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Abstract
Objective: To evaluate the impact of frailty, measured using the Canadian Study of Health and Aging Clinical Frailty Scale, on outcomes of older people hospitalized with acute illness. Method: Consecutive patients were randomly allocated to a model development sample or a model validation sample. Multivariate analyses were used to model in-hospital mortality, new nursing home placement, and length of stay. Variables selected in the development samples were tested in the validation samples. Results: The mean age of all 2,125 patients was 82.9 years. Most (93.6%) were admitted through the emergency department. Frailty predicted in-hospital mortality (odds ratio [OR] = 2.97 [2.11, 4.17]), new nursing home placement (OR = 1.60 [1.14, 2.24]), and length of hospital stay (hazard ratio = 0.87 [0.81, 0.93]). Discussion: Frailty is a strong predictor of adverse outcomes in older people hospitalized with acute illness. An increased awareness of its impact may alert clinicians to screen for frailty.
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352
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Guía de consenso para el abordaje de la neumonía adquirida en la comunidad en el paciente anciano. Rev Esp Geriatr Gerontol 2014; 49:279-91. [PMID: 24873864 PMCID: PMC7103352 DOI: 10.1016/j.regg.2014.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/11/2014] [Indexed: 11/29/2022]
Abstract
La incidencia de la neumonía adquirida en la comunidad se incrementa con la edad y se asocia a una elevada morbimortalidad debido a los cambios fisiológicos asociados al envejecimiento y a una mayor presencia de enfermedades crónicas. Debido a la importancia que tiene desde un punto de epidemiológico y pronóstico, y a la enorme heterogeneidad descrita en el manejo clínico, creemos que existía la necesidad de realizar un documento de consenso específico para este perfil de paciente. El propósito de este fue realizar una revisión de las evidencias en relación con los factores de riesgo para la etiología, la presentación clínica, el manejo y el tratamiento de la neumonía adquirida en la comunidad en los ancianos con el fin de elaborar una serie de recomendaciones específicas basadas en el análisis crítico de la literatura. Este documento es fruto de la colaboración de diferentes especialistas en representación de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Sociedad Española de Geriatría y Gerontología (SEGG), Sociedad Española de Quimioterapia (SEQ), Sociedad Española de Medicina Interna (SEMI), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Sociedad Española de Hospitalización a Domicilio (SEHAD) y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC).
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Launay CP, de Decker L, Kabeshova A, Annweiler C, Beauchet O. Screening for older emergency department inpatients at risk of prolonged hospital stay: the brief geriatric assessment tool. PLoS One 2014; 9:e110135. [PMID: 25333271 PMCID: PMC4198199 DOI: 10.1371/journal.pone.0110135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS. METHODS Based on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry. RESULTS Area under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (P<0.003). Prognostic value for prolonged LHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4) and a low likelihood ratio of positive test under 5.6. CONCLUSION Combinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients.
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Affiliation(s)
- Cyrille P. Launay
- Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
| | - Laure de Decker
- Department of Geriatrics, EA 1156–12, Nantes University Hospital, Nantes, France
| | - Anastasiia Kabeshova
- Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
| | - Cédric Annweiler
- Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
- Robarts Research Institute, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, Ontario, Canada
| | - Olivier Beauchet
- Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
- Biomathics, Paris, France
- * E-mail:
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355
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Toosizadeh N, Mohler J, Wendel C, Najafi B. Influences of frailty syndrome on open-loop and closed-loop postural control strategy. Gerontology 2014; 61:51-60. [PMID: 25278191 DOI: 10.1159/000362549] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/31/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As the population of older adults quickly increases, the incidence of frailty syndrome, a reduction in physiological reserve across multiple physiological systems, likewise increases. To date, impaired balance has been associated with frailty; however, the underlying frailty-related postural balance mechanisms remain unclear. OBJECTIVE The aim of the current study was to use open-loop (OL; postural muscles) and closed-loop (CL; postural muscles plus sensory feedback) mechanisms to explore differences in postural balance mechanisms between nonfrail (n = 44), prefrail (n = 59) and frail individuals (n = 19). METHODS One hundred and twenty-two older adults (age ≥65 years) without major mobility disorders were recruited, and frailty was measured using Fried's criteria. Each participant performed two 15-second trials of Romberg balance assessment, once with their eyes open and once with their eyes closed. Body-worn sensors were used to estimate center of gravity (COG) plots. Body-sway (traditional stabilogram analysis) and OLCL (stabilogram diffusion analysis) parameters were derived using COG plots and compared between groups using ANOVA. Frailty and prefrailty were estimated using a multiple variable logistic regression while controlling for age, body mass index, body-sway and OLCL parameters. RESULTS Between-group differences in the parameters of interest were more pronounced during the eyes-closed condition, for which OL duration was approximately 33 and 22% shorter, respectively, in the frail and prefrail groups when compared to nonfrail controls (mean = 1.9 ± 1.1 s, p = 0.01). The average rate of sway during the OL was 164 and 66% higher, respectively, in frail and prefrail when compared to nonfrail subjects (0.03 ± 0.02 cm(2)/s, p < 0.001). RESULTS also suggest that OLCL parameters can predict frail and prefrail categories when compared to nonfrail controls. Using this method, frailty was identified with a sensitivity and specificity of 97 and 88% (as compared to nonfrail), and prefrailty with 82 and 92%, respectively. CONCLUSIONS This study suggested an innovative method to differentiate between frailty status using sensory dependency characteristics of postural control. RESULTS suggest that postural muscle deconditioning may compromise balance in frail elders, leading to dependency on somatosensory feedback to compensate for errors and stabilize the system.
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Affiliation(s)
- Nima Toosizadeh
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) and Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, College of Medicine, University of Arizona, Tucson, Ariz., USA
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356
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Coelho T, Santos R, Paúl C, Gobbens RJJ, Fernandes L. Portuguese version of the Tilburg Frailty Indicator: Transcultural adaptation and psychometric validation. Geriatr Gerontol Int 2014; 15:951-60. [PMID: 25255891 DOI: 10.1111/ggi.12373] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 01/14/2023]
Abstract
AIM To present the translation and validation process of the Portuguese version of the Tilburg Frailty Indicator (TFI). METHODS A cross-sectional study was designed using a non-probability sample of 252 community-dwelling older adults. Preliminary studies were carried out for face and content validity assessment. Internal consistency, test-retest reliability, construct (convergent/divergent) and criterion validity were subsequently analyzed. RESULTS The sample was mainly women (75.8%), with a mean age of 79.2 ± 7.3 years. TFI internal consistency was good (KR-20 = 0.78). Test-retest reliability for the total was also good (r = 0.91), with kappa coefficients showing substantial agreement for most items. TFI physical and social domains correlated as expected with concurrent measures, whereas the TFI psychological domain showed similar correlations with other psychological and physical measures. The TFI showed a good to excellent discrimination ability in regard to frailty criteria, and fair to good ability to predict adverse outcomes. CONCLUSIONS The psychometric properties of the TFI seem to be consistently good. These findings provide initial evidence that the Portuguese version is a valid and reliable measure for assessing frailty in the elderly.
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Affiliation(s)
- Tiago Coelho
- School of Allied Health Sciences, Porto Polytechnic Institute, Vila Nova de Gaia, Portugal.,UNIFAI/ICBAS, University of Porto, Porto, Portugal
| | - Rubim Santos
- Activity and Human Movement Study Center, School of Allied Health Sciences, Porto Polytechnic Institute, Vila Nova de Gaia, Portugal
| | | | - Robbert J J Gobbens
- Research & Development Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Lia Fernandes
- UNIFAI/CINTESIS - Faculty of Medicine, University of Porto, Porto, Portugal
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357
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Ow MMG, Erasmus P, Minto G, Struthers R, Joseph M, Smith A, Warshow UM, Cramp ME, Cross TJS. Impaired functional capacity in potential liver transplant candidates predicts short-term mortality before transplantation. Liver Transpl 2014; 20:1081-8. [PMID: 24805969 DOI: 10.1002/lt.23907] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/04/2014] [Indexed: 12/31/2022]
Abstract
Liver transplantation (LT) is a lifesaving treatment. Because of the shortage of donor organs, some patients will not survive long enough to receive a transplant. The identification of LT candidates at increased risk of short-term mortality without transplantation may affect listing decisions. Functional capacity, determined with cardiopulmonary exercise testing (CPET), is a measure of cardiorespiratory reserve and predicts perioperative outcomes. This study examined the association between functional capacity and short-term survival before LT and the potential for CPET to predict 90-day mortality without transplantation. A total of 176 patients who were assessed for nonacute LT underwent CPET. Ninety days after the assessment, 10 of the 164 patients who had not undergone transplantation were deceased (mortality rate = 6.1%). According to a comparison of survivors and nonsurvivors, the Model for End-Stage Liver Disease score, UK Model for End-Stage Liver Disease (UKELD) score, age, anaerobic threshold, and peak oxygen uptake (VO(2)) were significant univariate predictors of 90-day mortality without transplantation, but only the UKELD score and peak VO(2) retained significance in a multivariate analysis. The mean peak VO(2) was significantly lower for nonsurvivors versus survivors (15.2 ± 3.3 versus 21.2 ± 5.3 mL/minute/kg, P < 0.001). According to a receiver operating characteristic (ROC) curve analysis, peak VO(2) performed well as a diagnostic test (area under the ROC curve = 0.84, 95% confidence interval = 0.76-0.92, sensitivity = 0.90, specificity = 0.74, P < 0.001). The optimal cutoff value for predicting mortality was ≤17.6 mL/minute/kg. The positive predictive value of a peak VO(2) ≤ 17.6 mL/minute/kg for 90-day mortality was greatest for patients with high UKELD scores: 38% of the patients with a UKELD score ≥ 57 and a peak VO(2) ≤ 17.6 mL/minute/kg died, whereas only 6% of the patients with a UKELD score ≥ 57 and a peak VO(2) > 17.6 mL/minute/kg died (P = 0.03). In conclusion, patients assessed for LT with an impaired functional capacity have poorer short-term survival; this is particularly true for individuals with worse liver disease severity.
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Affiliation(s)
- Maggie M G Ow
- South West Liver Unit, Derriford Hospital, Plymouth, United Kingdom
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Mandelblatt JS, Jacobsen PB, Ahles T. Cognitive effects of cancer systemic therapy: implications for the care of older patients and survivors. J Clin Oncol 2014; 32:2617-26. [PMID: 25071135 PMCID: PMC4129505 DOI: 10.1200/jco.2014.55.1259] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The number of patients with cancer who are age 65 years or older (hereinafter "older") is increasing dramatically. One obvious aspect of cancer care for this group is that they are experiencing age-related changes in multiple organ systems, including the brain, which complicates decisions about systemic therapy and assessments of survivorship outcomes. There is a consistent body of evidence from studies that use neuropsychological testing and neuroimaging that supports the existence of impairment following systemic therapy in selected cognitive domains among some older patients with cancer. Impairment in one or more cognitive domains could have important effects in the daily lives of older patients. However, an imperfect understanding of the precise biologic mechanisms underlying cognitive impairment after systemic treatment precludes development of validated methods for predicting which older patients are at risk. From what is known, risks may include lifestyle factors such as smoking, genetic predisposition, and specific comorbidities such as diabetes and cardiovascular disease. Risk also interacts with physiologic and cognitive reserve, because even at the same chronological age and with the same number of illnesses, older patients vary from having high reserve (ie, biologically younger than their age) to being frail (biologically older than their age). Surveillance for the presence of cognitive impairment is also an important component of long-term survivorship care with older patients. Increasing the workforce of cancer care providers who have geriatrics training or who are working within multidisciplinary teams that have this type of expertise would be one avenue toward integrating assessment of the cognitive effects of cancer systemic therapy into routine clinical practice.
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Affiliation(s)
- Jeanne S Mandelblatt
- Jeanne S. Mandelblatt, Georgetown University, Washington, DC; Paul B. Jacobsen, Moffitt Cancer Center, Tampa, FL; and Tim Ahles, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY.
| | - Paul B Jacobsen
- Jeanne S. Mandelblatt, Georgetown University, Washington, DC; Paul B. Jacobsen, Moffitt Cancer Center, Tampa, FL; and Tim Ahles, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Tim Ahles
- Jeanne S. Mandelblatt, Georgetown University, Washington, DC; Paul B. Jacobsen, Moffitt Cancer Center, Tampa, FL; and Tim Ahles, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Suijker JJ, Buurman BM, van Rijn M, van Dalen MT, ter Riet G, van Geloven N, de Haan RJ, Moll van Charante EP, de Rooij SE. A simple validated questionnaire predicted functional decline in community-dwelling older persons: prospective cohort studies. J Clin Epidemiol 2014; 67:1121-30. [PMID: 25103817 DOI: 10.1016/j.jclinepi.2014.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To modify and validate in primary health care the Identification of Seniors At Risk (ISAR) screening questionnaire to identify older persons at increased risk of functional decline and to compare this strategy with risk stratification by age alone. STUDY DESIGN AND SETTING Prospective development (n = 790) and validation cohorts (n = 2,573) of community-dwelling persons aged ≥70 years. Functional decline at 12 months was defined as an increase of at least one point on the modified Katz-activities of daily living index score compared with baseline or death. RESULTS Three items were independently associated with functional decline: age (odds ratio [OR]: 1.06 per year; 95% confidence interval [CI]: 1.02, 1.10), dependence in instrumental activities of daily living (OR: 2.17; 95% CI: 1.46, 3.22), and impaired memory (OR: 2.22; 95% CI: 1.41, 3.51). The area under the receiver operating characteristics curve (AUC) range of the ISAR-primary care model was 0.67-0.70, and 40.6% was identified at increased risk. Validation yielded an AUC range of 0.63-0.64. Age ≥75 years alone yielded an AUC range of 0.56-0.57 and identified 55.4% at increased risk in the development cohort. CONCLUSION Although the ISAR-Primary Care (ISAR-PC) has moderate predictive value, application of the ISAR-PC is more efficient than selection based on age alone in identifying persons at increased risk of functional decline.
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Affiliation(s)
- Jacqueline J Suijker
- Department of General Practice, Academic Medical Center - University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center - University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Marjon van Rijn
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center - University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Marlies T van Dalen
- Department of General Practice, Academic Medical Center - University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center - University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Nan van Geloven
- Clinical Research Unit, Academic Medical Center - University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Rob J de Haan
- Clinical Research Unit, Academic Medical Center - University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Academic Medical Center - University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center - University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
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361
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Rose M, Pan H, Levinson MR, Staples M. Can frailty predict complicated care needs and length of stay? Intern Med J 2014; 44:800-5. [DOI: 10.1111/imj.12502] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 03/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M. Rose
- Cabrini Medical Centre; Malvern Melbourne Victoria Australia
| | - H. Pan
- Aged Care Services; Caulfield General Medical Centre; Melbourne Victoria Australia
| | - M. R. Levinson
- Cabrini-Monash Department of Medicine; Cabrini Institute; Malvern Melbourne Victoria Australia
| | - M. Staples
- Cabrini-Monash Department of Medicine; Cabrini Institute; Malvern Melbourne Victoria Australia
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362
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Beauchet O, Launay CP, Merjagnan C, Kabeshova A, Annweiler C. Quantified self and comprehensive geriatric assessment: older adults are able to evaluate their own health and functional status. PLoS One 2014; 9:e100636. [PMID: 24968016 PMCID: PMC4072604 DOI: 10.1371/journal.pone.0100636] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 05/28/2014] [Indexed: 01/24/2023] Open
Abstract
Background There is an increased interest of individuals in quantifying their own health and functional status. The aim of this study was to examine the concordance of answers to a self-administered questionnaire exploring health and functional status with information collected during a full clinical examination performed by a physician among cognitively healthy adults (CHI) and older patients with mild cognitive impairment (MCI) or mild-to-moderate Alzheimer disease (AD). Methods Based on cross-sectional design, a total of 60 older adults (20 CHI, 20 patients with MCI, and 20 patients with mild-to-moderate AD) were recruited in the memory clinic of Angers, France. All participants completed a self-administered questionnaire in paper format composed of 33 items exploring age, gender, nutrition, place of living, social resources, drugs daily taken, memory complaint, mood and general feeling, fatigue, activities of daily living, physical activity and history of falls. Participants then underwent a full clinical examination by a physician exploring the same domains. Results High concordance between the self-administered questionnaire and physician's clinical examination was showed. The few divergences were related to cognitive status, answers of AD and MCI patients to the self-administered questionnaire being less reliable than those of CHI. Conclusion Older adults are able to evaluate their own health and functional status, regardless of their cognitive status. This result needs to be confirmed and opens new perspectives for the quantified self-trend and could be helpful in daily clinical practice of primary care.
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Affiliation(s)
- Olivier Beauchet
- Department of Neuroscience, Angers University Hospital, Angers, France
- Biomathics, Paris, France
- * E-mail:
| | - Cyrille P. Launay
- Department of Neuroscience, Angers University Hospital, Angers, France
| | - Christine Merjagnan
- Department of Neuroscience, Angers University Hospital, Angers, France
- Biomathics, Paris, France
| | | | - Cédric Annweiler
- Department of Neuroscience, Angers University Hospital, Angers, France
- Department of Medical Biophysics, the University of Western Ontario, London, Canada
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363
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Adverse outcomes of frailty in the elderly: the Rotterdam Study. Eur J Epidemiol 2014; 29:419-27. [DOI: 10.1007/s10654-014-9924-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 06/07/2014] [Indexed: 11/26/2022]
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364
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Abad-Díez JM, Calderón-Larrañaga A, Poncel-Falcó A, Poblador-Plou B, Calderón-Meza JM, Sicras-Mainar A, Clerencia-Sierra M, Prados-Torres A. Age and gender differences in the prevalence and patterns of multimorbidity in the older population. BMC Geriatr 2014; 14:75. [PMID: 24934411 PMCID: PMC4070347 DOI: 10.1186/1471-2318-14-75] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 06/12/2014] [Indexed: 12/17/2022] Open
Abstract
Background The coexistence of several chronic diseases in one same individual, known as multimorbidity, is an important challenge facing health care systems in developed countries. Recent studies have revealed the existence of multimorbidity patterns clustering systematically associated distinct clinical entities. We sought to describe age and gender differences in the prevalence and patterns of multimorbidity in men and women over 65 years. Methods Observational retrospective multicentre study based on diagnostic information gathered from electronic medical records of 19 primary care centres in Aragon and Catalonia. Multimorbidity patterns were identified through exploratory factor analysis. We performed a descriptive analysis of previously obtained patterns (i.e. cardiometabolic (CM), mechanical (MEC) and psychogeriatric (PG)) and the diseases included in the patterns stratifying by sex and age group. Results 67.5% of the aged population suffered two or more chronic diseases. 32.2% of men and 45.3% of women were assigned to at least one specific pattern of multimorbidity, and 4.6% of men and 8% of women presented more than one pattern simultaneously. Among women over 65 years the most frequent pattern was the MEC pattern (33.3%), whereas among men it was the CM pattern (21.2%). While the prevalence of the CM and MEC patterns decreased with age, the PG pattern showed a higher prevalence in the older age groups. Conclusions Significant gender differences were observed in the prevalence of multimorbidity patterns, women showing a higher prevalence of the MEC and PG patterns, as well as a higher degree of pattern overlapping, probably due to a higher life expectancy and/or worse health. Future studies on multimorbidity patterns should take into account these differences and, therefore, the study of multimorbidity and its impact should be stratified by age and sex.
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Affiliation(s)
- José María Abad-Díez
- Department of Health Wellbeing and Family, Government of Aragón, Zaragoza, Spain.
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Zhang WG, Zhu SY, Bai XJ, Zhao DL, Jiang SM, Li J, Li ZX, Fu B, Cai GY, Sun XF, Chen XM. Select aging biomarkers based on telomere length and chronological age to build a biological age equation. AGE (DORDRECHT, NETHERLANDS) 2014; 36:9639. [PMID: 24659482 PMCID: PMC4082565 DOI: 10.1007/s11357-014-9639-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 03/04/2014] [Indexed: 05/02/2023]
Abstract
The purpose of this study is to build a biological age (BA) equation combining telomere length with chronological age (CA) and associated aging biomarkers. In total, 139 healthy volunteers were recruited from a Chinese Han cohort in Beijing. A genetic index, renal function indices, cardiovascular function indices, brain function indices, and oxidative stress and inflammation indices (C-reactive protein [CRP]) were measured and analyzed. A BA equation was proposed based on selected parameters, with terminal telomere restriction fragment (TRF) and CA as the two principal components. The selected aging markers included mitral annulus peak E anterior wall (MVEA), intima-media thickness (IMT), cystatin C (CYSC), D-dimer (DD), and digital symbol test (DST). The BA equation was: BA = −2.281TRF + 26.321CYSC + 0.025DD − 104.419MVEA + 34.863IMT − 0.265DST + 0.305CA + 26.346. To conclude, telomere length and CA as double benchmarks may be a new method to build a BA.
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Affiliation(s)
- Wei-Guang Zhang
- />Department of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), State Chronic Kidney Disease Clinical Research Center (2013BAI09B05), Chinese PLA General Hospital, Beijing, 100853 China
| | - Shu-Ying Zhu
- />Department of Nephrology, The Second Affiliated Hospital of Nanchang Medical University, Nanchang, China
| | - Xiao-Juan Bai
- />Departments of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - De-Long Zhao
- />Department of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), State Chronic Kidney Disease Clinical Research Center (2013BAI09B05), Chinese PLA General Hospital, Beijing, 100853 China
| | - Shi-Min Jiang
- />Department of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), State Chronic Kidney Disease Clinical Research Center (2013BAI09B05), Chinese PLA General Hospital, Beijing, 100853 China
| | - Juan Li
- />Department of Cardiovascular, Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, Beijing, China
| | - Zuo-Xiang Li
- />Department of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), State Chronic Kidney Disease Clinical Research Center (2013BAI09B05), Chinese PLA General Hospital, Beijing, 100853 China
| | - Bo Fu
- />Department of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), State Chronic Kidney Disease Clinical Research Center (2013BAI09B05), Chinese PLA General Hospital, Beijing, 100853 China
| | - Guang-Yan Cai
- />Department of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), State Chronic Kidney Disease Clinical Research Center (2013BAI09B05), Chinese PLA General Hospital, Beijing, 100853 China
| | - Xue-Feng Sun
- />Department of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), State Chronic Kidney Disease Clinical Research Center (2013BAI09B05), Chinese PLA General Hospital, Beijing, 100853 China
| | - Xiang-Mei Chen
- />Department of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), State Chronic Kidney Disease Clinical Research Center (2013BAI09B05), Chinese PLA General Hospital, Beijing, 100853 China
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Mohler MJ, Fain MJ, Wertheimer AM, Najafi B, Nikolich-Žugich J. The Frailty Syndrome: Clinical measurements and basic underpinnings in humans and animals. Exp Gerontol 2014; 54:6-13. [DOI: 10.1016/j.exger.2014.01.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/23/2014] [Accepted: 01/27/2014] [Indexed: 01/10/2023]
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Li G, Ioannidis G, Pickard L, Kennedy C, Papaioannou A, Thabane L, Adachi JD. Frailty index of deficit accumulation and falls: data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton cohort. BMC Musculoskelet Disord 2014; 15:185. [PMID: 24885323 PMCID: PMC4046442 DOI: 10.1186/1471-2474-15-185] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 05/22/2014] [Indexed: 11/24/2022] Open
Abstract
Background To investigate the association between frailty index (FI) of deficit accumulation and risk of falls, fractures, death and overnight hospitalizations in women aged 55 years and older. Methods The data were from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton Cohort. In this 3-year longitudinal, observational cohort study, women (N = 3,985) aged ≥55 years were enrolled between May 2008 and March 2009 in Hamilton, Canada. A FI including co-morbidities, activities of daily living, symptoms and signs, and healthcare utilization was constructed using 34 health deficits at baseline. Relationship between the FI and falls, fractures, death and overnight hospitalizations was examined. Results The FI was significantly associated with age, with a mean rate of deficit accumulation across baseline age of 0.004 or 0.021 (on a log scale) per year. During the third year of follow-up, 1,068 (31.89%) women reported at least one fall. Each increment of 0.01 on the FI was associated with a significantly increased risk of falls during the third year of follow-up (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.02-1.03). The area under the curve (AUC) of the predictive model was 0.69 (95% CI: 0.67-0.71). Results of subgroup and sensitivity analyses indicated the relationship between the FI and risk of falls was robust, while bootstrap analysis judged its internal validation. The FI was significantly related to fractures (hazard ratio [HR]: 1.02, 95% CI: 1.01-1.03), death (OR: 1.05, 95% CI: 1.03-1.06) during the 3-year follow-up period and overnight hospitalizations (incidence rate ratio [IRR]: 1.02, 95% CI: 1.02-1.03) for an increase of 0.01 on the FI during the third year of follow-up. Measured by per standard deviation (SD) increment of the FI, the ORs were 1.21 and 1.40 for falls and death respectively, while the HR was 1.17 for fractures and the IRR was 1.18 for overnight hospitalizations respectively. Conclusion The FI of deficit accumulation increased with chronological age significantly. The FI was associated with and predicted increased risk of falls, fractures, death and overnight hospitalizations significantly.
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Affiliation(s)
| | | | | | | | | | | | - Jonathan D Adachi
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4 L8, Canada.
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Borges CN, de Almeida JM, Lima D, Cabral M, Bandeira F. Prevalence of morphometric vertebral fractures in old men and the agreement between different methods in the city of Recife, Brazil. Rheumatol Int 2014; 34:1387-94. [PMID: 24807694 DOI: 10.1007/s00296-014-3035-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
Osteoporosis is relatively common in men and has a great impact on quality of life. Despite the importance of the subject, there are few studies regarding the prevalence of morphometric vertebral fractures in men and the associated risk factors. To determine the prevalence of morphometric vertebral fractures in elderly men by three different methods and the agreement between them, 234 asymptomatic men aged >60 years (mean age 69.4 ± 6.5 years) were evaluated using lateral thoracolumbar radiograph that were analyzed by two experienced radiologists according to semiquantitative (SQ) Genant and algorithm-based qualitative (ABQ) Jiang methods. A third senior radiologist adjudicated Genant's method. The highest prevalence of fractures in ABQ Jiang and SQ Genant methods were 37.6 and 36.8 %, respectively (both examiner 2). The lowest prevalence rates were 26.5 % in ABQ Jiang method and 5.6 % in SQ Genant (both examiner 1). The prevalence found by the Genant adjudicated was 31.6 %. The agreement between the examiners were 69.2 % in ABQ Jiang method (κ 0.30; 95 % CI 0.17-0.43) and 65.5 % in SQ Genant (κ 0.09; 95 % CI 0.01-0.17). We evaluated skin phototype, waist circumference, hypertension, body mass index (BMI), history of fracture, calcium intake, serum 25 OHD and sun index. After multivariate regression analysis, we found that lower BMI (prevalence ratio = 1.41; p = 0.024; 95 % CI 1.05-2.03) and sun index (prevalence ratio = 1.45; p = 0.049; 95 % CI 1.01-1.95) were independently associated with morphometric vertebral fractures.
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Affiliation(s)
- Carla Nubia Borges
- Division of Endocrinology, Diabetes and Bone Disease, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Rua Marechal Rondon, 120, apto 1602, Recife, Pernambuco, CEP: 52061-050, Brazil
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Pickard S. Frail bodies: geriatric medicine and the constitution of the fourth age. SOCIOLOGY OF HEALTH & ILLNESS 2014; 36:549-563. [PMID: 25650444 DOI: 10.1111/1467-9566.12084] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Clinical discourses of frailty are central both to the construction of the social category of the fourth age and to the role and identity of hospital geriatric medicine. However, the influence of such clinical discourses is not just from science to the social sphere and nor do these discourses have their source in a putative truth of the old body but emerge from an interplay between physiological facts, discourses of governmentality, productive processes associated with late modern capitalism and the professional ambitions of geriatric medicine. The article explores this interplay in the two key discourses of frailty that have emerged in the clinical literature during the past 15 years, that of the phenotype and the accumulation of deficits, respectively. Outlining the development of the discourse of senescence from its origins to the more recent emergence of a nosological category of frailty the article explores how these key discourses capture the older body according to particular sets of norms. These norms link physiological understanding with broader discourses of governmentality, including the professional project of geriatric medicine. In particular, metaphorical representations in the discourses of frailty convey key cultural and clinical assumptions concerning both older bodies and old age more generally.
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Affiliation(s)
- Susan Pickard
- Department of Sociology, Social Policy and Criminology, University of Liverpool
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Tavassoli N, Guyonnet S, Abellan Van Kan G, Sourdet S, Krams T, Soto ME, Subra J, Chicoulaa B, Ghisolfi A, Balardy L, Cestac P, Rolland Y, Andrieu S, Nourhashemi F, Oustric S, Cesari M, Vellas B. Description of 1,108 older patients referred by their physician to the "Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability" at the gerontopole. J Nutr Health Aging 2014; 18:457-64. [PMID: 24886728 DOI: 10.1007/s12603-014-0462-z] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Frailty is considered as an early stage of disability which, differently from disability, is still amenable for preventive interventions and is reversible. In 2011, the "Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability" was created in Toulouse, France, in association with the University Department of General Medicine and the Midi-Pyrénées Regional Health Authority. This structure aims to support the comprehensive and multidisciplinary assessment of frail older persons, to identify the specific causes of frailty and to design a personalized preventive plan of intervention against disability. In the present paper, we describe the G.F.C structure, organization, details of the global evaluation and preventive interventions against disability, and provide the main characteristics of the first 1,108 patients evaluated during the first two years of operation. METHODS Persons aged 65 years and older, considered as frail by their physician (general practitioner, geriatrician or specialist) in the Toulouse area, are invited to undergo a multidisciplinary evaluation at the G.F.C. Here, the individual is assessed in order to detect the potential causes for frailty and/or disability. At the end of the comprehensive evaluation, the team members propose to the patient (in agreement with the general practitioner) a Personalized Prevention Plan (PPP) specifically tailored to his/her needs and resources. The G.F.C also provides the patient's follow-up in close connection with family physicians. RESULTS Mean age of our population was 82.9 ± 6.1 years. Most patients were women (n=686, 61.9%). According to the Fried criteria, 423 patients (39.1%) were pre-frail, and 590 (54.5%) frail. Mean ADL (Activities of Daily Living) score was 5.5 ± 1.0. Consistently, IADL (Instrumental ADL) showed a mean score of 5.6 ± 2.4. The mean gait speed was 0.78 ± 0.27 and 25.6% (272) of patients had a SPPB (Short Physical Performance Battery) score equal to or higher than 10. Dementia was observed in 14.9% (111) of the G.F.C population according to the CDR scale (CDR ≥2). Eight percent (84) presented an objective state of protein-energy malnutrition with MNA (Mini Nutritional Assessment) score < 17 and 39.5% (414) were at risk of malnutrition (MNA=17-23.5). Concerning PPP, for 54.6% (603) of patients, we found at least one medical condition which needed a new intervention and for 32.8% (362) substantial therapeutic changes were recommended. A nutritional intervention was proposed for 61.8% (683) of patients, a physical activity intervention for 56.7% (624) and a social intervention for 25.7% (284). At the time of analysis, a one-year reassessment had been carried out for 139 (26.7%) of patients. CONCLUSIONS The G.F.C was developed to move geriatric medicine to frailty, an earlier stage of disability still reversible. Its particularity is that it is intended for a single target population that really needs preventive measures: the frail elderly screened by physicians. The screening undergone by physicians was really effective because 93.6% of the subjects who referred to this structure were frail or pre-frail according to Fried's classification and needed different medical interventions. The creation of units like the G.F.C, specialized in evaluation, management and prevention of disability in frail population, could be an interesting option to support general practitioners, promote the quality of life of older people and increase life expectancy without disability.
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Affiliation(s)
- N Tavassoli
- Neda Tavassoli, Gérontopôle de Toulouse, Hôpital Garonne, 224 avenue de Casselardit, 31300 Toulouse, France, Tel.: (33) 5 61 77 64 94 Fax: (33) 5 61 49 64 75 E-mail:
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Theou O, Brothers TD, Peña FG, Mitnitski A, Rockwood K. Identifying common characteristics of frailty across seven scales. J Am Geriatr Soc 2014; 62:901-6. [PMID: 24697631 DOI: 10.1111/jgs.12773] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To determine whether commonly used frailty scales exhibit shared characteristics when applied to a representative sample of middle-aged and older Europeans. DESIGN Secondary analysis of the Survey of Health, Ageing, and Retirement in Europe (SHARE). SETTING Eleven European countries. PARTICIPANTS Community-dwelling adults (N = 27,527; mean age 65.3 ± 10.5, 55% female). MEASUREMENTS Frailty was assessed using SHARE-operationalized versions of seven frailty scales: Edmonton Frail Scale, FRAIL scale, Groningen Frailty Indicator, frailty phenotype, Tilburg Frailty Indicator, a 70-item frailty index (FI), and a 44-item frailty index based on Comprehensive Geriatric Assessment. RESULTS All frailty scales demonstrated right-skewed density distributions. On all scales, frailty scores increased nonlinearly with age, between 1% (FRAIL) and 3.6% (FI) per year on a log scale. Frailty scores on all scales exhibited dose-response relationships with 5-year mortality. On all scales, women had higher frailty scores than men of the same age but demonstrated better survival than did men with the same frailty score. On all scales except the frailty phenotype, 99% of participants had scores below the scale's theoretical maximum. CONCLUSION On each frailty scale, frailty score increased nonlinearly with age, mortality risk increased with frailty score, and women had higher scores than men but demonstrated better survival. Each scale except the frailty phenotype demonstrated an upper limit to frailty below the scale's theoretical maximum. Across commonly used frailty scales, these characteristics are common in nature but differ in magnitude.
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Affiliation(s)
- Olga Theou
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L, Sitjà-Rabert M, Salvà A. Physical Exercise Interventions for Improving Performance-Based Measures of Physical Function in Community-Dwelling, Frail Older Adults: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2014; 95:753-769.e3. [DOI: 10.1016/j.apmr.2013.11.007] [Citation(s) in RCA: 278] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 11/08/2013] [Accepted: 11/13/2013] [Indexed: 12/25/2022]
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Drubbel I, Numans ME, Kranenburg G, Bleijenberg N, de Wit NJ, Schuurmans MJ. Screening for frailty in primary care: a systematic review of the psychometric properties of the frailty index in community-dwelling older people. BMC Geriatr 2014; 14:27. [PMID: 24597624 PMCID: PMC3946826 DOI: 10.1186/1471-2318-14-27] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 02/20/2014] [Indexed: 11/10/2022] Open
Abstract
Background To better accommodate for the complex care needs of frail, older people, general practitioners must be capable of easily identifying frailty in daily clinical practice, for example, by using the frailty index (FI). To explore whether the FI is a valid and adequate screening instrument for primary care, we conducted a systematic review of its psychometric properties. Methods We searched the Cochrane, PubMed and Embase databases and included original studies focusing on the criterion validity, construct validity and responsiveness of the FI when applied in community-dwelling older people. We evaluated the quality of the studies included using the Quality in Prognosis Studies (QUIPS) tool. This systematic review was conducted based on the PRISMA statement. Results Of the twenty studies identified, eighteen reported on FIs derived from research data, one reported upon an FI derived from an administrative database of home-care clients, and one reported upon an FI derived from routine primary care data. In general, the FI showed good criterion and construct validity but lacked studies on responsiveness. When compared with studies that used data gathered for research purposes, there are indications that the FI mean score and range might be different in datasets using routine primary care data; however, this finding needs further investigation. Conclusions Our results suggest that the FI is a valid frailty screening instrument. However, further research using routine Electronic Medical Record data is necessary to investigate whether the psychometric properties of the FI are generalizable to a primary care setting and to facilitate its interpretation and implementation in daily clinical practice. Trial registration PROSPERO systematic review register number: CRD42013003737.
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Affiliation(s)
- Irene Drubbel
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str, 6,131, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands.
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Abstract
Purpose
– It is well recognised that individuals have much to contribute to the care that they receive, with attendant benefits on outcomes and reduction in cost. The recognition of individuals who access care services as interdependent citizens embedded in both formal and informal support networks is a shift that acknowledges their active role as partners in management of their own care and in service innovation and development. The purpose of this paper is therefore to explore and illustrate some of the domains of co-production.
Design/methodology/approach
– In this paper, the authors review the literature, both peer-reviewed and professional, in order to provide a broad and contemporary commentary on this emergent approach. This literature is critically summarised and presented along with a narrative that discusses the context in Wales, where the authors are based. The approach to this paper is to bring together existing knowledge and also propose potential avenues for further research and practise development.
Findings
– There is a diverse literature on this topic and the application of co-production appears potentially transformational within health and social care. Implementation of the principles of co-production has the potential to improve health and social care services in a range of settings. Real changes in outcomes and experience and reduction in societal cost can be achieved by making the people of Wales active partners in the design and delivery of their own health and social care.
Originality/value
– This review offers a readily accessible commentary on co-production, which may be of value to a wide range of professional groups and policy makers. This paper also reflects an original attempt to summarise knowledge and propose further areas for work. Most importantly, this paper offers a start point for co-production to become a reality for service provision with all the attendant benefits that will arise from this development.
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Rockwood MR, MacDonald E, Sutton E, Rockwood K, Baron M. Frailty index to measure health status in people with systemic sclerosis. J Rheumatol 2014; 41:698-705. [PMID: 24584923 DOI: 10.3899/jrheum.130182] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To develop and validate, as a measure of overall health status, a Frailty Index (FI) for patients (n=1372) in the Canadian Scleroderma Research Group (CSRG) Registry. METHODS Forty-four items were selected from the CSRG database as health deficits and recoded using FI criteria. To test construct validity, we compared measurement properties of the CSRG-FI to other FI, and related it to measures of damage, age, and time since diagnosis. To test criterion validity, we compared the baseline FI to that at last recorded visit and to mortality. RESULTS The mean CSRG-FI was 0.33 with a sub-maximal limit of 0.67. In patients with diffuse disease, the mean was 0.38(SD 0.14); in patients with limited disease, the mean was 0.31(SD 0.13). The CSRG-FI was weakly (but significantly) correlated with the Rodnan Skin Score (r=0.28 in people with diffuse disease; 0.18 with limited) and moderately with the Physician Assessment of Damage (r=0.51 for both limited and diffuse). The risk of death increased with higher FI scores and with higher physician ratings of damage. The area under the receiver operating characteristic curve for the baseline FI in relation to death was 0.75, higher than for other measures (range: 0.57-0.67). CONCLUSION The FI quantifies overall health status in people with scleroderma and predicts mortality. Whether the FI might help with decisions about who might best be served by more aggressive treatment, such as bone marrow transplantation, needs to be evaluated.
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Affiliation(s)
- Michael R Rockwood
- From Geriatric Medicine Research; Division of Rheumatology; Division of Geriatric Medicine, Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax, Nova Scotia; and Division of Rheumatology, Department of Medicine, McGill University and SMBD-Jewish General Hospital, Montreal, Quebec, Canada
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Cohn B, Keim SM, Sanders AB. Can Anticoagulated Patients be Discharged Home Safely from the Emergency Department after Minor Head Injury? J Emerg Med 2014; 46:410-7. [DOI: 10.1016/j.jemermed.2013.08.107] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 08/18/2013] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Half a century after the inception of the term "successful aging (SA)," a consensus definition has not emerged. The current study aims to provide a comprehensive snapshot of operational definitions of SA. METHODS A systematic review across MedLine, PsycInfo, CINAHL, EMBASE, and ISI Web of Knowledge of quantitative operational definitions of SA was conducted. RESULTS Of the 105 operational definitions, across 84 included studies using unique models, 92.4% (97) included physiological constructs (e.g. physical functioning), 49.5% (52) engagement constructs (e.g. involvement in voluntary work), 48.6% (51) well-being constructs (e.g. life satisfaction), 25.7% (27) personal resources (e.g. resilience), and 5.7% (6) extrinsic factors (e.g. finances). Thirty-four definitions consisted of a single construct, 28 of two constructs, 27 of three constructs, 13 of four constructs, and two of five constructs. The operational definitions utilized in the included studies identify between <1% and >90% of study participants as successfully aging. CONCLUSIONS The heterogeneity of these results strongly suggests the multidimensionality of SA and the difficulty in categorizing usual versus successful aging. Although the majority of operationalizations reveal a biomedical focus, studies increasingly use psychosocial and lay components. Lack of consistency in the definition of SA is a fundamental weakness of SA research.
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381
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Lohman M, Dumenci L, Mezuk B. Sex differences in the construct overlap of frailty and depression: evidence from the Health and Retirement Study. J Am Geriatr Soc 2014; 62:500-5. [PMID: 24576097 DOI: 10.1111/jgs.12689] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the degree of diagnostic overlap between frailty and depression and to investigate whether sex differences in symptom endorsement influence this overlap. DESIGN Cross-sectional latent class analysis. SETTING Data were from the 2008 wave of the Health and Retirement Study, a nationally representative longitudinal survey of health characteristics of older adults. PARTICIPANTS Community-dwelling adults aged 65 and older completing a general health questionnaire and consenting to physical measurements (N = 3,665). MEASUREMENTS Frailty was measured using criteria developed in the Cardiovascular Health Study, and depressive symptoms were measured using the eight-item Center for Epidemiologic Studies Depression scale. RESULTS Frailty and depression were best modeled as two distinct but highly correlated constructs with three and four classes of symptom response, respectively. Measurement overlap was high in men and women. Approximately 73% of individuals with severe depressive symptoms and 86% with primarily somatic depressive symptoms were categorized as concurrently frail. The degree of construct overlap between depression and frailty did not significantly vary according to sex, but women were significantly more likely to endorse all frailty and depressive symptoms. CONCLUSION Measures of depression and frailty identify substantially overlapping populations of older men and women. More-frequent endorsement of depressive symptoms, but not differential endorsement of somatic symptoms, may contribute to the higher prevalence of frailty in women. The symptom of exhaustion is particularly important to the correlation between these two conditions. Findings will inform clinician and researcher efforts to refine the definition of geriatric syndromes such as frailty and to develop effective interventions.
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Affiliation(s)
- Matthew Lohman
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
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382
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383
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Jung HW, Kim SW, Ahn S, Lim JY, Han JW, Kim TH, Kim KW, Kim KI, Kim CH. Prevalence and outcomes of frailty in Korean elderly population: comparisons of a multidimensional frailty index with two phenotype models. PLoS One 2014; 9:e87958. [PMID: 24505338 PMCID: PMC3913700 DOI: 10.1371/journal.pone.0087958] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Frailty is related to adverse outcomes in the elderly. However, current status and clinical significance of frailty have not been evaluated for the Korean elderly population. We aimed to investigate the usefulness of established frailty criteria for community-dwelling Korean elderly. We also tried to develop and validate a new frailty index based on a multidimensional model. METHODS We studied 693 participants of the Korean Longitudinal Study on Health and Aging (KLoSHA). We developed a new frailty index (KLoSHA Frailty Index, KFI) and compared predictability of it with the established frailty indexes from the Cardiovascular Health Study (CHS) and Study of Osteoporotic Fracture (SOF). Mortality, hospitalization, and functional decline were evaluated. RESULTS The prevalence of frailty was 9.2% (SOF index), 13.2% (CHS index), and 15.6% (KFI). The criteria from CHS and KFI correlated with each other, but SOF did not correlate with KFI. During the follow-up period (5.6 ± 0.9 years), 97 participants (14.0%) died. Frailty defined by KFI predicted mortality better than CHS index (c-index: 0.713 and 0.596, respectively; p<0.001, better for KFI). In contrast, frailty by SOF index was not related to mortality. The KFI showed better predictability for following functional decline than CHS index (area under the receiver-operating characteristic curve was 0.937 for KFI and 0.704 for CHS index, p = 0.001). However, the SOF index could not predict subsequent functional decline. Frailty by the KFI (OR = 2.13, 95% CI 1.04-4.35) and CHS index (OR = 2.24, 95% CI 1.05-4.76) were associated with hospitalization. In contrast, frailty by the SOF index was not correlated with hospitalization (OR = 1.43, 95% CI 0.68-3.01). CONCLUSION Prevalence of frailty was higher in Korea compared to previous studies in other countries. A novel frailty index (KFI), which includes domains of comprehensive geriatric assessment, is a valid criterion for the evaluation and prediction of frailty in the Korean elderly population.
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Affiliation(s)
- Hee-Won Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hui Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki-Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Kwang-il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
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Sternberg SA, Levin R, Dkaidek S, Edelman S, Resnick T, Menczel J. Frailty and osteoporosis in older women--a prospective study. Osteoporos Int 2014; 25:763-8. [PMID: 24002542 DOI: 10.1007/s00198-013-2471-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 07/23/2013] [Indexed: 01/13/2023]
Abstract
UNLABELLED Despite sharing common risk factors and biological pathways, the relationship between frailty and osteoporosis (OP) is not clear. This prospective study has shown that frailty defined by the Vulnerable Elders Survey can predict a decrease in bone mineral density after 1 year. Thus, frail older women should be assessed for osteoporosis. INTRODUCTION Frailty and OP share common risk factors such as age, sarcopenia, lack of physical activity, low body weight, and smoking. Despite shared risk factors and biological pathways, the relationship between frailty and OP is not clear. The purpose of our prospective study was to examine this relationship in a community sample of older women. METHODS A sample of 235 community-dwelling women was assessed for demographic, medical, frailty and OP status at baseline, and after at least 1 year. Frailty was assessed using the Cardiovascular Health study (CHS) frailty phenotype and using the Vulnerable Elders Survey (VES-13). OP was measured using dual photon absorptiometry bone mineral density (BMD). Descriptive statistics and regression models were used. RESULTS At baseline, 235 women with a mean age of 77.6 (SD = 5.4), body mass index (BMI) of 28.3 (SD = 5.2) kg/m(2), and BMD of 0.7 (SD = 0.2) g/cm(2)were assessed. No correlation was found between BMD and the CHS (BMD spine, r = 0.009, p = 0.889; BMD hips, r = 0.050, p = 0.473) or the VES-13 (BMD spine, r = 0.034, p = 0.605; BMD hips, r = -0.042, p = 0.537) frailty scales. One hundred fifty-two (63.9 %) women were assessed after 1 year. In a regression model, women who were frail at baseline (VES-13) were found to have a statistically significantly lower hip and spine BMD at follow-up (controlling for BMI) than women who were non-frail at baseline (p = 0.0393, hip; p = 0.0069, spine). CONCLUSIONS Frailty status as defined by the VES-13 predicts a decrease in BMD after 1 year.
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385
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Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatr 2014; 14:1. [PMID: 24393272 PMCID: PMC3905102 DOI: 10.1186/1471-2318-14-1] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/16/2013] [Indexed: 01/10/2023] Open
Abstract
Background The prevalence and significance of frailty are seldom studied in hospitalized patients. Aim of this study is to evaluate the prevalence of frailty and to determine the extent that frailty predicts delirium, falls and mortality in hospitalized older patients. Methods In a prospective study of 220 older patients, frailty was determined using the Cardiovascular Health Study (CHS) and the Study of Osteoporotic Fracture (SOF) frailty index. Patients were classified as nonfrail, prefrail, and frail, according to the specific criteria. Covariates included clinical and laboratory parameters. Outcome variables included in hospital delirium and falls, and 6-month mortality. Results The CHS frailty index was available in all 220 patients, of which 1.5% were classified as being nonfrail, 58.5% as prefrail, and 40% as frail. The SOF frailty index was available in 204 patients, of which 16% were classified as being nonfrail, 51.5% as prefrail, and 32.5% as frail. Frailty, as identified by the CHS and SOF indexes, was a significant risk factor for 6-month mortality. However, after adjustment for multiple risk factors, frailty remained a strong independent risk factor only for the model with the CHS index (OR 4.7, 95% CI 1.7-12.8). Frailty (identified by CHS and SOF indexes) was not found to be a risk factor for delirium or falls. Conclusions Frailty, as measured by the CHS index, is an independent risk factor for 6-month mortality. The CHS and the SOF indexes have limited value as risk assessment tools for specific geriatric syndromes (e.g., falls and delirium) in hospitalized older patients.
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Affiliation(s)
- Etienne Joosten
- Department of Internal Medicine, Division of Geriatric Medicine, University Hospitals, Leuven, Belgium.
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386
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Auyeung TW, Lee JSW, Leung J, Kwok T, Woo J. The selection of a screening test for frailty identification in community-dwelling older adults. J Nutr Health Aging 2014; 18:199-203. [PMID: 24522474 DOI: 10.1007/s12603-013-0365-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Frailty in older Chinese has been less often studied and the selection of one screening test feasible in primary care and population survey is needed. We attempted to examine the sensitivity and specificity of each of the five Fried's criteria as a single screening test in the identification of frailty. METHODS We recruited 4000 community-dwelling Chinese adults 65 years or older stratified by 3 age-stratum and identified frailty as having 3 or more of Fried's criteria: underweight(BMI<18.5), handgrip strength( RESULTS The proportion of frailty in the 3 age groups (65-69 years, 70-74 years, 75 years and above) were 2.3%, 3.4% and 11.9% respectively in men and 1.4%, 2.6% and 11.6% in women. Among the 5 criteria, walking speed, grip strength and physical activity (PASE score) divided at their respective lowest quintile values, achieved similar Area Under Curve in the Receiver Operating Characteristics analysis. For walking speed, the sensitivity and specificity were 82.7% and 83.1% in men and 91.9% and 84.5% in women respectively. For grip strength, the corresponding values were 89.5% and 80.6% in men; and 84.5% and 81.9% in women. For physical activity, they were 83.7% and 83.5% in men; and 82.8% and 84.7% in women. CONCLUSION Either walking speed or grip strength measurement may be suitable for frailty screening in primary care or population health survey. A cut-off value of 0.9 m/s in walking speed and 28 kg in grip strength for older men; and a corresponding value of 0.8 m/s and 18 kg for older women is recommended for the screening of frailty in community-dwelling older Chinese adults.
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Affiliation(s)
- T W Auyeung
- Tung Wai Auyeung, The S. H. Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Department of Medicine and Geriatrics, Pok Oi Hospital, Au Tau, NT, Hong Kong, Email : , Telephone: 852 24868985, Fax: 852 24868976
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387
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Forti P, Maioli F, Lega MV, Montanari L, Coraini F, Zoli M. Combination of the clock drawing test with the physical phenotype of frailty for the prediction of mortality and other adverse outcomes in older community dwellers without dementia. Gerontology 2013; 60:204-11. [PMID: 24356341 DOI: 10.1159/000356701] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/09/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cognitive assessment is thought to increase the ability of the physical phenotype of frailty to identify older persons at a higher risk for adverse outcomes. OBJECTIVE Data from a cohort of dementia-free community dwellers were used to investigate whether the clock drawing test (CDT), a quick and easy cognitive screening test, is associated with adverse health outcomes independently of the physical phenotype of frailty. METHODS This was a prospective population-based cohort study of 766 dementia-free Italian community dwellers aged 65 years or older. Baseline assessment included the physical phenotype of frailty, 3 different CDT protocols [Sunderland, Shulman, and the clock drawing interpretation scale (CDIS)], and several health confounders. Hazard ratios (HR) and odds ratio (OR) along with their corresponding 95% confidence intervals (CI) from models adjusted for frailty and sociodemographic and health confounders were used to estimate the independent association of the CDT with the 7-year risk of all-cause mortality and the 3-year risk of new and worsening disability, hospitalization, and fractures. RESULTS After adjustment for confounders, the Sunderland CDT was significantly associated with all-cause mortality independently of the physical phenotype of frailty (HR = 1.44, 95% CI 1.03-2.01, p = 0.031). However, compared to all nonfrail participants with a normal Sunderland CDT, the HR was 1.57 (95% CI 1.09-2.26, p = 0.016) for those with impairment on the Sunderland CDT only, 2.48 (95% CI 1.46-4.20, p = 0.001) for those with frailty only, and 2.52 (95% CI 1.34-4.77, p = 0.004) for those with both frailty and impairment on the Sunderland CDT. Mortality was unrelated to the CDIS CDT (p = 0.359) and the Shulman CDT (p = 0.281). No statistically significant relationship was found between nonlethal outcomes and any CDT protocol, although trends were found for an association of both the Sunderland CDT (p = 0.118) and the CDIS CDT with worsening disability (p = 0.154). CONCLUSIONS In older persons, depending on the scoring system, the CDT may predict the mortality risk independently of the physical phenotype of frailty. However, combining the two measurements does not improve their individual prognostic abilities.
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Affiliation(s)
- Paola Forti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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388
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Mandelblatt JS, Hurria A, McDonald BC, Saykin AJ, Stern RA, VanMeter JW, McGuckin M, Traina T, Denduluri N, Turner S, Howard D, Jacobsen PB, Ahles T. Cognitive effects of cancer and its treatments at the intersection of aging: what do we know; what do we need to know? Semin Oncol 2013; 40:709-25. [PMID: 24331192 PMCID: PMC3880205 DOI: 10.1053/j.seminoncol.2013.09.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is a fairly consistent, albeit non-universal body of research documenting cognitive declines after cancer and its treatments. While few of these studies have included subjects aged 65 years and older, it is logical to expect that older patients are at risk of cognitive decline. Here, we use breast cancer as an exemplar disease for inquiry into the intersection of aging and cognitive effects of cancer and its therapies. There are a striking number of common underlying potential biological risks and pathways for the development of cancer, cancer-related cognitive declines, and aging processes, including the development of a frail phenotype. Candidate shared pathways include changes in hormonal milieu, inflammation, oxidative stress, DNA damage and compromised DNA repair, genetic susceptibility, decreased brain blood flow or disruption of the blood-brain barrier, direct neurotoxicity, decreased telomere length, and cell senescence. There also are similar structure and functional changes seen in brain imaging studies of cancer patients and those seen with "normal" aging and Alzheimer's disease. Disentangling the role of these overlapping processes is difficult since they require aged animal models and large samples of older human subjects. From what we do know, frailty and its low cognitive reserve seem to be a clinically useful marker of risk for cognitive decline after cancer and its treatments. This and other results from this review suggest the value of geriatric assessments to identify older patients at the highest risk of cognitive decline. Further research is needed to understand the interactions between aging, genetic predisposition, lifestyle factors, and frailty phenotypes to best identify the subgroups of older patients at greatest risk for decline and to develop behavioral and pharmacological interventions targeting this group. We recommend that basic science and population trials be developed specifically for older hosts with intermediate endpoints of relevance to this group, including cognitive function and trajectories of frailty. Clinicians and their older patients can advance the field by active encouragement of and participation in research designed to improve the care and outcomes of the growing population of older cancer patients.
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Affiliation(s)
- Jeanne S Mandelblatt
- Departments of Oncology and Population Sciences, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
| | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Brenna C McDonald
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Robert A Stern
- Departments of Neurology and Neurosurgery and Director, Clinical Core, BU Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA
| | - John W VanMeter
- Department of Neurology, Georgetown University Medical Center, Georgetown University, Washington, DC
| | - Meghan McGuckin
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Tiffani Traina
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neelima Denduluri
- Department of Medicine, Georgetown University; Virginia Cancer Specialists, US Oncology, Arlington, VA
| | - Scott Turner
- Department of Neurology, Georgetown University Medical Center, Georgetown University, Washington, DC
| | - Darlene Howard
- Department of Psychology, Georgetown University, Washington, DC
| | - Paul B Jacobsen
- Division of Population Science, Moffitt Cancer Center, Tampa, FL
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Psychiatry, Weill Cornell Medical College, New York, NY
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389
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Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14:392-7. [PMID: 23764209 DOI: 10.1016/j.jamda.2013.03.022] [Citation(s) in RCA: 2405] [Impact Index Per Article: 218.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 02/07/2023]
Abstract
Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty. 1. Physical frailty is an important medical syndrome. The group defined physical frailty as "a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death." 2. Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy. 3. Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons. 4. For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (>5%) due to chronic disease should be screened for frailty.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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390
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van Kempen JAL, Schers HJ, Melis RJF, Olde Rikkert MGM. Construct validity and reliability of a two-step tool for the identification of frail older people in primary care. J Clin Epidemiol 2013; 67:176-83. [PMID: 24189087 DOI: 10.1016/j.jclinepi.2013.08.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/14/2013] [Accepted: 08/13/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To study the reliability and construct validity of the EASY-Care Two-step Older persons Screening (EASY-Care TOS), a practice-based tool that helps family physicians (FPs) to identify their frail older patients. STUDY DESIGN AND SETTING This validation study was conducted in six FP practices. We determined the construct validity by comparing the results of the EASY-Care TOS with other commonly used frailty constructs [Fried Frailty Criteria (FFC), Frailty Index (FI)] and with other related constructs (ie, multimorbidity, disability, cognition, mobility, mental well-being, and social context). To determine interrater reliability, an independent second EASY-Care TOS assessment was made for a subpopulation. RESULTS We included 587 older patients (mean age 77 ± 5 years, 56% women). According to EASY-Care TOS, 39.4% of patients were frail. EASY-Care TOS frailty correlated better with FI frailty (0.63) than with FFC frailty (0.52). A high correlation was found with multimorbidity (0.50), disabilities (0.53), and mobility (0.55) and a moderate correlation with cognition (0.31) and mental well-being (0.38). Reliability testing showed 89% agreement (Cohen's κ 0.63) between EASY-Care TOS frailty judgment by two different assessments. CONCLUSION EASY-Care TOS correlated well with relevant physical and psychosocial measures. Accordingly, these results show that the EASY-Care TOS identifies patients who have a wide spectrum of interacting problems.
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Affiliation(s)
- Janneke A L van Kempen
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Henk J Schers
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - René J F Melis
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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391
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Harttgen K, Kowal P, Strulik H, Chatterji S, Vollmer S. Patterns of frailty in older adults: comparing results from higher and lower income countries using the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Study on Global AGEing and Adult Health (SAGE). PLoS One 2013; 8:e75847. [PMID: 24204581 PMCID: PMC3812225 DOI: 10.1371/journal.pone.0075847] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/23/2013] [Indexed: 01/10/2023] Open
Abstract
We use the method of deficit accumulation to describe prevalent and incident levels of frailty in community-dwelling older persons and compare prevalence rates in higher income countries in Europe, to prevalence rates in six lower income countries. Two multi-country data collection efforts, SHARE and SAGE, provide nationally representative samples of adults aged 50 years and older. Forty items were used to construct the frailty index in each data set. Our study shows that the level of frailty was distributed along the socioeconomic gradient in both higher and lower income countries such that those individuals with less education and income were more likely to be frail. Frailty increased with age and women were more likely to be frail in most countries. Across samples we find that the level of frailty was higher in the higher income countries than in the lower income countries.
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Affiliation(s)
| | - Paul Kowal
- World Health Organization, Geneva, Switzerland
| | - Holger Strulik
- University of Göttingen, Department of Economics, Göttingen, Germany
| | | | - Sebastian Vollmer
- University of Göttingen, Department of Economics, Göttingen, Germany
- Harvard School of Public Health, Department of Global Health and Population, Boston, Massachusetts, United States of America
- * E-mail:
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392
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Abstract
SummaryEmergency care of elderly patients is frequent and complex in the emergency department. Frail older patients have a high risk of poor short-term results following emergency care. There is no practical universal or standardized tool defining frailty. It must be systematically identified in older patients at risk using a screening test, and in those who are positive, a diagnostic scale of frailty or preferably a geriatric scale adapted to emergency care is carried out. An adapted geriatric assessment including brief scales related to clinical, mental, functional and social aspects has been proposed. There are currently no geriatric intervention models with sufficient evidence in frail older patients.
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393
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Kutner NG, Zhang R, Allman RM, Bowling CB. Correlates of ADL difficulty in a large hemodialysis cohort. Hemodial Int 2013; 18:70-7. [PMID: 24118865 DOI: 10.1111/hdi.12098] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Needing assistance with activities of daily living (ADL) is an early indicator of functional decline and has important implications for individuals' quality of life. However, correlates of need for ADL assistance have received limited attention among patients undergoing maintenance hemodialysis (HD). A multicenter cohort of 742 prevalent HD patients was assessed in 2009-2011 and classified as frail, prefrail and nonfrail by the Fried frailty index (recent unintentional weight loss, reported exhaustion, low grip strength, slow walk speed, low physical activity). Patients reported need for assistance with 4 ADL tasks and identified contributing symptoms/conditions (pain, balance, endurance, weakness, others). Nearly 1 in 5 patients needed assistance with 1 or more ADL. Multivariable analysis showed increased odds for needing ADL assistance among frail (odds ratio [OR] 11.35; 95% confidence interval [CI] 5.50-23.41; P < 0.001) and prefrail (OR 1.93; 95% CI 1.01-3.68; P = 0.046) compared with non-frail patients. In addition, the odds for needing ADL assistance were lower among blacks compared with whites and were higher among patients with diabetes, lung disease, and stroke. Balance, weakness, and "other" (frequently dialysis-related) symptoms/conditions were the most frequently named reasons for ADL difficulty. In addition to interventions such as increasing physical activity that might delay or reverse the process of frailty, the immediate symptoms/conditions to which individuals attribute their ADL difficulty may have clinical relevance for developing targeted management and/or treatment approaches.
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Affiliation(s)
- Nancy G Kutner
- United States Renal Data System, Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, Georgia, USA
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394
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Bouillon K, Kivimäki M, Hamer M, Shipley MJ, Akbaraly TN, Tabak A, Singh-Manoux A, Batty GD. Diabetes risk factors, diabetes risk algorithms, and the prediction of future frailty: the Whitehall II prospective cohort study. J Am Med Dir Assoc 2013; 14:851.e1-6. [PMID: 24103860 PMCID: PMC3820037 DOI: 10.1016/j.jamda.2013.08.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 12/30/2022]
Abstract
Objective To examine whether established diabetes risk factors and diabetes risk algorithms are associated with future frailty. Design Prospective cohort study. Risk algorithms at baseline (1997–1999) were the Framingham Offspring, Cambridge, and Finnish diabetes risk scores. Setting Civil service departments in London, United Kingdom. Participants There were 2707 participants (72% men) aged 45 to 69 years at baseline assessment and free of diabetes. Measurements Risk factors (age, sex, family history of diabetes, body mass index, waist circumference, systolic and diastolic blood pressure, antihypertensive and corticosteroid treatments, history of high blood glucose, smoking status, physical activity, consumption of fruits and vegetables, fasting glucose, HDL-cholesterol, and triglycerides) were used to construct the risk algorithms. Frailty, assessed during a resurvey in 2007–2009, was denoted by the presence of 3 or more of the following indicators: self-reported exhaustion, low physical activity, slow walking speed, low grip strength, and weight loss; “prefrailty” was defined as having 2 or fewer of these indicators. Results After a mean follow-up of 10.5 years, 2.8% of the sample was classified as frail and 37.5% as prefrail. Increased age, being female, stopping smoking, low physical activity, and not having a daily consumption of fruits and vegetables were each associated with frailty or prefrailty. The Cambridge and Finnish diabetes risk scores were associated with frailty/prefrailty with odds ratios per 1 SD increase (disadvantage) in score of 1.18 (95% confidence interval: 1.09–1.27) and 1.27 (1.17–1.37), respectively. Conclusion Selected diabetes risk factors and risk scores are associated with subsequent frailty. Risk scores may have utility for frailty prediction in clinical practice.
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Affiliation(s)
- Kim Bouillon
- Department of Epidemiology and Public Health, University College London, London, UK.
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395
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McNallan SM, Chamberlain AM, Gerber Y, Singh M, Kane RL, Weston SA, Dunlay SM, Jiang R, Roger VL. Measuring frailty in heart failure: a community perspective. Am Heart J 2013; 166:768-74. [PMID: 24093859 DOI: 10.1016/j.ahj.2013.07.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/02/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Frailty, an important prognostic indicator in heart failure (HF), may be defined as a biological phenotype or an accumulation of deficits. Each method has strengths and limitations, but their utility has never been evaluated in the same community HF cohort. METHODS Southeastern Minnesota residents with HF were recruited from 2007 to 2011. Frailty according to the biological phenotype was defined as 3 or more of: weak grip strength, physical exhaustion, slowness, low activity and unintentional weight loss >10 lb in 1 year. Intermediate frailty was defined as 1 to 2. The deficit index was defined as the proportion of deficits present out of 32 deficits. RESULTS Among 223 patients (mean age 71 ± 14, 61% male), 21% were frail and 48% intermediate frail according to the biological phenotype. The deficit index ranged from 0.02-0.75, with a mean (SD) of 0.25 (0.13). Over a mean follow-up of 2.4 years, 63 patients died. After adjustment for age, sex and ejection fraction, patients categorized as frail by the biological phenotype had a 2-fold increased risk of death compared to those with no frailty, whereas a 0.1 unit increase in the deficit index was associated with a 44% increased risk of death. Both measures predicted death equally (C-statistics: 0.687 for biological phenotype and 0.700 for deficit index). CONCLUSION The deficit index and the biological phenotype equally predict mortality. As the biological phenotype is not routinely assessed clinically, the deficit index, which can be ascertained from medical records, is a feasible alternative to ascertain frailty.
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396
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Frailty and cognitive impairment--a review of the evidence and causal mechanisms. Ageing Res Rev 2013; 12:840-51. [PMID: 23831959 DOI: 10.1016/j.arr.2013.06.004] [Citation(s) in RCA: 473] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/14/2013] [Accepted: 06/25/2013] [Indexed: 12/23/2022]
Abstract
Incidence rates of cognitive impairment and dementia are rising with the ageing population. Meanwhile, the limited success of current treatments has led to a search for early markers of dementia which could predict future progression or improve quality of life for those already suffering from the disease. One focus has been on the correlation between physical and cognitive measures with an increasing interest in the association between frailty and cognitive decline. Frailty is an age-related syndrome described as the decreased ability of an organism to respond to stressors. A number of epidemiological studies have reported that frailty increases the risk of future cognitive decline and that cognitive impairment increases the risk of frailty suggesting that cognition and frailty interact within a cycle of decline associated with ageing. This paper reviews the evidence for an association between frailty and cognitive impairment and outlines some of the mechanisms that potentially underpin this relationship from brain neuropathology and hormonal dysregulation to cardiovascular risk and psychological factors.
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397
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Mrózek E, Povoski SP, Shapiro CL. The challenges of individualized care for older patients with localized breast cancer. Expert Rev Anticancer Ther 2013; 13:963-73. [PMID: 23984898 DOI: 10.1586/14737140.2013.820568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individualized care is achieved when the appropriate screening and/or evaluative tests are used, the treatment plan is driven by evidence-based data and the patient's functional ability, physical and mental health, preference and social situation are incorporated into treatment decisions. Breast cancer is a disease of aging; yet, the management of breast cancer in older women in most cases lacks evidence from prospective randomized clinical trials (i.e., level 1 evidence) to support treatment recommendations. Older women are underrepresented in therapeutic clinical studies, even though studies show that selected fit older women enrolled on clinical trials derive similar benefits as younger women. Very few studies have focused on the distribution and biological behavior of different molecular subtypes of breast cancer in older women making it difficult to conclude whether old age adds extra biological complexity. A comprehensive geriatric assessment that includes a multidimensional process designed to assess functional ability, physical health, cognitive and mental health, social issues and environmental situation of elderly person should be an integral part of individualized care for older patients with breast cancer. However, incorporation of this tool into standard oncology practice is very slow despite the expected steep increase in older individuals with cancer projected over the next 25 years. All of the factors mentioned above hinder progress in delivering individualized care to older patients with breast cancer. This article provides an overview on progress and challenges of individualized and personalized health care in older women with breast cancer.
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Affiliation(s)
- Ewa Mrózek
- Division of Medical Oncology, The Wexner Medical Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA.
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398
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Theou O, Brothers TD, Mitnitski A, Rockwood K. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. J Am Geriatr Soc 2013; 61:1537-51. [PMID: 24028357 DOI: 10.1111/jgs.12420] [Citation(s) in RCA: 424] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To operationalize frailty using eight scales and to compare their content validity, feasibility, prevalence estimates of frailty, and ability to predict all-cause mortality. DESIGN Secondary analysis of the Survey of Health, Ageing and Retirement in Europe (SHARE). SETTING Eleven European countries. PARTICIPANTS Individuals aged 50 to 104 (mean age 65.3 ± 10.5, 54.8% female, N = 27,527). MEASUREMENTS Frailty was operationalized using SHARE data based on the Groningen Frailty Indicator, the Tilburg Frailty Indicator, a 70-item Frailty Index (FI), a 44-item FI based on a Comprehensive Geriatric Assessment (FI-CGA), the Clinical Frailty Scale, frailty phenotype (weighted and unweighted versions), the Edmonton Frail Scale, and the FRAIL scale. RESULTS All scales had fewer than 6% of cases with at least one missing item, except the SHARE-frailty phenotype (11.1%) and the SHARE-Tilburg (12.2%). In the SHARE-Groningen, SHARE-Tilburg, SHARE-frailty phenotype, and SHARE-FRAIL scales, death rates were 3 to 5 times as high in excluded cases as in included ones. Frailty prevalence estimates ranged from 6% (SHARE-FRAIL) to 44% (SHARE-Groningen). All scales categorized 2.4% of participants as frail. Of unweighted scales, the SHARE-FI and SHARE-Edmonton scales most accurately predicted mortality at 2 (SHARE-FI area under the receiver operating characteristic curve (AUC) = 0.77, 95% confidence interval (CI) = 0.75-0.79); SHARE-Edmonton AUC = 0.76, 95% CI = 0.74-0.79) and 5 (both AUC = 0.75, 95% CI = 0.74-0.77) years. The continuous score of the weighted SHARE-frailty phenotype (AUC = 0.77, 95% CI = 0.75-0.78) predicted 5-year mortality better than the unweighted SHARE-frailty phenotype (AUC = 0.70, 95% CI = 0.68-0.71), but the categorical score of the weighted SHARE-frailty phenotype did not (AUC = 0.70, 95% CI = 0.68-0.72). CONCLUSION Substantive differences exist between scales in their content validity, feasibility, and ability to predict all-cause mortality. These frailty scales capture related but distinct groups. Weighting items in frailty scales can improve their predictive ability, but the trade-off between specificity, predictive power, and generalizability requires additional evaluation.
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Affiliation(s)
- Olga Theou
- Geriatric Medicine Research, Dalhousie University, Halifax, Nova Scotia, Canada
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399
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You EC, Dunt DR, Doyle C. Case managed community aged care: what is the evidence for effects on service use and costs? J Aging Health 2013; 25:1204-42. [PMID: 23958520 DOI: 10.1177/0898264313499931] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effects of case management in community aged care (CMCAC) interventions on service use and costs. METHOD Five databases were searched from inception to 2011 July to include randomized control trials and comparative observational English studies. Results were summarized by using the best-evidence synthesis approach. RESULTS Twenty-one studies were included. Available studies supported improvements in clients' use of case management services (all of the four studies), some community services (8 of the 10) and nursing home admission and stay (around one half), delay of nursing home placement (all of the two studies), and achieving cost neutrality (8 of the 11). The effects on medical care utilization were varying. DISCUSSION In general, these positive effects justify the further development and refinement of CMCAC programs. Result applicability is limited by only including English studies. Cost studies applying a societal perspective, and full economic appraisals where appropriate are warranted.
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400
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Schwenk M, Howe C, Saleh A, Mohler J, Grewal G, Armstrong D, Najafi B. Frailty and technology: a systematic review of gait analysis in those with frailty. Gerontology 2013; 60:79-89. [PMID: 23949441 DOI: 10.1159/000354211] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/08/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND New technologies for gait assessment are emerging and have provided new avenues for accurately measuring gait characteristics in home and clinic. However, potential meaningful clinical gait parameters beyond speed have received little attention in frailty research. OBJECTIVE To study gait characteristics in different frailty status groups for identifying the most useful parameters and assessment protocols for frailty diagnosis. METHODS We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Age Line. Articles were selected according to the following criteria: (1) population: individuals defined as frail, prefrail, or transitioning to frail, and (2) outcome measures: quantitative gait variables as obtained by biomechanical analysis. Effect sizes (d) were calculated for the ability of parameters to discriminate between different frailty status groups. RESULTS Eleven publications met inclusion criteria. Frailty definitions, gait protocols and parameters were inconsistent, which made comparison of outcomes difficult. Effect sizes were calculated only for the three studies which compared at least two different frailty status groups. Gait speed shows the highest effect size to discriminate between frailty subgroups, in particular during habitual walking (d = 0.76-6.17). Gait variability also discriminates between different frailty status groups in particular during fast walking. Prominent parameters related to prefrailty are reduced cadence (d = 1.43) and increased step width variability (d = 0.64), whereas frailty (vs. prefrail status) is characterized by reduced step length during habitual walking (d = 1.32) and increased double support during fast walking (d = 0.78). Interestingly, one study suggested that dual-task walking speed can be used to predict prospective frailty development. CONCLUSION Gait characteristics in people with frailty are insufficiently analyzed in the literature and represent a major area for innovation. Despite the paucity of work, current results suggest that parameters beyond speed could be helpful in identifying different categories of frailty. Increased gait variability might reflect a multisystem reduction and may be useful in identifying frailty. In addition, a demanding task such as fast walking or adding a cognitive distractor might enhance the sensitivity and specificity of frailty risk prediction and classification, and is recommended for frailty assessment using gait analysis.
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Affiliation(s)
- Michael Schwenk
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) and Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, College of Medicine, University of Arizona, Tucson, Ariz., USA
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