus on potential frailty biomarker domains and identify specific frailty biomarkers to be measured in the CLSA biological samples. The workshop was structured with presentations in the morning to frame the discussions for the afternoon session, which was organized as a free-flowing discussion to benefit from the expertise of the participants. Participants and speakers were from Canada, Italy, Spain, United Kingdom and the United States. Herein we provide pertinent background information, a summary of all the presentations with key figures and tables, and the distillation of the discussions. In addition, moving forward, the principles CFN will use to approach frailty biomarker research and development are outlined. Findings from the workshop are helping CFN and CLSA plan and conduct the analysis of biomarkers in the CLSA samples and which will inform a follow-up data access competition.
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Jayanama K, Theou O, Blodgett J, Cahill L, Rockwood K. EFFECTS OF NUTRIENTS AND BODY MEASUREMENTS ON MORTALITY RISK IN FRAIL PEOPLE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kehler D, Giacomantonio N, Firth W, Rockwood K, Theou O. THE IMPACT OF CARDIAC REHABILITATION ON FRAILTY SEVERITY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - W Firth
- Nova Scotia Health Authority
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McGarrigle L, Squires E, Wallace L, Gorman M, Rockwood K, Theou O. INVESTIGATING THE PSYCHOMETRIC PROPERTIES OF THE PICTORIAL FIT-FRAIL SCALE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | - M Gorman
- St. Martha’s Regional Hospital, Antigonish, Nova Scotia, Canada
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Kim D, Glynn RJ, Avorn J, Lipsitz LA, Rockwood K, Schneeweiss S. VALIDATION OF A CLAIMS-BASED FRAILTY INDEX AGAINST PHYSICAL PERFORMANCE AND CLINICAL OUTCOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Kim
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, Boston, Massachusetts, United States
| | - R J Glynn
- Divisions of Preventive Medicine and Pharmacoepidemiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - J Avorn
- Brigham and Women’s Hospital, Boston, MA, USA
| | - L A Lipsitz
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - K Rockwood
- Division of Geriatric Medicine, Dalhousie Univerity, Halifax, Nova Scotia, Canada
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Wallace L, Theou O, Godin J, Andrew M, Rockwood K. COMPARING A NEUROPATHOLOGICAL INDEX WITH TRADITIONAL PATHOLOGY IN PREDICTING ALZHEIMER’S DEMENTIA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Farrell S, Mitnitski A, Rockwood K, Rutenberg A. A NETWORK PERSPECTIVE OF AGING AND FRAILTY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Theou O, Kehler D, Mallery K, MacLean M, Rockwood K. EXAMINING THE IMPACT OF UPRIGHT TIME ON FRAILTY CHANGES IN ACUTE CARE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Roberts JC, Lattimore S, Recht M, Jackson S, Gue D, Squire S, Robinson KS, Price V, Denne M, Richardson S, Rockwood K. Goal Attainment Scaling for haemophilia (GAS-Hēm): testing the feasibility of a new patient-centric outcome measure in people with haemophilia. Haemophilia 2018; 24:e199-e206. [PMID: 29626387 DOI: 10.1111/hae.13454] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 01/24/2023]
Abstract
INTRODUCTION To address the need for a patient-reported outcome that can measure clinically and personally meaningful change in people with haemophilia (PwH) on prophylaxis, an approach based on Goal Attainment Scaling (GAS) was developed: the GAS-Hēm. AIM To establish real-world feasibility of GAS-Hēm in PwH. METHODS Patients aged 5-65 years were enroled from four North American centres for a 12-week study. The primary outcome was the proportion of participants who completed GAS-Hēm interviews at baseline, 6 and 12 weeks. GAS-Hēm scores were obtained by subject- and clinician-rated goal attainment at Weeks 6 and 12, and compared with quality of life (QoL) measures and annualized bleed rate (ABR) for construct validity. Goals were evaluated qualitatively for content validity. Responsiveness was calculated using standardized response means (SRM). RESULTS Forty-two participants set 63 goals. Participants preferred to define (37/63) their own goals or further individualize (23/63) from the GAS-Hēm menu. Thirty of the 37 self-defined goals were matched to goals on the GAS-Hēm menu. The most common goal areas were: weight, exercise and nutrition (n = 17); leisure activities (n = 8); and joint problems (n = 7). Both participant- and clinician-rated GAS-Hēm scores at 6 weeks (n = 40) and 12 weeks (n = 41) demonstrated satisfactory goal attainment (SRM [subject-rated] at 12 weeks for adult and paediatric groups was 1.25 and 1.16, respectively). Correlations of GAS-Hēm scores with QoL measures and ABR were uniformly small. CONCLUSION GAS-Hēm was feasible and tapped constructs not captured by ABR or QoL measures.
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Affiliation(s)
- J C Roberts
- Bleeding & Clotting Disorders Institute, Peoria, IL, USA
| | - S Lattimore
- The Hemophilia Center at Oregon Health & Science University, Portland, OR, USA
| | - M Recht
- The Hemophilia Center at Oregon Health & Science University, Portland, OR, USA
| | - S Jackson
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada
| | - D Gue
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada
| | - S Squire
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada
| | | | - V Price
- IWK Health Center, Halifax, NS, Canada
| | - M Denne
- Shire, US Medical Affairs, Chicago, IL, USA
| | | | - K Rockwood
- Dalhousie University, Halifax, NS, Canada.,DGI Clinical Inc., Halifax, NS, Canada
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Rao SK, Wallace LMK, Theou O, Rockwood K. Is it better to be happy or not depressed? Depression mediates the effect of psychological well-being on adverse health outcomes in older adults. Int J Geriatr Psychiatry 2017; 32:1000-1008. [PMID: 27524809 DOI: 10.1002/gps.4559] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To examine the relationship between psychological well-being and depression in older adults and the relative contribution these psychological factors have on risk of functional disability, frailty, and mortality. METHODS This is a secondary analysis of 1668 community-dwelling older adults without dementia who participated in the second wave of the Canadian Study of Health and Aging. Baseline assessments of psychological well-being (Ryff scale) and depression (Geriatric Depression Scale; GDS) were collected. At 5-year follow-up, mortality data were collected; frailty and disability in activities of daily living were evaluated using the frailty index (FI) and the Lawton-Brody scale, respectively. RESULTS Area under the receiver-operating characteristic curve indicated that GDS and Ryff scores were able to independently discriminate whether individuals were considered frail (C = 0.66; C = 0.59, respectively), had limitations in basic (C = 0.64; C = 0.57, respectively) or instrumental (C = 0.70; C = 0.57, respectively) activities of daily living, or had died (C = 0.63; C = 0.57) at follow-up (all P < 0.01). Regression models in which the Ryff and GDS were included in the same model demonstrated that the GDS significantly predicted frailty, disability, and mortality, whereas the Ryff effect was not significant. Mediation analysis determined that the effect of psychological well-being on adverse outcomes was fully mediated by depression. CONCLUSIONS Our results suggest that although both depression and psychological well-being appear to modulate risk for adverse physical health outcomes, depression mediates this relationship. Detecting and treating depressive symptoms should be of high priority in older patients to mitigate risk of future physical health adversities including mortality. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- S K Rao
- Department of Psychiatry, University of Ottawa, Ottawa, Canada.,The Royal Ottawa Mental Health Centre, Ottawa, Canada
| | - L M K Wallace
- Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
| | - O Theou
- Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
| | - K Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, Canada.,Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Canada
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Guaraldi G, Malagoli A, Theou O, Brothers TD, Wallace L, Torelli R, Mussini C, Sartini S, Kirkland SA, Rockwood K. Correlates of frailty phenotype and frailty index and their associations with clinical outcomes. HIV Med 2017; 18:764-771. [PMID: 28737297 DOI: 10.1111/hiv.12527] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Frailty is a predictor of adverse health outcomes and can be measured across the life course, including among people living with HIV. The purpose of this study was to examine two commonly used measures of frailty - the frailty index (FI) and frailty phenotype - to assess common characteristics and to describe associations with multimorbidity, falls, and disability in people aging with HIV. METHODS This was a cross-sectional observational study including 482 consecutive HIV-infected patients (mean age 53.9 ± SD 6.9 years; 75% male) attending the multidisciplinary metabolic clinic at the University of Modena, Italy. Frailty was measured with the frailty phenotype and a 37-item FI. RESULTS The mean FI score was 0.28±0.1 and frailty phenotype categories were: 3.1% frail, 51.9% pre-frail, and 45% robust. The duration of antiretroviral therapy was significantly different across levels of frailty as measured by both frailty tools (P < 0.01), but the nadir CD4 count was only significant for the FI (P = 0.01); current CD4 count was not significantly different across frailty levels using either tool. Both frailty measures were associated with multimorbidity; the FI was associated with Instrumental Activities of Daily Living impairment and falls history, whereas the frailty phenotype was not. CONCLUSIONS The frailty phenotype and the FI demonstrated similar characteristics in patients at a tertiary-level HIV clinic. The FI had a stronger association with age, nadir CD4 count, comorbidities, falls, and disability. Integrating frailty assessments in clinical practice will be crucial for the development of interventions in age-related conditions, including disability and falls, in older persons living with HIV.
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Affiliation(s)
- G Guaraldi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - A Malagoli
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - O Theou
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - T D Brothers
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lmk Wallace
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - R Torelli
- Azienda Ospedaliero-Universitaria Policlinico - Modena, Modena, Italy
| | - C Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - S Sartini
- Azienda Ospedaliero-Universitaria Policlinico - Modena, Modena, Italy
| | - S A Kirkland
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - K Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
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Theou O, Sluggett J, Bell J, Tan E, Emery T, Morley J, Rockwood K, Visvanathan R. FRAILTY IN AUSTRALIAN RESIDENTIAL AGED CARE FACILITIES: RELATIONSHIP WITH ONE-YEAR OUTCOMES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O. Theou
- Dalhousie University, Halifax, Nova Scotia, Canada,
| | - J. Sluggett
- Monash University, Melbourne, Victoria, Australia,
| | - J. Bell
- Monash University, Melbourne, Victoria, Australia,
| | - E.C. Tan
- Monash University, Melbourne, Victoria, Australia,
| | - T. Emery
- Resthaven Incorporated, Adelaide, South Australia, Australia,
| | - J.E. Morley
- Saint Louis University, Saint Louis, Missouri
| | - K. Rockwood
- Dalhousie University, Halifax, Nova Scotia, Canada,
| | - R. Visvanathan
- University of Adelaide, Adelaide, South Australia, Australia,
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20
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Rockwood K. USING A FRAILTY INDEX BASED ON DEFICIT ACCUMULATION. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K. Rockwood
- Dalhousie University, Halifax, Nova Scotia, Canada
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21
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Affiliation(s)
- A.E. Kane
- Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada,
| | - E. Gregson
- Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada,
- Capital District Health Authority, Halifax, Nova Scotia, Canada
| | - O. Theou
- Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada,
- Capital District Health Authority, Halifax, Nova Scotia, Canada
| | - K. Rockwood
- Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada,
- Capital District Health Authority, Halifax, Nova Scotia, Canada
| | - S.E. Howlett
- Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada,
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Lee J, Chignell M, Tong T, Émond M, Sirois M, Goldstein J, Rockwood K, Tierney M. PREDICT - PREDICTING EMERGENCY DEPARTMENT INCIDENT DELIRIUM WITH AN INTERACTIVE COMPUTER TABLET. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J.S. Lee
- Medicine, Div of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada,
- Sunnybrook Research Institute, Toronto, Ontario, Canada,
| | - M. Chignell
- Medicine, Div of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada,
| | - T. Tong
- Medicine, Div of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada,
| | - M. Émond
- Laval University, Quebec, Quebec, Canada,
| | - M. Sirois
- Laval University, Quebec, Quebec, Canada,
| | - J. Goldstein
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - K. Rockwood
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - M.C. Tierney
- Medicine, Div of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada,
- Sunnybrook Research Institute, Toronto, Ontario, Canada,
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McGilton K, Rockwood K. A SAMPLE OF QUALITY OF LIFE RESEARCH FROM THE CANADIAN CONSORTIUM ON NEURODEGENERATION IN AGING. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K. McGilton
- Toronto Rehabilitation Institute - University Health Network, Ontario, Canada
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24
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Hanratty B, Spilsbury K, Rockwood K. FRAILTY PREVENTION, IDENTIFICATION AND MANAGEMENT: WHAT CAN RESEARCH ADD? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B. Hanratty
- Newcastle University, Newcastle upon Tyne, United Kingdom
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Affiliation(s)
| | | | - S. Farrell
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - K. Rockwood
- Dalhousie University, Halifax, Nova Scotia, Canada
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26
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Thibeau S, McDermott K, McFall G, Wiebe S, Rockwood K, Dixon R. FRAILTY EFFECTS ON COGNITIVE CHANGES IN AGING ARE MODERATED BY DOMAIN, GENETIC RISK, AND SEX. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S. Thibeau
- University of Alberta, Edmonton, Alberta, Canada
| | - K. McDermott
- University of Alberta, Edmonton, Alberta, Canada
| | - G. McFall
- University of Alberta, Edmonton, Alberta, Canada
| | - S. Wiebe
- University of Alberta, Edmonton, Alberta, Canada
| | | | - R.A. Dixon
- University of Alberta, Edmonton, Alberta, Canada
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27
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Theou O, Chapman I, Wijeyaratne L, Piantadosi C, Lange K, Naganathan V, Hunter P, Cameron ID, Rockwood K, Visvanathan R. Can an Intervention with Testosterone and Nutritional Supplement Improve the Frailty Level of Under-Nourished Older People? J Frailty Aging 2017; 5:247-252. [PMID: 27883172 DOI: 10.14283/jfa.2016.108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine whether a testosterone and a high calorie nutritional supplement intervention can reduce frailty scores in undernourished older people using multiple frailty tools. DESIGN Randomized controlled trial. SETTING/PARTICIPANTS 53 community-dwelling, undernourished men and women aged >65 years from South Australia, Victoria and New South Wales. INTERVENTION Intervention group received oral testosterone undecanoate and a high calorie supplement (2108-2416 kJ/day) whereas the control group received placebo testosterone and low calorie supplement (142-191 kJ/day). MEASUREMENTS Frailty was operationalized using three frailty indices (FI-lab, FI-self-report, FI-combined) and the frailty phenotype. RESULTS There were no significant differences in changes in frailty scores at either 6 or 12 months follow up between the two treatment groups for all scales. Participants at the intervention group were 4.8 times more likely to improve their FI-combined score at both time points compared to the placebo group. CONCLUSION A testosterone and a high calorie nutritional supplement intervention did not improve the frailty levels of under-nourished older people. Even so, when frailty was measured using a frailty index combining self-reported and lab data we found that participants who received the intervention were more likely to show persistent improvement in their frailty scores.
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Affiliation(s)
- O Theou
- Olga Theou, Dalhousie University and Nova Scotia Health Authority, Suite 1313, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia B3H 2E1, Canada. Tel: 902-473-4846, e-mail:
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Abstract
When people age their mortality rate increases exponentially, following Gompertz's law. Even so, individuals do not die from old age. Instead, they accumulate age-related illnesses and conditions and so become increasingly vulnerable to death from various external and internal stressors. As a measure of such vulnerability, frailty can be quantified using the frailty index (FI). Larger values of the FI are strongly associated with mortality and other adverse health outcomes. This association, and the insensitivity of the FI to the particular health variables that are included in its construction, makes it a powerful, convenient, and increasingly popular integrative health measure. Still, little is known about why the FI works so well. Our group has recently developed a theoretical network model of health deficits to better understand how changes in health are captured by the FI. In our model, health-related variables are represented by the nodes of a complex network. The network has a scale-free shape or "topology": a few nodes have many connections with other nodes, whereas most nodes have few connections. These nodes can be in two states, either damaged or undamaged. Transitions between damaged and non-damaged states are governed by the stochastic environment of individual nodes. Changes in the degree of damage of connected nodes change the local environment and make further damage more likely. Our model shows how age-dependent acceleration of the FI and of mortality emerges, even without specifying an age-damage relationship or any other time-dependent parameter. We have also used our model to assess how informative individual deficits are with respect to mortality. We find that the information is larger for nodes that are well connected than for nodes that are not. The model supports the idea that aging occurs as an emergent phenomenon, and not as a result of age-specific programming. Instead, aging reflects how damage propagates through a complex network of interconnected elements.
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Affiliation(s)
- A B Mitnitski
- Department of Medicine, Dalhousie University, Halifax, Canada.
- Geriatric Medicine Research Unit, Halifax, Canada.
| | - A D Rutenberg
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - S Farrell
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - K Rockwood
- Department of Medicine, Dalhousie University, Halifax, Canada
- Geriatric Medicine Research Unit, Halifax, Canada
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29
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Rockwood K, Blodgett JM, Theou O, Sun MH, Feridooni HA, Mitnitski A, Rose RA, Godin J, Gregson E, Howlett SE. A Frailty Index Based On Deficit Accumulation Quantifies Mortality Risk in Humans and in Mice. Sci Rep 2017; 7:43068. [PMID: 28220898 PMCID: PMC5318852 DOI: 10.1038/srep43068] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/18/2017] [Indexed: 02/06/2023] Open
Abstract
Although many common diseases occur mostly in old age, the impact of ageing itself on disease risk and expression often goes unevaluated. To consider the impact of ageing requires some useful means of measuring variability in health in animals of the same age. In humans, this variability has been quantified by counting age-related health deficits in a frailty index. Here we show the results of extending that approach to mice. Across the life course, many important features of deficit accumulation are present in both species. These include gradual rates of deficit accumulation (slope = 0.029 in humans; 0.036 in mice), a submaximal limit (0.54 in humans; 0.44 in mice), and a strong relationship to mortality (1.05 [1.04–1.05] in humans; 1.15 [1.12–1.18] in mice). Quantifying deficit accumulation in individual mice provides a powerful new tool that can facilitate translation of research on ageing, including in relation to disease.
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Affiliation(s)
- K Rockwood
- Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, N.S., Canada
| | - J M Blodgett
- Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, N.S., Canada
| | - O Theou
- Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, N.S., Canada
| | - M H Sun
- Department of Pharmacology, Dalhousie University, Halifax, N.S., Canada
| | - H A Feridooni
- Department of Pharmacology, Dalhousie University, Halifax, N.S., Canada
| | - A Mitnitski
- Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, N.S., Canada
| | - R A Rose
- Department of Physiology &Biophysics, Dalhousie University, Halifax, N.S., Canada
| | - J Godin
- Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, N.S., Canada
| | - E Gregson
- Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, N.S., Canada
| | - S E Howlett
- Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, N.S., Canada.,Department of Pharmacology, Dalhousie University, Halifax, N.S., Canada
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30
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Recht M, Konkle BA, Jackson S, Neufeld EJ, Rockwood K, Pipe S. Recognizing the need for personalization of haemophilia patient‐reported outcomes in the prophylaxis era. Haemophilia 2016; 22:825-832. [PMID: 27581872 DOI: 10.1111/hae.13066] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2016] [Indexed: 01/19/2023]
Affiliation(s)
- M. Recht
- The Hemophilia Center Oregon Health & Science University Portland OR USA
| | - B. A. Konkle
- Division of Hematology Bloodworks NW and Department of Medicine University of Washington Seattle WA USA
| | - S. Jackson
- Division of Hematology Department of Medicine University of British Columbia Vancouver BC Canada
| | - E. J. Neufeld
- Dana‐Farber/Boston Children's Cancer and Blood Disorders Center Boston Hemophilia Center Boston MA USA
| | - K. Rockwood
- Division of Geriatric Medicine Dalhousie University Halifax Nova Scotia Canada
| | - S. Pipe
- Departments of Pediatrics and Pathology University of Michigan Ann Arbor MI USA
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Mitnitski A, Song X, Rockwood K. Corrigendum to "Trajectories of changes over twelve years in the health status of Canadians from late middle age" [Exp. Gerontol. 47/12 (2012) 893-899]. Exp Gerontol 2016; 83:171. [PMID: 27499524 DOI: 10.1016/j.exger.2016.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Mitnitski
- Department of Medicine, Dalhousie University, Suite 229, 5790 University Ave., Halifax, Nova Scotia B3H 1V7, Canada.
| | - X Song
- Department of Medicine, Dalhousie University, Suite 229, 5790 University Ave., Halifax, Nova Scotia B3H 1V7, Canada; Institute for Biodiagnostics - Atlantic, National Research Council, Halifax B3H 3A7, Canada
| | - K Rockwood
- Department of Medicine, Dalhousie University, Suite 229, 5790 University Ave., Halifax, Nova Scotia B3H 1V7, Canada; QEII Health Science Centre, Division of Geriatric Medicine, Suite 1421, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia B3H 2E1, Canada
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Biritwum RB, Minicuci N, Yawson AE, Theou O, Mensah GP, Naidoo N, Wu F, Guo Y, Zheng Y, Jiang Y, Maximova T, Kalula S, Arokiasamy P, Salinas-Rodríguez A, Manrique-Espinoza B, Snodgrass JJ, Sterner KN, Eick G, Liebert MA, Schrock J, Afshar S, Thiele E, Vollmer S, Harttgen K, Strulik H, Byles JE, Rockwood K, Mitnitski A, Chatterji S, Kowal P. Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa. Maturitas 2016; 91:8-18. [PMID: 27451316 DOI: 10.1016/j.maturitas.2016.05.012] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/18/2016] [Accepted: 05/23/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The severe burden imposed by frailty and disability in old age is a major challenge for healthcare systems in low- and middle-income countries alike. The current study aimed to provide estimates of the prevalence of frailty and disability in older adult populations and to examine their relationship with socioeconomic factors in six countries. METHODS Focusing on adults aged 50+ years, a frailty index was constructed as the proportion of deficits in 40 variables, and disability was assessed using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), as part of the Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, Russia and South Africa. RESULTS This study included a total of 34,123 respondents. China had the lowest percentages of older adults with frailty (13.1%) and with disability (69.6%), whereas India had the highest percentages (55.5% and 93.3%, respectively). Both frailty and disability increased with age for all countries, and were more frequent in women, although the sex gap varied across countries. Lower levels of both frailty and disability were observed at higher levels of education and wealth. Both education and income were protective factors for frailty and disability in China, India and Russia, whereas only income was protective in Mexico, and only education in South Africa. CONCLUSIONS Age-related frailty and disability are increasing concerns for older adult populations in low- and middle-income countries. The results indicate that lower levels of frailty and disability can be achieved for older people, and the study highlights the need for targeted preventive approaches and support programs.
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Affiliation(s)
- R B Biritwum
- University of Ghana, Department of Community Health, Accra, Ghana.
| | - N Minicuci
- University of Ghana, Department of Community Health, Accra, Ghana; National Research Council, Neuroscience Institute, Padova, Italy.
| | - A E Yawson
- University of Ghana, Department of Community Health, Accra, Ghana.
| | - O Theou
- Dalhousie University, Geriatric Medicine, Halifax, Canada.
| | - G P Mensah
- University of Ghana, Department of Community Health, Accra, Ghana.
| | - N Naidoo
- World Health Organization, SAGE team, Geneva, Switzerland.
| | - F Wu
- Shanghai Municipal Center for Disease Control and Prevention (Shanghai CDC), Shanghai, PR China.
| | - Y Guo
- Shanghai Municipal Center for Disease Control and Prevention (Shanghai CDC), Shanghai, PR China.
| | - Y Zheng
- Shanghai Municipal Center for Disease Control and Prevention (Shanghai CDC), Shanghai, PR China.
| | - Y Jiang
- Capital Medical University, Clinical Trial and Research Center for Stroke, Beijing Tiantan Hospital, Beijing, PR China.
| | - T Maximova
- National Research Institute of Public Health (FSBI, RAMS), Moscow, Russian Federation.
| | - S Kalula
- University of Cape Town, Division of Geriatric Medicine, The Albertina and Walter Sisulu Institute of Ageing in Africa, South Africa; Groote Schuur Hospital, International Longevity Centre, Cape Town, South Africa.
| | - P Arokiasamy
- International Institute of Population Studies, Mumbai, India.
| | - A Salinas-Rodríguez
- National Institute of Public Health, Center for Evaluation Research and Surveys, Cuernavaca, Morelos, Mexico.
| | - B Manrique-Espinoza
- National Institute of Public Health, Center for Evaluation Research and Surveys, Cuernavaca, Morelos, Mexico.
| | - J J Snodgrass
- University of Oregon, Department of Anthropology, Eugene, USA.
| | - K N Sterner
- University of Oregon, Department of Anthropology, Eugene, USA.
| | - G Eick
- University of Oregon, Department of Anthropology, Eugene, USA.
| | - M A Liebert
- University of Oregon, Department of Anthropology, Eugene, USA.
| | - J Schrock
- University of Oregon, Department of Anthropology, Eugene, USA.
| | - S Afshar
- University of Southampton, Faculty of Medicine, United Kingdom
| | - E Thiele
- Vassar College, Department of Biology, Poughkeepsie, NY, USA.
| | - S Vollmer
- University of Göttingen, Department of Economics, Germany; Harvard T.H. Chan School of Public Health, Boston, USA.
| | | | - H Strulik
- University of Gottingen, Department of Economics, Gottingen, Germany.
| | - J E Byles
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, Australia.
| | - K Rockwood
- Dalhousie University, Geriatric Medicine, Halifax, Canada.
| | - A Mitnitski
- Dalhousie University, Geriatric Medicine, Halifax, Canada.
| | - S Chatterji
- World Health Organization, SAGE team, Geneva, Switzerland.
| | - P Kowal
- World Health Organization, SAGE team, Geneva, Switzerland; University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, Australia.
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Abstract
Frailty is a multiply determined vulnerability state. People who are frail are at risk of many adverse health outcomes, including death. For any individual, this risk can only be expressed probabilistically. Even very fit people can suddenly die or become catastrophically disabled, but their risk of both is much lower than a very frail person, who might nevertheless suddenly succumb without worsening health. Frailty occurs with ageing, a stochastic, dynamic process of deficit accumulation. Deficits occur ubiquitously at subcellular levels, ultimately affecting tissues, organs and integrated organ action, especially under stress. Some people are disposed to accumulate deficits at higher rates, but on average, deficit accumulation varies across the life course and likely is mutable. In this way, the clinical definition of frailty is distinct from the statistical definition, which sees frailty as a fixed factor for an individual. Recent, early animal work links subcellular deficits to whole body frailty. In humans, clinically detectable health deficits combine to increase the risk of adverse health outcomes. The rate of deficit accumulation occurs with remarkable regularity around the world, as does a limit to frailty. Of note, when 20+ deficits are counted, these characteristics are indifferent to which deficits are considered. The expression of risk in relation to deficit accumulation varies systematically. For example, at any given level of deficit accumulation, men are more susceptible to adverse health outcomes than are women. Likewise, in China, the lethality of deficit accumulation appears to be higher than in Western countries. In consequence, it may be necessary to better distinguish between frailty and physiological reserve; the latter may apply chiefly in relation to microscopic deficits. The expression of frailty risk in relation to deficit accumulation depends on the environment, including both the physical and social circumstances in which people find themselves.
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Affiliation(s)
- K Rockwood
- Prof. Kenneth Rockwood, Centre for Health Care of the Elderly, Capital District Health Authority, 1421-5955 Veterans', Memorial Lane, Halifax Nova Scotia, Canada, B3H 2E1. Telephone 001-902-473-8687; Fax 001-902-473-1050, E-mail:
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Hao Q, Song X, Yang M, Dong B, Rockwood K. Understanding Risk in the Oldest Old: Frailty and the Metabolic Syndrome in a Chinese Community Sample Aged 90+ Years. J Nutr Health Aging 2016; 20:82-8. [PMID: 26728938 DOI: 10.1007/s12603-016-0680-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the relationship between frailty and the metabolic syndrome and to evaluate how these contribute to mortality in very old people. DESIGN Secondary analysis of data from the Project of Longevity and Aging in Dujiangyan. SETTING Community sample from Sichuan Province, China. PARTICIPANTS People aged 90+ years (n=767; baseline age=93.7±3.4 years; 68.0% women. MEASUREMENTS After a baseline health assessment, participants were followed for four years (54.0% died). A frailty index (FI) was calculated as the sum of deficits present, divided by the 35 health-related deficits considered. Relationships between the FI and the metabolic syndrome were tested; their effect on death was examined. RESULTS The mean FI was 0.26 ±0.11. Higher FI scores were associated with a greater risk of death, adjusted for age, sex, education, and metabolic syndrome items. The hazard ratio was 1.03 (95% confidence interval 1.02, 1.04) for each 1% percent increase of the FI. The mortality risk did not change with the metabolic syndrome (odds ratio=0.99; 0.71-1.36). CONCLUSIONS In the oldest old, frailty was a significant risk for near-term death, regardless of the metabolic syndrome. Even using age-adjusted models, the epidemiology of late life illness may need to account for frailty routinely.
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Affiliation(s)
- Q Hao
- Kenneth Rockwood, Division of Geriatric Medicine, Dalhousie University, Suite 1421-5955 Veterans Memorial Lane, Halifax, Nova Scotia, B3H 2E1, Canada, Tel: 1-902-473-8631; Fax: 1-902-473-1050,
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Beckett N, Warwick J, Rockwood K, Mitnitski A, Thijs L, Bulpitt C, Ruth P. O-004: Impact of blood pressure lowering treatment on frailty in the HYpertension in the Very Elderly Trial (HYVET). Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30018-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Theou O, O'Connell MDL, King-Kallimanis BL, O'Halloran AM, Rockwood K, Kenny RA. Measuring frailty using self-report and test-based health measures. Age Ageing 2015; 44:471-7. [PMID: 25687601 DOI: 10.1093/ageing/afv010] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/17/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND previously, frailty indices were constructed using mostly subjective health measures. The reporting error in this type of measure can have implications on the robustness of frailty findings. OBJECTIVE to examine whether frailty assessment differs when we construct frailty indices using solely self-reported or test-based health measures. DESIGN secondary analysis of data from The Irish LongituDinal study on Ageing (TILDA). SUBJECTS AND METHODS 4,961 Irish residents (mean age: 61.9 ± 8.4; 54.2% women) over the age of 50 years who underwent a health assessment were included in this analysis. We constructed three frailty indices using 33 self-reported health measures (SRFI), 33 test-based health measures (TBFI) and all 66 measures combined (CFI). The 2-year follow-up outcomes examined were all-cause mortality, disability, hospitalisation and falls. RESULTS all three indices had a right-skewed distribution, an upper limit to frailty, a non-linear increase with age, and had a dose-response relationship with adverse outcomes. Levels of frailty were lower when self-reported items were used (SRFI: 0.12 ± 0.09; TBFI: 0.17 ± 0.15; CFI: 0.14 ± 0.13). Men had slightly higher frailty index scores than women when test-based measures were used (men: 0.17 ± 0.09; women: 0.16 ± 0.10). CFI had the strongest prediction for risk of adverse outcomes (ROC: 0.64-0.81), and age was not a significant predictor when it was included in the regression model. CONCLUSIONS except for sex differences, characteristics of frailty are similar regardless of whether self-reported or test-based measures are used exclusively to construct a frailty index. Where available, self-reported and test-based measures should be combined when trying to identify levels of frailty.
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Affiliation(s)
- O Theou
- Dalhousie University, Geriatric Medicine, Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia B3H2E1, Canada
| | - M D L O'Connell
- The Irish Longitudinal Study on Ageing, Department of Medical Gerontology, Trinity College, Dublin 2, Ireland
| | - B L King-Kallimanis
- The Irish Longitudinal Study on Ageing, Department of Medical Gerontology, Trinity College, Dublin 2, Ireland
| | - A M O'Halloran
- The Irish Longitudinal Study on Ageing, Department of Medical Gerontology, Trinity College, Dublin 2, Ireland
| | - K Rockwood
- Dalhousie University, Geriatric Medicine, Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia B3H2E1, Canada
| | - R A Kenny
- The Irish Longitudinal Study on Ageing, Department of Medical Gerontology, Trinity College, Dublin 2, Ireland Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
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Kennedy CC, Ioannidis G, Rockwood K, Thabane L, Adachi JD, Kirkland S, Pickard LE, Papaioannou A. A Frailty Index predicts 10-year fracture risk in adults age 25 years and older: results from the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 2014; 25:2825-32. [PMID: 25103215 PMCID: PMC5094886 DOI: 10.1007/s00198-014-2828-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/25/2014] [Indexed: 11/26/2022]
Abstract
UNLABELLED We created a 30-item Frailty Index in the Canadian Multicentre Osteoporosis Study. A Frailty Index is a sensitive measure that can quantify fracture risk according to degree of frailty. Our results indicated that at any age, frailty was an important independent risk factor for fracture over 10 years. INTRODUCTION In later life, frailty has been linked to fractures. It is likely that the antecedents of fracture are seen across the life course, in ways not entirely captured by traditional osteoporosis risk factors. Using data collected from the prospective, population-based Canadian Multicentre Osteoporosis Study (CaMos), we created the 30-item CaMos Frailty Index and examined whether it was associated with incident fractures over 10 years. METHODS All CaMos participants aged 25 years and older (n = 9,423) were included in the analysis. To examine the relationship between baseline Frailty Index scores and incident fractures, a competing risk proportional sub-distribution hazards model was used with death considered a competing risk. Analyses were adjusted for age, sex, body mass index, education level, femoral neck T-score, and antiresorptive therapy. RESULTS At baseline, the mean age was 62.1 years [standard deviation (SD) 13.4], and 69.4 % were women. The mean Frailty Index score was 0.13 (SD 0.11), ranging from 0 to 0.66. For every 0.10 increase in Frailty Index scores (approximately one SD), the hazard ratio was 1.25 (p < 0.001) for all fractures, 1.18 (p = 0.043) for hip fractures, and 1.30 (p ≤ 0.001) for clinical vertebral fractures. CONCLUSION The CaMos Frailty Index quantified fracture risk according to degree of frailty. Irrespective of age and bone mineral density, the Frailty Index was associated with hip, vertebral, and all-type clinical fractures. Predicting late onset illnesses may have to consider overall health status and not just traditional risk factors.
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Affiliation(s)
- C C Kennedy
- Department of Medicine, Division of Geriatrics, McMaster University, St. Peter's Hospital, GERAS Centre, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada,
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Rockwood K. Can't we talk about something more pleasant? Age Ageing 2014. [DOI: 10.1093/ageing/afu103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Guo H, Song X, Vandorpe R, Zhang Y, Chen W, Zhang N, Schmidt MH, Rockwood K. Evaluation of common structural brain changes in aging and Alzheimer disease with the use of an MRI-based brain atrophy and lesion index: a comparison between T1WI and T2WI at 1.5T and 3T. AJNR Am J Neuroradiol 2014; 35:504-12. [PMID: 23988753 PMCID: PMC7964740 DOI: 10.3174/ajnr.a3709] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 06/20/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Brain Atrophy and Lesion Index combines several common, aging-related structural brain changes and has been validated for high-field MR imaging. In this study, we evaluated measurement properties of the Brain Atrophy and Lesion Index by use of T1WI and T2WI at 1.5T and 3T MR imaging to comprehensively assess the usefulness of the lower field-strength testing. MATERIALS AND METHODS Data were obtained from the Alzheimer's Disease Neuroimaging Initiative. Images of subjects (n = 127) who had T1WI and T2WI at both 3T and 1.5T on the same day were evaluated, applying the Brain Atrophy and Lesion Index rating. Criterion and construct validity and interrater agreement were tested for each field strength and image type. RESULTS Regarding reliability, the intraclass correlation coefficients for the Brain Atrophy and Lesion Index score were consistently high (>0.81) across image type and field strength. Regarding construct validity, the Brain Atrophy and Lesion Index score differed among diagnostic groups, being lowest in people without cognitive impairment and highest in those with Alzheimer disease (F > 5.14; P < .007). Brain Atrophy and Lesion Index scores correlated with age (r > 0.37, P < .001) and cognitive performance (r > 0.38, P < .001) and were associated with positive amyloid-β test (F > 3.96, P < .050). The T1WI and T2WI Brain Atrophy and Lesion Index scores were correlated (r > 0.93, P < .001), with the T2WI scores slightly greater than the T1WI scores (F > 4.25, P < .041). Regarding criterion validation of the 1.5T images, the 1.5T scores were highly correlated with the 3T Brain Atrophy and Lesion Index scores (r > 0.93, P < .001). CONCLUSIONS The higher field and T2WI more sensitively detect subtle changes in the deep white matter and perivascular spaces in particular. Even so, 1.5T Brain Atrophy and Lesion Index scores are similar to those obtained by use of 3T images. The Brain Atrophy and Lesion Index may have use in quantifying the impact of dementia on brain structures.
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Affiliation(s)
- H Guo
- From the Neuroimaging Research Laboratory, Biomedical Translational Imaging Center (H.G., X.S., W.C., N.Z.), QEII & IWK Health Centre (former National Research Council Canada Institute for Biodiagnostics-Atlantic), Halifax, Nova Scotia, Canada
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Rockwood K. Levels of life. Age Ageing 2013. [DOI: 10.1093/ageing/aft094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tang Z, Wang C, Song X, Shi J, Mitnitski A, Fang X, Yu P, Rockwood K. Co-occurrence of cardiometabolic diseases and frailty in older Chinese adults in the Beijing Longitudinal Study of Ageing. Age Ageing 2013. [DOI: 10.1093/ageing/aft072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Berrut G, Andrieu S, Araujo de Carvalho I, Baeyens JP, Bergman H, Cassim B, Cerreta F, Cesari M, Cha HB, Chen LK, Cherubini A, Chou MY, Cruz-Jentoft AJ, De Decker L, Du P, Forette B, Forette F, Franco A, Guimaraes R, Guttierrez-Robledo LM, Jauregui J, Khavinson V, Lee WJ, Peng LN, Perret-Guillaume C, Petrovic M, Retornaz F, Rockwood K, Rodriguez-Manas L, Sieber C, Spatharakis G, Theou O, Topinkova E, Vellas B, Benetos A. Promoting access to innovation for frail old persons. IAGG (International Association of Gerontology and Geriatrics), WHO (World Health Organization) and SFGG (Société Française de Gériatrie et de Gérontologie) Workshop--Athens January 20-21, 2012. J Nutr Health Aging 2013; 17:688-93. [PMID: 24097023 DOI: 10.1007/s12603-013-0039-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED Frailty tends to be considered as a major risk for adverse outcomes in older persons, but some important aspects remain matter of debate. OBJECTIVES The purpose of this paper is to present expert's positions on the main aspects of the frailty syndrome in the older persons. PARTICIPANTS Workshop organized by International Association of Gerontology and Geriatrics (IAGG), World Health Organization (WHO) and Société Française de Gériatrie et de Gérontologie (SFGG). RESULTS Frailty is widely recognized as an important risk factor for adverse health outcomes in older persons. This can be of particular value in evaluating non-disabled older persons with chronic diseases but today no operational definition has been established. Nutritional status, mobility, activity, strength, endurance, cognition, and mood have been proposed as markers of frailty. Another approach calculates a multidimensional score ranging from "very fit" to "severely frail", but it is difficult to apply into the medical practice. Frailty appears to be secondary to multiple conditions using multiple pathways leading to a vulnerability to a stressor. Biological (inflammation, loss of hormones), clinical (sarcopenia, osteoporosis etc.), as well as social factors (isolation, financial situation) are involved in the vulnerability process. In clinical practice, detection of frailty is of major interest in oncology because of the high prevalence of cancer in older persons and the bad tolerance of the drug therapies. Presence of frailty should also be taken into account in the definition of the cardiovascular risks in the older population. The experts of the workshop have listed the points reached an agreement and those must to be a priority for improving understanding and use of frailty syndrome in practice. CONCLUSION Frailty in older adults is a syndrome corresponding to a vulnerability to a stressor. Diagnostic tools have been developed but none can integrate at the same time the large spectrum of factors and the simplicity asked by the clinical practice. An agreement with an international common definition is necessary to develop screening and to reduce the morbidity in older persons.
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Affiliation(s)
- G Berrut
- Pr Athanase Benetos, MD, PhD, Département de Médecine Gériatrique, CHU de Nancy, Avenue de Bourgogne, BP 217, 54511 Vandoeuvre-les-Nancy, France,
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Mitnitski A, Song X, Rockwood K. Trajectories of changes over twelve years in the health status of Canadians from late middle age. Exp Gerontol 2012; 47:893-9. [DOI: 10.1016/j.exger.2012.06.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 06/04/2012] [Accepted: 06/29/2012] [Indexed: 11/28/2022]
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Fang X, Shi J, Song X, Mitnitski A, Tang Z, Wang C, Yu P, Rockwood K. Frailty in relation to the risk of falls, fractures, and mortality in older Chinese adults: results from the Beijing Longitudinal Study of Aging. J Nutr Health Aging 2012; 16:903-7. [PMID: 23208030 DOI: 10.1007/s12603-012-0368-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Falls are well known to be associated with adverse health outcomes, especially when complicated by fracture. Falls are more common in people who are frail and readily related to several items in the frailty phenotype. Less is known about the relationship between falls and frailty defined as deficit accumulation. Our objective was to investigate the relationship between falls, fractures, and frailty based on deficit accumulation. DESIGN Representative cohort study, with 8 year follow-up. SETTING The Beijing Longitudinal Study of Aging (BLSA). PARTICIPANTS 3,257 Chinese people aged 55+ years at baseline. MEASUREMENTS A frailty index (FI) was constructed using 33 health deficits, but excluding falls and fractures. The rates of falls, fractures and death as a function of age and the FI were analyzed. Multivariable models evaluated the relationships between frailty and the risk of recurrent falls, fractures, and mortality adjusting for age, sex, and education. Self or informant reported fall and fracture data were verified against participants' health records. RESULTS Of 3,257 participants at baseline (1992), 360 people (11.1%) reported a history of falls, and 238 (7.3%) reported fractures. By eight years, 1,155 people had died (35.3%). The FI was associated with an increased risk of recurrent falls (OR=1.54; 95% confidence interval (CI)=1.34-1.76), fractures (OR=1.07; 95% CI=0.94-1.22), and death (OR=1.50, 95% CI=1.41-1.60). The FI showed a significant effect on mortality in a multivariate Cox regression model (Hazard Rate=1.29, 95% CI=1.25-1.33). When adjusted for the FI, neither falls nor fractures were associated with mortality. CONCLUSION Falls and fractures were common in older Chinese adults, and associated with frailty. Only frailty was independently associated with death.
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Affiliation(s)
- X Fang
- Department of Epidemiology and Social Medicine, Xuanwu Hospital, The Capital Medical University, Beijing, China
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Wang C, Song X, Mitnitski A, Yu P, Fang X, Tang Z, Shi J, Rockwood K. Gender Differences in the Relationship Between Smoking and Frailty: Results From the Beijing Longitudinal Study of Aging. J Gerontol A Biol Sci Med Sci 2012; 68:338-46. [DOI: 10.1093/gerona/gls166] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mitnitski A, Fallah N, Rockwood MRH, Rockwood K. Transitions in cognitive status in relation to frailty in older adults: a comparison of three frailty measures. J Nutr Health Aging 2011; 15:863-7. [PMID: 22159774 DOI: 10.1007/s12603-011-0066-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Cognitive decline is related to frailty. Frailty can be operationalized in different ways, which have an unknown impact on the estimation of risk. Here, we compared 3 frailty measures in relation to cognitive changes and mortality in the Canadian Study of Health and Aging (CSHA). DESIGN Prospective population-based study, with 5 year follow up. PARTICIPANTS/SETTING 2,305 subjects aged 70+ years. METHODS For each participant, cognitive status was measured by the errors in the Modified Mini-Mental State Examination (3MS) score. Three frailty measures were used: a Frailty Index based on the Comprehensive Geriatric Assessment (FI-CGA) evaluated from 47 potential deficits, a Clinical Frailty Score and the Fried frailty phenotype. Multivariate Poisson regression and multivariate logistic regression were used to examine the association between baseline cognitive errors and frailty and death, respectively, while controlling for possible confounders (age, sex, education, and baseline cognitive status). RESULTS Changes in cognitive status were strongly associated with baseline cognition and frailty, however defined. In multivariate models adjusted for age, sex and education, each frailty measure was associated with cognitive decline and with mortality. The frailest people (from the highest FI-CGA tertile) rarely showed cognitive improvement or stabilization (1.5%, 95% CI=0.002%-2.8%) compared with non-frail people (from the lowest tertile of the FI-CGA), of whom 27.8% (95% CI=24.5%-31.1%) did not deteriorate. CONCLUSIONS Frail elderly people have an increased risk of cognitive decline. All frailty measures allowed quantification of individual vulnerability and predict both cognitive changes and mortality.
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Affiliation(s)
- A Mitnitski
- Department of the Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
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Abstract
AIMS To compare the relative prognostic importance in older people of diagnosed diabetes, the number and severity of co-morbidities and frailty. METHODS Two thousand three hundred and five people aged > or = 70 years comprised the clinical examination cohort of the Canadian Study of Health and Aging. Frailty was defined as a score of > or = 5 on a 7-point Clinical Frailty Scale. The cohort was followed for 5 years. RESULTS Diabetes was more likely to be associated with medium-term mortality (adjusted hazard ratio (HR) 1.42; 95% confidence interval (CI) 1.20-1.69) than co-morbidity (HR 1.03; 95% CI 1.01-1.05). Frailty most strongly predicted death (HR 2.72; 95% CI 2.34-3.16). Frail older adults were 2.62 times (95% CI 1.36-5.06) more likely to have a complication of diabetes, independent of age, sex and number of years living with diabetes. People with diabetes were younger than those without (81.3 vs. 83.3 years) but a similar proportion were frail (42.2 vs.43.4%). The median life expectancy for frail older adults with diabetes was 23 months (95% CI 18-28 months). CONCLUSIONS In this cohort, the risk of mortality in older people was defined more precisely by a clinical measure of frailty than by diabetes or burden of co-morbidity. Those with diagnosed diabetes were younger than those without but had the same frailty status; diabetes can therefore be considered to increase 'biological age' by 2 years in those aged over 70 years. The limited life expectancy of frail older people with diabetes highlights the importance of recognizing frailty and supports the individualization of care in older people with diabetes.
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Affiliation(s)
- R E Hubbard
- Geriatric Medicine Research Unit, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Canada.
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Lucicesare A, Hubbard RE, Fallah N, Forti P, Searle SD, Mitnitski A, Ravaglia G, Rockwood K. Comparison of two frailty measures in the Conselice Study of Brain Ageing. J Nutr Health Aging 2010; 14:278-81. [PMID: 20305994 DOI: 10.1007/s12603-010-0061-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Uncertainty about the definition of frailty is reflected by the development of many ways to identify frail people. We aimed to compare the validity of two frailty measures in participants of the Conselice Study of Brain Aging. DESIGN Prospective population-based study with 4 year follow up. PARTICIPANTS/SETTING 1,016 subjects aged 65 and over in a rural Italian population. METHODS For each participant, a Frailty Index (FI) and a Conselice Study of Brain Aging Score (CSBAS) were determined. The FI was created from 43 deficits according to a standardized methodology; 7 variables derived from a previously validated Easy Prognostic Score comprised the CSBAS. RESULTS The FI had characteristic properties described in other population samples, with a gamma distribution, a 99% limit of about 0.64 and higher values in women than men. CSBAS and FI were strongly correlated with each other (r = 0.72) and both correlated with age (r = 0.32, r = 0.27, respectively). Each was independently predictive of death in a multivariate model, with greater specificity and sensitivity than age alone. CONCLUSIONS Frailty can be measured by different tools and facilitates a more direct quantification of individual vulnerability than chronological age alone. Though the Frailty Index and the Conselice Study of Brain Aging Score are underpinned by different rationales, clinical utility will continue to motivate their development.
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Affiliation(s)
- A Lucicesare
- Department of Internal Medicine, Cardioangiology, and Hepatology, University Hospital Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
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