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Hanawa Y, Murasaki W, Namba H, Oishi K. Red blood cell distribution width predicts coronary artery lesions in Kawasaki disease: insights from a Japanese cohort. Pediatr Rheumatol Online J 2025; 23:31. [PMID: 40134015 PMCID: PMC11934559 DOI: 10.1186/s12969-025-01083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 03/16/2025] [Indexed: 03/27/2025] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute vasculitis that causes coronary artery lesions. This study aimed to identify risk factors for the early prediction of coronary artery disease (CAD) in KD. METHODS We conducted a retrospective analysis of 175 Japanese children diagnosed with KD between January 2019 and March 2024. Univariate and multivariate logistic regression analyses were performed to identify predictors of CAD, and the diagnostic performance of various indicators was assessed using receiver operating characteristic (ROC) curves. The correlations between red blood cell distribution width (RDW) and iron-related anemia biomarkers were also evaluated. RESULTS Of these, 77 with CAD were classified into the CAD group, while 98 without CAD were categorized as the non-CAD group. Patients in the CAD group were younger and had lower levels of hemoglobin (Hb), total protein, albumin, uric acid, and urea nitrogen, but a higher RDW coefficient of variation (RDW-CV) than the non-CAD group. Logistic regression analysis identified RDW-CV as an independent predictor of CAD. ROC curve analysis demonstrated moderate predictive performance for RDW-CV, with an area under the curve of 0.636 (sensitivity, 55.8%; specificity, 70.4%). Significant correlations were observed between RDW-CV and iron-related anemia biomarkers in the CAD group, but not in the non-CAD group. CONCLUSIONS Iron dysregulation may be associated with CAD, and RDW-CV may aid in identifying patients who may develop CAD in KD. Our findings were consistent with previous studies in other Asian populations, supporting the utility of RDW-CV as a predictor of CAD in KD in populations with various ethnic backgrounds.
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Affiliation(s)
- Yamato Hanawa
- Department of Pediatrics, Jikei University Kashiwa Hospital, 163-1, Kashiwa-shita, Kashiwa, Chiba, Japan.
- Department of Pediatrics, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan.
| | - Wataru Murasaki
- Department of Pediatrics, Jikei University Kashiwa Hospital, 163-1, Kashiwa-shita, Kashiwa, Chiba, Japan
- Department of Pediatrics, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan
| | - Hiroyuki Namba
- Department of Pediatrics, Jikei University Kashiwa Hospital, 163-1, Kashiwa-shita, Kashiwa, Chiba, Japan
- Department of Pediatrics, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan
| | - Kimihiko Oishi
- Department of Pediatrics, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan
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Yu Y, Wu X, Lu Y, Li Y. Development and validation of a nomogram to predict frailty risk in Chinese older adults combined with physical fitness test indicators. Geriatr Nurs 2025; 61:689-698. [PMID: 39516093 DOI: 10.1016/j.gerinurse.2024.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 10/07/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024]
Abstract
This study aimed to develop and validate a nomogram combined with the indicators of the physical fitness test to predict frailty risk in Chinese older adults. We recruited 344 participants from a community in Hebei Province, China. Data were collected on 57 candidate factor variables from sociodemographic factors, lifestyle factors, clinical factors, body composition test, and physical fitness test. Ultimately 6 factor variables were included in this predictive model: age, nutritional risk, hypertension, multimorbidity, depression and 2-Minute step test. The area under the curve (AUC) value in the training set and validation set is 0.866 and 0.854, which indicates that the model has a good ability to discriminate. The results of the H-L test indicate that the model is well calibrated. The calibration curves also indicate a good model fit. The model provides older adults with risk indicators to identify and prevent the onset of frailty as early as possible.
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Affiliation(s)
- Yichao Yu
- School of Sports Coaching, Beijing Sports University, Beijing 100084, China; Laboratory of Sports Stress and Adaptation of General Administration of Sport, Beijing Sport University, Beijing 100084, China; Key Laboratory of Sport Training of General Administration of Sport of China, Beijing Sport University, Beijing 100084, China
| | - Xiaoxue Wu
- Laboratory of Sports Stress and Adaptation of General Administration of Sport, Beijing Sport University, Beijing 100084, China; School of Sports Medicine and Rehabilitation, Beijing Sports University, Beijing 100084, China
| | - Yifan Lu
- Laboratory of Sports Stress and Adaptation of General Administration of Sport, Beijing Sport University, Beijing 100084, China; School of Sports Medicine and Rehabilitation, Beijing Sports University, Beijing 100084, China
| | - Yating Li
- Zhengzhou College of Finance and Economics, Zhengzhou 450000, China.
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Uyar GC, Kılıç MK. Evaluation of the effects of thyroid functions on frailty in geriatric patients using the Edmonton, SOF and FRAIL Scales. BMC Geriatr 2024; 24:1051. [PMID: 39736552 DOI: 10.1186/s12877-024-05643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 12/17/2024] [Indexed: 01/01/2025] Open
Abstract
BACKGROUND AND RATIONALE: Thyroid dysfunction in older adults often mimics the signs of aging, impacting metabolism and overall physiological balance. While age-related chronic conditions have been extensively studied, the relationship between thyroid function and frailty remains underexplored. OBJECTIVE This study aimed to evaluate the effects of thyroid dysfunction on frailty among individuals aged 65 years and older. Thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and thyroid peroxidase antibody (anti-TPO) levels were analyzed. The study further examined the correlation between thyroid dysfunction, chronic diseases, sociodemographic factors, and optimal TSH levels in relation to frailty, using the Study of Osteoporotic Fractures (SOF), Edmonton Frail Scale (EFS), and FRAIL scales. METHODS This cross-sectional study included 220 older adults with either treated or untreated thyroid dysfunction. Comprehensive geriatric assessments were conducted, including detailed medical histories, sociodemographic data collection, and thyroid function tests. Frailty was assessed using the SOF, EFS, and FRAIL scales. Multivariate logistic regression analyses were performed to identify significant associations between thyroid parameters and frailty. RESULTS The median age of participants was 73 years, and 68.2% (n = 150) were women. Frailty prevalence was significantly higher in individuals with abnormal TSH levels (outside the 0.5-6 mIU/L range). Lower fT3 levels and the fT3/fT4 ratio were significantly associated with frailty, particularly as assessed by the SOF and EFS scales. In contrast, the FRAIL scale revealed a significant association between increased frailty and lower fT3 levels only. Subgroup analysis indicated that in individuals aged ≥ 80 years, a lower fT3/fT4 ratio was consistently associated with frailty across all frailty scales, whereas in those aged < 80 years, lower TSH levels showed a strong association with frailty as assessed by the FRAIL scale. These findings underscore age-specific variations in the relationship between thyroid function and frailty. CONCLUSION This study highlights the significant impact of thyroid dysfunction on frailty in older adults. Lower fT3 levels and the fT3/fT4 ratio emerged as key indicators of increased frailty, particularly on the SOF and EFS scales. Subgroup analysis further emphasized the importance of age-specific assessments, with a lower fT3/fT4 ratio being a critical indicator of frailty in individuals aged ≥ 80 years, while lower TSH levels were significant in those aged < 80 years. Abnormal TSH levels were strongly associated with frailty on the SOF scale, suggesting the need to consider thyroid dysfunction as a modifiable risk factor. Additionally, factors such as age, sex, education, thyroid medication use, and comorbidities influenced frailty status. Incorporating thyroid function tests into frailty assessments could enhance early identification and targeted interventions for at-risk older adults, particularly when age-specific thresholds are applied.
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Affiliation(s)
- Galip Can Uyar
- Department of Medical Oncology, Ankara Etlik City Hospital, Yenimahalle, Ankara, Turkey.
| | - Mustafa Kemal Kılıç
- Department of Internal Medicine, Ankara Training and Research Hospital, Ankara, Turkey
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Değer MS, Sezerol MA, Atak M. Assessment of frailty, daily life activities, and nutrition of elderly immigrants: A household based cross-sectional study. Medicine (Baltimore) 2024; 103:e37729. [PMID: 38669436 PMCID: PMC11049769 DOI: 10.1097/md.0000000000037729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/05/2024] [Indexed: 04/28/2024] Open
Abstract
With the global migrant population on the rise, it's imperative to focus on the health status of more vulnerable groups within these communities. The elderly immigrants face myriad physical and psychosocial challenges that significantly impact their health and quality of life. This study aims to investigate the nutrition, daily life activities, and clinical frailty status of elderly immigrants residing in Türkiye. A cross-sectional design was employed in the Sultanbeyli District, focusing on Syrian immigrants aged 65 and over. Participants were surveyed face-to-face by interpreters proficient in Arabic. The questionnaire comprised sociodemographic details, health status, and scales like Katz Daily Life Activities, Clinical Frailty, and Mini Nutritional Assessment. The data analysis was executed using SPSS 22. Continuous variables were presented as mean ± standard deviation (SD) and median, while categorical ones were expressed in numbers and percentages (%). A significance level of P < .05 was considered for the analyses. The average age of the participants was determined as 71.64 ± 6.20 years. In the study group, 49.7% were female, 75.5% were younger than 75 years old, 47.7% had less than primary school education, 56.3% were married, 42.4% had a low income level, and 56.9% lived in the same household with 5 or more people. Among the participants in the study group, 47% had walking and balance problems, 29.1% had a history of falls in the last year, 10.6% were disabled, 69.5% complained of pain, 82.8% had a chronic illness, and 43% had polypharmacy. The median value of the KATZ Daily Living Activities scale was 6, the mean score of the Clinical Frailty Score scale was 3.25 ± 1.25, and the mean score of the Mini Nutritional Assessment scale was 12.40 ± 2.15. Among immigrant elderly individuals, 88.1% were able to sustain their lives independently, 13.9% were clinically frail, and 3.3% were at risk of malnutrition. Factors such as age, level of education, socioeconomic status, marital status, number of cohabitants in the household, BMI, neurological problems, walking-balance disorders, disability, and presence of chronic diseases are associated with daily life activities, frailty, and malnutrition status. It is believed that broader field research with greater participation would be beneficial for evaluating the nutritional status of immigrant elderly individuals.
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Affiliation(s)
- Mehmet Sait Değer
- Department of Public Health, Hitit University – Faculty of Medicine, Çorum, Türkiye
| | - Mehmet Akif Sezerol
- Department of Public Health, Istanbul Medipol University – School of Medicine, Istanbul, Türkiye
| | - Muhammed Atak
- Department of Public Health, Istanbul University – Istanbul Faculty of Medicine, Istanbul, Türkiye
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Falutz J, Lee D. Frailty and cognition in older people with HIV: recognizing the importance of geriatric syndromes. AIDS 2023; 37:2247-2249. [PMID: 37877280 DOI: 10.1097/qad.0000000000003715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Julian Falutz
- Division of Geriatrics and Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada
| | - Daniel Lee
- Division of Infectious Diseases & Global Public Health, University of California, San Diego Health, San Diego, California, USA
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Bozkurt ME, Catikkas NM, Erdogan T, Oren MM, Kilic C, Karan MA, Bahat G. Frailty and its associates in community-dwelling older adults. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230681. [PMID: 37971124 PMCID: PMC10645168 DOI: 10.1590/1806-9282.20230681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/26/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE While the literature contains several studies on the frailty assessed during hospitalization and/or outpatient settings and nursing homes, few studies have assessed frailty in community-dwelling older adults. We investigated the prevalence of frailty and associated factors among older adults in a sample of community-dwelling older adults. METHODS We included community-dwelling older adults >60 years living in the Fatih District of the Istanbul Province. We conducted the study between November 2014 and May 2015. We collected the data such as age, sex, number of diseases and drugs, functional status, frailty, the presence of geriatric syndromes, common diseases, and quality-of-life assessment. Frailty was evaluated by the FRAIL scale. RESULTS A total of 204 adults (mean age: 75.4±7.3 years) were included, of whom 30.4% were robust, 42.6% were pre-frail, and 27% were frail. In multivariate analyses, associated factors of frailty were the number of drugs [odds ratio (OR)=1.240, p=0.036], the presence of cognitive impairment (OR=0.300, p=0.016), and falls (OR=1.984, p=0.048). CONCLUSION The present study established the prevalence of frailty in a large district in the largest metropolis in the country through a valid screening method. Our results suggest that clinicians should consider frailty evaluation in patients with multiple drug usage, cognitive impairment, and falls.
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Affiliation(s)
- Meris Esra Bozkurt
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics – İstanbul, Turkey
| | - Nezahat Muge Catikkas
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics – İstanbul, Turkey
| | - Tugba Erdogan
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics – İstanbul, Turkey
| | - Meryem Merve Oren
- Istanbul University, Istanbul Medical School, Department of Public Health – İstanbul, Turkey
| | - Cihan Kilic
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics – İstanbul, Turkey
| | - Mehmet Akif Karan
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics – İstanbul, Turkey
| | - Gulistan Bahat
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics – İstanbul, Turkey
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Yang Y, Wang Q, Gao L, Liu S, Zhao J, Liu G, Zhang S. Promising applications of red cell distribution width in diagnosis and prognosis of diseases with or without disordered iron metabolism. Cell Biol Int 2023. [PMID: 37092585 DOI: 10.1002/cbin.12029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
Many indicators, including red cell distribution width (RDW) and iron metabolism, are sensitive to a variety of risk factors, and are associated with the pathological alterations and disease onset. RDW reflects the degree of heterogeneous volumes of peripheral red blood cells (RBCs). It has been well-known that increased RDW indicates iron deficiency anemia, hemolytic anemia, ineffective erythropoiesis, and shorten lifespan of RBCs. Increased RDW is also prevalent in various non-anemic pathological conditions and diseases. We here review the factors affecting RDW, particularly disordered iron metabolism, chronic inflammation, and oxidative stress, and recapitulate the interplays among these factors. Furthermore, we review the application of increased RDW together with disordered iron homeostasis and the deregulations of hepcidin expression and ferritin levels in the diagnoses and prognosis of anemic and nonanemic diseases. RDW is inexpensive and readily available and may be valuable in adding to the diagnosis and monitoring of many pathological conditions. RDW combined with other indicators, for example, hepcidin and ferritin levels, should be utilized more frequently in clinical practice.
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Affiliation(s)
- Yashuang Yang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong, China
| | - Quanshu Wang
- Biomedical Sciences College & Shandong Medicinal Biotechnology Centre, Shandong First Medical University, Jinan, Shandong, China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Ling Gao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong, China
| | - Sijin Liu
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong, China
| | - Guoliang Liu
- Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Shuping Zhang
- Biomedical Sciences College & Shandong Medicinal Biotechnology Centre, Shandong First Medical University, Jinan, Shandong, China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
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Tari Selcuk K, Atan RM, Arslan S, Sahin N. Relationship between food insecurity and geriatric syndromes in older adults: A multicenter study in Turkey. Exp Gerontol 2023; 172:112054. [PMID: 36513213 DOI: 10.1016/j.exger.2022.112054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
AIMS In this study, the aim was to determine the prevalence of geriatric syndromes such as frailty, sarcopenia risk and malnutrition in older adults and to investigate the relationship between food insecurity, and frailty, risk of sarcopenia and malnutrition. METHODS The study was cross-sectional. It was conducted between February 2022 and June 2022 with 707 older adults. The data were collected through the face-to-face interview method with a questionnaire including the Descriptive Information Form, Household Food Insecurity Access Scale (HFIAS), Frail Scale, Sarcopenia Risk Screening Scale (SARC-F) and Mini Nutritional Assessment-Short Form (MNA-SF). Numbers, percentages, mean, standard deviation, Pearson chi-square test and binary logistic regression analysis were used in data analysis. RESULTS In the present sample, 30% of the participants experienced some degree of food insecurity. The prevalence of frailty, sarcopenia risk, and malnutrition in the participants was 15.3%, 19.5%, and 1.3%, respectively. We determined that food insecurity was not associated with pre-frailty/frailty and sarcopenia risk. After adjusment for potential counfounders moderate and severe food insecurity was associated with higher odds of malnutrition risk and malnutrition (AOR: 2.06, 95% CI: 1.21-3.51, p:0.007). CONCLUSION While food insecurity is not associated with pre-frailty/frailty and sarcopenia risk, moderate and severe food insecurity is a modifiable risk factor for malnutrition risk and malnutrition. Thus, economic and social policies to eliminate food insecurity should be implemented, and efforts to prevent food insecurity should be planned through inter-sectoral cooperation.
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Affiliation(s)
- Kevser Tari Selcuk
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir 10200, Turkey.
| | - Ramazan Mert Atan
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey.
| | - Sedat Arslan
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir 10200, Turkey.
| | - Nursel Sahin
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir 10200, Turkey.
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Qin Y, Hao X, Lv M, Zhao X, Wu S, Li K. A global perspective on risk factors for frailty in community-dwelling older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 105:104844. [PMID: 36335672 DOI: 10.1016/j.archger.2022.104844] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frailty has become an important determinant of a series of adverse health outcomes. We explored the risk factors for frailty in older adults in the community from a global perspective and explore whether there are ethnic differences in these risk factors. METHODS The systematic review and meta-analysis (PROSPERO registration number: CRD42022323342) was searched using six electronic databases, including PubMed, Embase, the Cochrane Library, Web of Science, PsycINFO (EBSCO) and CINAHL (EBSCO) from inception to October 2021. We assessed study eligibility by inclusion and excluded criteria. Cohort studies included were assessed according to the Newcastle-Ottawa Scale. Cross-sectional studies were assessed by the bias risk evaluation standard recommended by the Agency for Health care Research and Quality. The results were reported by a narrative synthesis and pooled analyses. Statistical analyses were performed in Review Manager 5.3 software. RESULTS We reviewed 10870 studies, and 62 studies were included. The results showed a significant association between multidomain risk factors and the frailty of global older adults, including demographic factors, health-related factors, and physical factors. Marital status, depression, risk of malnutrition, history of falls and disease-related symptoms are also risk factors for frailty among older people in Asia. CONCLUSION Multiple domain factors were associated with frailty among older people around the world. Compared with the rest of the world, Asian populations are exposed to more risk factors for frailty. Therefore, health care providers should consider the characteristics of risk factors for frailty in this region when formulating intervention measures related to frailty.
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Affiliation(s)
- Yuan Qin
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Xiaonan Hao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Miaohua Lv
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Xuetong Zhao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Shuang Wu
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Kun Li
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China.
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Ceylan S, Oytun MG, Baş AO, Koca M, Doğu BB, Halil MG, Cankurtaran M, Balcı C. Frailty in community-dwelling older adults: reliability and validity of the Turkish version of the Gérontopôle frailty screening tool. Turk J Med Sci 2022; 52:2004-2010. [PMID: 36945979 PMCID: PMC10390194 DOI: 10.55730/1300-0144.5549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/26/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Recognizing frailty had a great importance in countries with an increasing geriatric population. The study aims to evaluate the reliability and validation of the Gérontopôle frailty screening tool (GFST), which was developed to screen frailty in the community-dwelling older adults, for the Turkish population. METHODS In this crosssectional study, participants who applied to the geriatrics outpatient clinic of a university hospital were included. Comprehensive geriatric assessments of all patients were performed. The validity of the GFST was tested by its concordance with the FRAIL scale. Test-retest and interrater reliability analyses were made. RESULTS Ninety-six patients were included in the study. Sixty-one and five-tenths percent (n = 59) of them are females. The median age was 72.0 (IQR: 10.0). There was a moderate concordance between the GFST and the FRAIL scale (Cohen's kappa: 0.566, p < 0.001). The Gérontopôle frailty screening tool interrater and retest reliabilities were excellent (Cohen's kappa: 0.814, p < 0.001 and 1.0, p < 0.001; respectively). The sensitivity of the GFST determined according to the FRAIL scale is 69.39%, the specificity is 86.36%, the positive predictive value is 85.00%, and the negative predictive value is 71.70%. DISCUSSION The Gérontopôle frailty screening tool, which can be used by all healthcare professionals, is a valid and reliable tool for the Turkish geriatric population.
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Affiliation(s)
- Serdar Ceylan
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Merve Güner Oytun
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Arzu Okyar Baş
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Meltem Koca
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Burcu Balam Doğu
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Meltem Gülhan Halil
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Mustafa Cankurtaran
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Cafer Balcı
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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Aşık Z, Kılınç Ş, Kurşun Ö, Özen M. Validation of the Clinical Frailty Scale version 2.0 in Turkish older patients. Geriatr Gerontol Int 2022; 22:730-735. [PMID: 35871523 DOI: 10.1111/ggi.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Abstract
AIM Frailty is a syndrome that affects certain older adults more than others, and it has physical, cognitive, psychological, social and environmental aspects. The aim of our study was to determine the validity and reliability of the Clinical Frailty Scale (CFS) version 2.0 in Turkish. In total, 204 older adults aged ≥65 years took part in this study. METHODS The necessary permissions were obtained from Rockwood et al. The Turkish version of CFS version 2.0 had been appropriately translated through translation to the back-translation process. A questionnaire was used to investigate certain descriptive features, as well as the newly edited Turkish translation of CFS version 2.0, the Turkish version of the FRAIL Scale and the Turkish version of the Edmonton Frail Scale. RESULTS The age range was 65-95 years. In a Pearson correlation analysis, a positive link was discovered between FRAIL and CFS (r = 0.761 and P = 0.000) as well as CFS and Edmonton (r = 0.895 and P = 0.000). CONCLUSION The Turkish translation of CFS version 2.0 has been determined to be suitable, valid and reliable for use in frailty screening in outpatient clinics. Geriatr Gerontol Int 2022; 22: 730-735.
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Affiliation(s)
- Zeynep Aşık
- Department of Family Medicine Antalya Training and Research Hospital Antalya Turkey
| | - Şule Kılınç
- Department of Family Medicine Karaman Sarıveliler Country State Hospital Sarıveliler Turkey
| | - Özge Kurşun
- Department of Family Medicine Çaldıran Soğuksu Family Health Center Çaldıran Turkey
| | - Mehmet Özen
- Department of Family Medicine Antalya Training and Research Hospital Antalya Turkey
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12
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Screening for frailty and sarcopenia in community-dwelling older adults: a cross-sectional study from the Eastern Black Sea region of Turkey. Aging Clin Exp Res 2022; 34:2047-2056. [PMID: 35704240 DOI: 10.1007/s40520-022-02164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/24/2022] [Indexed: 11/01/2022]
Abstract
AIM The purpose of this study was to investigate the prevalence of frailty, sarcopenia and associated factors among community-dwelling older adults living in the Eastern Black Sea region of Turkey. METHODS The study sample comprised 404 community-dwelling older adults living in the Eastern Black Sea region of Turkey. These subjects or proxies were contacted by mobile phone or the internet. The sociodemographic characteristics, falls and chronic pain were recorded. Frailty, sarcopenia, malnutrition, activities of daily living and instrumental activities of daily living were assessed using the FRAIL scale, SARC-F, Mini Nutrition Assessment-Short Form, Barthel Index and Lawton instrumental activities of daily living scale, respectively. RESULTS The 404 older adults comprised 62% females and 38% males with a mean age of 73.4 ± 7.4 years. The prevalence of positive frailty and sarcopenia screening were detected as 37.4% and 46.8%, respectively. The strongest associations with frailty were the presence of chronic lung disease [Odds ratio (OR) = 10.3; 95% confidence interval (CI) = 2.1, 49.8] and chronic pain [OR = 6.9; 95% CI = 3.2, 15.0]. The associations with sarcopenia were falls (OR = 7.4; 95% CI = 4.2, 12.9), dependence in instrumental activities of daily living (OR = 4.3; 95% CI = 2.2, 8.4), advancing age (OR = 2.6; 95% Cl = 1.4, 4.7), and dependence in daily living activities (OR = 2.2; 95% Cl = 1.3, 4.0). Female gender and falls were found to be co-related factors for frailty and sarcopenia. CONCLUSIONS Female gender and falls were independently associated with frailty and sarcopenia. In addition, chronic lung disease and chronic pain were major risk factors for frailty, while advancing age and dependence in daily living activities were major risk factors for sarcopenia. These factors should be considered to be able to identify individuals at high risk of frailty and sarcopenia and to prevent these geriatric syndromes.
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Uzun HG, Simsek E, Engin C, Yagdi T, Karapolat H, Ozbaran M, Nalbantgil S. Relation Between Frailty and 1-Year Outcomes After Implantation of a Left Ventricular Assist Device. Am J Cardiol 2022; 173:88-93. [PMID: 35361473 DOI: 10.1016/j.amjcard.2022.02.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022]
Abstract
Frailty has been associated with morbidity and mortality in patients with heart failure and those who underwent cardiac surgery. We aimed to study the effect of frailty on cardiovascular outcomes and the reversibility of frailty after the left ventricular assist device (LVAD) implantation. A total of 51 consecutive patients (44 men; aged 54 ± 10 years) scheduled to undergo LVAD implantation were assessed for frailty (Fried's phenotype, frail ≥3/5), cognitive function (using Mini-Cog), and depression (utilizing Patient Health Questionnaire-9) before the surgery and 3 months afterward. Patients were observed for mortality and adverse events [all-cause readmission, bleeding, renal dysfunction, and ventricular fibrillation (VF)/sustained ventricular tachycardia (VT)] for 12 months. More than half of the patients (54%) were designated as frail. Although there was no statistical difference in mortality among frail and nonfrail patients, frail ones were more likely to have a prolonged length of stay [adjusted odds ratio (AOR) 14.9, 95% confidence interval 1.6 to 132.5, p = 0.01]. At the 3-month reassessment after operation, frailty and cognition rates were better (frailty score [lower is better]: 3 vs 1.5, p <0.0001; cognition score [higher is better]: 4.5 vs 5, p = 0.001), and patients had less depression (Patient Health Questionnaire-9 score [lower is better]: 8 vs 4, p <0.0001). Of the secondary outcomes, only postoperative VF/sustained VT reached statistical significance in being more common among frail patients than nonfrail ones (p = 0.02). Although frailty was not associated with mortality at 1 year, prolonged length of stay occurred more with frail LVAD patients. Frailty status, cognitive function, and depressive mood all improved in most patients after LVAD.
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Affiliation(s)
| | | | | | | | - Hale Karapolat
- Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
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Prevalence of Frailty among Community-Dwelling Older Adults in Asian Countries: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10050895. [PMID: 35628034 PMCID: PMC9140771 DOI: 10.3390/healthcare10050895] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 12/14/2022] Open
Abstract
This study aimed to synthesize frailty prevalence among community-dwelling older adults in Asia and identify factors influencing prevalence estimates. Five electronic databases were searched by 29 April 2022, including representative samples of community-dwelling adults who were aged 60 years and older and lived in Asia. Cross-sectional or national longitudinal population-based cohort studies completed with validated instruments were selected. Twenty-one studies with 52,283 participants were included. The pooled prevalence rate of frailty was 20.5% (95% CI = 15.5% to 26.0%). The estimated frailty prevalence was 14.6% (95% CI = 10.9% to 18.8%) while assessed by the Fried frailty phenotype, 28.0% (95% CI = 21.3% to 35.3%) by the Cumulative Frailty Index, 36.4% (95% CI = 33.6% to 39.3%) by the Study of Osteoporotic Fractures (SOF) index, and 46.3% (95% CI = 40.1% to 52.4%) by the Clinical Frailty Scale (p < 0.01). Subgroup analysis in studies using the Fried’s phenotype tool found that frailty prevalence was increased with older age (p = 0.01) and was higher in those who were single (21.5%) than in married participants (9.0%) (p = 0.02). The study results supported a better understanding of frailty prevalence in different geographical distributions and provide references for health policy decision-making regarding preventing frailty progression in older adults.
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ERDEM SANCAK Z, HAKİ C, DEMİRCİ H. Determining the frailty status in patients who apply for home health care. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.988602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background To examine the relationship between an institutionally prepared standardized patient evaluation form and the Edmonton Frail Scale (EFS) in patients receiving home health care.
Material and Methods Our prospective, observational study included 200 patients over the age of 18 who requested home health care, regardless of gender. The EFS and institutional data collection forms were applied consecutively on the same day to all patients included in the study.
Results Among the 200 individuals recruited for the study, 59% were female and 41% were male; the overall average age was 80 years. According to the EFS results, 4.5% of the patients were classified as non-frail, 6% were vulnerable, and 89.5% had varying degrees of frailty (mild, moderate and severe). There was a significant positive correlation between EFS score and age (p
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Affiliation(s)
- Zeynep ERDEM SANCAK
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital
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de Souza LF, Canever JB, Moreira BDS, Danielewicz AL, de Avelar NCP. Association Between Fear of Falling and Frailty in Community-Dwelling Older Adults: A Systematic Review. Clin Interv Aging 2022; 17:129-140. [PMID: 35173427 PMCID: PMC8843349 DOI: 10.2147/cia.s328423] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/25/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/OBJECTIVE Fear of falling (FoF) and frailty are common problems in older adults. FoF can lead to self-imposed restriction of activities and then further decline in physical capacities that predispose older adults to frailty. Evaluating the association of these two geriatric syndromes may be the first step for understanding their complex relationship and might ultimately lead to establishing therapeutic goals and guiding treatments for older adults with frailty. This systematic review was conducted to provide evidence regarding the association between FoF and frailty. METHODS All the articles that provided information on the association between FoF and frailty were selected from PubMed, Scopus, CINAHL, and EMBASE in search of relevant papers. Articles reporting information on the association between FoF (exposure) and frailty (outcome), with older adults (age ≥60 years) living in the community (ie, living either at home or in places of residence that do not provide nursing care or rehabilitation) were included. Only original articles with observational design (cross-sectional or longitudinal/cohort) were included. The methodological quality of included articles was evaluated independently by the two assessors through the Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal checklist for longitudinal and cross-sectional studies, respectively. RESULTS The initial searches found 4,342 articles, of which 10 articles were included in this review: 7 cross-sectional and 2 longitudinal studies, and 1 study with cross-sectional and longitudinal analyses. The total sample was composed of 6,294 community-dwelling older adults (61.8% women). Among the longitudinal studies, adjusted odds ratios ranged from 1.18 (95% CI = 1.02; 1.36) to 9.87 (95% CI = 5.22; 18.68), while the adjusted odds ratios of the cross-sectional studies ranged from 1.04 (95% CI = 1.02; 1.07) to 7.16 (95% CI = 2.34; 21.89). CONCLUSION FoF increases the risk of frailty in community-dwelling older adults. The knowledge of this association is of utmost importance in clinical practice, since it can help health professionals in the development of rehabilitation, prevention, and health promotion protocols. In addition, these findings can contribute to the development of public health policies and actions aimed at reducing the FoF and consequently the frailty. PROSPERO CRD42021276775.
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Affiliation(s)
- Larissa Franciny de Souza
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Bruno de Souza Moreira
- René Rachou Institute, Oswaldo Cruz Foundation (Fiocruz Minas), Belo Horizonte, Minas Gerais, Brazil
| | - Ana Lúcia Danielewicz
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Núbia Carelli Pereira de Avelar
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
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Alqahtani BA, Alshehri MM, Elnaggar RK, Alsaad SM, Alsayer AA, Almadani N, Alhowimel A, Alqahtani M, Alenazi AM. Prevalence of Frailty in the Middle East: Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10010108. [PMID: 35052272 PMCID: PMC8775476 DOI: 10.3390/healthcare10010108] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023] Open
Abstract
(1) We aimed to systematically search available data on the prevalence of frailty among community-dwelling elders in Middle Eastern countries. The results from available studies are cumulated to provide comprehensive evidence for the prevalence of frailty. (2) Methods: A meta-analysis was done. A literature search was carried out using PRISMA guidelines in PubMed, Web of Science, and SCOPUS websites for studies up to 2020. Inclusion criteria entailed all primary studies conducted in Middle Eastern countries on frailty in community-dwelling older adults aged 60 years and older. (3) Results: A total of 10 studies were selected for this study. Random-effects meta-analysis of nine studies indicated there was a pooled prevalence rate of 0.3924 with a standard error of 0.037. This pooled prevalence point estimate of 0.3924 was statistically significant (p < 0.001). The Egger’s regression test and the trim-fill method for detecting publication bias did not detect any evidence of publication bias in the sample of included studies. The Egger’s regression test was not statistically significant. The trim-fill method indicated zero studies were missing on either side; (4) Conclusions: The study’s findings indicate that the prevalence of frailty is higher in Middle Eastern nations. Despite indications that many of these nations’ populations are rapidly ageing, we presently lack information on the incidence of frailty in these populations; this information is essential to health, policymakers, and social care planning.
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Affiliation(s)
- Bader A. Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (R.K.E.); (A.A.); (A.M.A.)
- Correspondence: ; Tel.: +966-580422762; Fax: +966-115882000
| | - Mohammed M. Alshehri
- Physical Therapy Department, Jazan University, Jazan 82412, Saudi Arabia;
- Medical Research Center, Jazan University, Jazan 45142, Saudi Arabia
| | - Ragab K. Elnaggar
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (R.K.E.); (A.A.); (A.M.A.)
- Department of Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - Saad M. Alsaad
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Ahmed A. Alsayer
- College of Science and Arts, Taibah University, Medina 42353, Saudi Arabia;
| | - Noura Almadani
- Community Health Nursing Department, Nursing College, Princess Nourah Bint Abdulrahman University, Riyadh 84428, Saudi Arabia;
| | - Ahmed Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (R.K.E.); (A.A.); (A.M.A.)
| | | | - Aqeel M. Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (R.K.E.); (A.A.); (A.M.A.)
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Abstract
Frailty is a geriatric syndrome characterized by decreased daily living activity, weight loss, weakness, and dependency caused by the cumulative decline in many physiological systems over the life span. This study examined older adults' perceptions of frailty. The study used a descriptive qualitative design. Data were collected using semistructured interviews with 14 older adults admitted to the geriatrics outpatient clinic in one Turkish institution from September to December 2019. The interviews were transcribed and analyzed using the MAXQDA data analysis software. Codes were combined into themes. The respondents were aged 74.5 ± 8.7 years. Two themes emerged from the qualitative data: (i) the conceptualization of frailty; and (ii) coping with frailty. Some of the participants self-identified as frail, a natural consequence of aging. Another group of participants emphasized the feelings of hopelessness and hopefulness in coping with frailty in their remaining lives. This study provides insights into older Turkish adults' opinions regarding frailty, including the development of frailty and its relationship with health status and daily life. This understanding may be used to detect frailty in older adults and to improve frail older adults' care interventions.
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Affiliation(s)
- Cigdem Canbolat Seyman
- Cigdem Canbolat Seyman, PhD, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Yasemin Sara, MSc, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Selçuk University, Konya, Turkey
| | - Yasemin Sara
- Cigdem Canbolat Seyman, PhD, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Yasemin Sara, MSc, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Selçuk University, Konya, Turkey
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Jiao J, Guo N, Xie L, Ying Q, Zhu C, Guo X, Wen X, Jin J, Wang H, Lv D, Zhao S, Wu X, Xu T. Association between Frailty and 90-Day Outcomes amongst the Chinese Population: A Hospital-Based Multicentre Cohort Study. Gerontology 2021; 68:8-16. [PMID: 33915544 DOI: 10.1159/000514948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Frailty has gained increasing attention as it is by far the most prevalent geriatric condition amongst older patients which heavily impacts chronic health status. However, the relationship between frailty and adverse health outcomes in China is far from clear. This study explored the relation between frailty and a panel of adverse health outcomes. METHODS We performed a multicentre cohort study of older inpatients at 6 large hospitals in China, with two-stage cluster sampling, from October 2018 to April 2019. Frailty was measured according to the FRAIL scale and categorized into robust, pre-frail, and frail. A multivariable logistic regression model and multilevel multivariable negative binomial regression model were used to analyse the relationship between frailty and adverse outcomes. Outcomes were length of hospitalization, as well as falls, readmission, and mortality at 30 and 90 days after enrolment. All regression models were adjusted for age, sex, BMI, surgery, and hospital ward. RESULTS We included 9,996 inpatients (median age 72 years and 57.8% male). The overall mortality at 30 and 90 days was 1.23 and 1.88%, respectively. At 30 days, frailty was an independent predictor of falls (odds ratio [OR] 3.19; 95% CI 1.59-6.38), readmission (OR 1.45; 95% CI 1.25-1.67), and mortality (OR 3.54; 95% confidence interval [CI] 2.10-5.96), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. At 90 days, frailty had a strong predictive effect on falls (OR 2.10; 95% CI 1.09-4.01), readmission (OR 1.38; 95% CI 1.21-1.57), and mortality (OR 6.50; 95% CI 4.00-7.97), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. There seemed to be a dose-response association between frailty categories and fall or mortality, except for readmission. CONCLUSIONS Frailty is closely related to falls, readmission, and mortality at 30 or 90 days. Early identification and intervention for frailty amongst older inpatients should be conducted to prevent adverse outcomes.
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Affiliation(s)
- Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Guo
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingli Xie
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiaoyan Ying
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinying Guo
- Department of Geriatric, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
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Qin Y, Li J, McPhillips M, Lukkahatai N, Yu F, Li K. Association of fear of falling with frailty in community-dwelling older adults: A cross-sectional study. Nurs Health Sci 2021; 23:516-524. [PMID: 33825287 DOI: 10.1111/nhs.12840] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 12/30/2022]
Abstract
This study aimed to describe frailty and fear of falling and examine the cross-sectional association between frailty and fear of falling in community-dwelling older adults in China. We recruited 165 older adults from five selected communities in the five districts of Changchun, Jilin Province. Participants were asked to complete a demographic questionnaire, the Short Falls Efficacy Scale-International, and the Tilburg Frailty Indicator. We found that 60% of our participants were frail and that 81% reported a fear of falling. Using binary logistic regression, we found that the participants with fear of falling were 7.2 times more likely to be frail. These findings suggest that fear of falling should be regularly screened in clinical practice to help identify older adults with greater risks of frailty. Future longitudinal studies of larger sample size are needed to confirm the association. Moreover, frailty prevention programs that include strategies to reduce the fear of falling should be tested among community-dwelling older adults.
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Affiliation(s)
- Yuan Qin
- School of Nursing, Jilin University, Changchun, China
| | - Junxin Li
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Miranda McPhillips
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Nada Lukkahatai
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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YÜCELER KAÇMAZ H, ERAT A, CEYHAN Ö. A POINT TO EVALUATE IN THE COVID 19 PANDEMIC PROCESS: FRAILTY. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.891622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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22
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Güngör Başaran AY, Akal Yıldız E. Nutrition Status, Muscle Mass, and Frailty in Older People: A Cross-Sectional Study Conducted in Cyprus. J Am Coll Nutr 2021; 41:318-324. [PMID: 33729904 DOI: 10.1080/07315724.2021.1884142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Aging is a worldwide serious public health problem. Frailty is also becoming an alarming geriatric syndrome. This study was conducted to analyze the relationship of frailty with nutritional and muscle status in individuals aged 65 and older. METHOD The study was carried out between July 2018 and September 2019 among 347 people aged 65 and older residing in Cyprus. All the data were collected and measured with face-to-face interview method by the researcher which includes demographic information, a retrospective 1-day food consumption record, Edmonton Frailty Scale (EFS), anthropometric measurements, hand grip strength, muscle mass, and walking speed. RESULTS The average age of individuals was 73.12 ± 6.78 years. When sex, education levels, and drug usage were compared with EFS levels, severity of frailty was found to be significantly higher in females, non-educated individuals, and in individuals using 3 or more drugs everyday (p < 0.05). Body mass index (BMI) values of non-frail participants were found significantly higher than mildly, moderately, and severely frail participants (p < 0.05). It was observed that there was a statistically significant and negative correlation between the participants' EFS scores and muscle mass (p < 0.05). A negative correlation between hand grip strength and EFS scores was also observed. Energy and protein intake was not found to be significantly different in EFS level groups, while calcium intake of participants with mild, moderate, and severe frailty was found to be significantly lower than in those who were not frail or apparently vulnerable (p < 0.05). CONCLUSIONS Being female, having low education levels, using more than 3 drugs per day, and having lower muscle mass increases frailty levels. As a consequence, higher education, decreasing the number of drugs used per day, and preserving muscle mass with adequate activity are important cornerstones of decreasing frailty risk.
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Affiliation(s)
- Asiye Yeter Güngör Başaran
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Eastern Mediterranean University, Famagusta, North Cyprus, Cyprus
| | - Emine Akal Yıldız
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Eastern Mediterranean University, Famagusta, North Cyprus, Cyprus
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Teoh RJJ, Mat S, Khor HM, Kamaruzzaman SB, Tan MP. Falls, frailty, and metabolic syndrome in urban dwellers aged 55 years and over in the Malaysian elders longitudinal research (MELoR) study - a cross-sectional Study. Postgrad Med 2020; 133:351-356. [PMID: 33143493 DOI: 10.1080/00325481.2020.1842026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES While metabolic syndrome, falls, and frailty are common health issues among older adults which are likely to be related, the potential interplay between these three conditions has not previously been investigated. We investigated the relationship between metabolic syndrome with falls, and the role of frailty markers in this potential relationship, among community-dwelling older adults. METHODS Data from the first wave Malaysian Elders Longitudinal Research (MELoR) study comprising urban dwellers aged 55 years and above were utilized. Twelve-month fall histories were established during home-based, computer-assisted interviews which physical performance, anthropometric and laboratory measures were obtained during a hospital-based health check. Gait speed, exhaustion, weakness, and weight loss were employed as frailty markers. RESULTS Data were available for 1415 participants, mean age of 68.56 ± 7.26 years, 57.2% women. Falls and metabolic syndrome were present in 22.8% and 44.2%, respectively. After adjusting for age, sex, and multiple comorbidities, metabolic syndrome was significantly associated with falls in the sample population [odds ratio (OR): 1.33, 95% confidence interval (CI): 1.03; 1.72]. This relationship was attenuated by the presence of slow gait speed, but not exhaustion, weakness, or weight loss. CONCLUSION Metabolic syndrome was independently associated with falls among older adults, and this relationship was accounted for by the presence of slow gait speed. Future studies should determine the value of screening for frailty and falls with gait speed in older adults with metabolic syndrome as a potential fall prevention measure.
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Affiliation(s)
- Ru Jian Jonathan Teoh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hui Min Khor
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
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Romeo FJ, Smietniansky M, Cal M, Garmendia C, Valle Raleigh JM, Seropian IM, Falconi M, Oberti P, Kotowicz V, Agatiello CR, Berrocal DH. Measuring frailty in patients with severe aortic stenosis: a comparison of the edmonton frail scale with modified fried frailty assessment in patients undergoing transcatheter aortic valve replacement. J Geriatr Cardiol 2020; 17:441-446. [PMID: 32863827 PMCID: PMC7416067 DOI: 10.11909/j.issn.1671-5411.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Francisco J Romeo
- Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Smietniansky
- Division of Internal Medicine and Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariela Cal
- Division of Internal Medicine and Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Cristian Garmendia
- Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan M Valle Raleigh
- Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio M. Seropian
- Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariano Falconi
- Division Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Oberti
- Division Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Vadim Kotowicz
- Division of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carla R. Agatiello
- Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel H Berrocal
- Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Jiao J, Wang Y, Zhu C, Li F, Zhu M, Wen X, Jin J, Wang H, Lv D, Zhao S, Wu X, Xu T. Prevalence and associated factors for frailty among elder patients in China: a multicentre cross-sectional study. BMC Geriatr 2020; 20:100. [PMID: 32164595 PMCID: PMC7068995 DOI: 10.1186/s12877-020-1496-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/27/2020] [Indexed: 12/27/2022] Open
Abstract
Background To date, most previous studies of frailty among hospitalized elderly Chinese patients have been conducted based on small samples, which cannot represent the elderly patient population. The aim of this study was to identify the prevalence of and risk factors for frailty among elderly patients in China. Study design and setting This cross-sectional study surveyed 9996 elderly patients from 6 tertiary-level hospitals in China. The prevalence of frailty among patients from selected wards was surveyed by trained investigators. A mixed-effects Poisson regression model was used to analyse the factors associated with frailty among elderly patients. Results The mean age of all subjects was 72.47 ± 5.77 years. The prevalence rate of frailty in this study was 18.02%. After adjustments were made for the confounding effect of the clustering of hospital wards, a mixed-effects Poisson regression model showed that the associated factors of frailty included the following: age (OR: 1.016, 95% CI: 1.012–1.020), BMI < 18.5 (OR: 1.248, 95% CI: 1.171–1.330), female gender (OR: 1.058, 95% CI: 1.004–1.115), ethnic minority (OR: 1.152, 95% CI: 1.073–1.236), admission to hospital by the emergency department (OR: 1.104, 95% CI: 1.030–1.184), transit from another hospital (OR: 1.159, 95% CI: 1.049–1.279), former alcohol use (OR: 1.094, 95% CI: 1.022–1.171), fall history in the past 12 months (OR: 1.257, 95% CI: 1.194–1.323), vision dysfunction (OR: 1.144, 95% CI: 1.080–1.211), cognition impairment (OR: 1.182, 95% CI: 1.130–1.237), sleeping dysfunction (OR: 1.215, 95% CI: 1.215–1.318), urinary dysfunction (OR: 1.175, 95% CI: 1.104–1.251), and defecation dysfunction (OR: 1.286, 95% CI: 1.217–1.358). The results also showed some of the following protective effects: BMI > 28 (OR: 0.897, 95% CI: 0.856–0.940); higher education level, including middle school (OR: 0.915, 95% CI: 0.857, 0.977) and diploma and above (OR: 0.891, 95% CI: 0.821, 0.966); and current alcohol use (OR: 0.869, 95% CI: 0.815, 0.927). Conclusion We identified a relatively high prevalence of frailty among elderly patients, and there are several associated factors among the population derived from this investigation of a large-scale, multicentre, nationally representative Chinese elderly inpatient population. Trial registration Chinese Clinical Trial Registry, ChiCTR1800017682, registered 09 August 2018.
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Affiliation(s)
- Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Wang
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fangfang Li
- Department of Endocrinae. Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minglei Zhu
- Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji medical college, Huazhong University of Science and Technology, Wuhan, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Haerbin Medical University, Haerbin, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
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Hou P, Xue HP, Mao XE, Li YN, Wu LF, Liu YB. Inflammation markers are associated with frailty in elderly patients with coronary heart disease. Aging (Albany NY) 2019; 10:2636-2645. [PMID: 30325739 PMCID: PMC6224228 DOI: 10.18632/aging.101575] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/24/2018] [Indexed: 12/24/2022]
Abstract
The neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) are important indicators of adverse outcomes and have predictive value for many diseases; however, the relationships between frailty, and the NLR and RDW in patients with coronary heart disease (CHD) have not been determined. In this cross-sectional study, we investigated the association between frailty, and the NLR and RDW in elderly CHD patients ≥ 60 years of age. Frailty was defined according to frailty phenotype. Of 345 patients enrolled in the study, 22.6%, 58.3%, and 19.1% were characterized as robust, pre-frail, and frail, respectively. A significant positive correlation was observed between frailty and the NLR (r = 0.169) and RDW (r = 0.196). After adjusting for confounders, linear regression analyses showed that participants in the 4th quartile of the NLR or RDW were more likely to have a higher frailty phenotype score. Based on multivariable logistic regression, patients in the 4th quartile of the NLR and RDW, the fully-adjusted odds ratios for incident frailty were 2.894 (p = 0.011) and 2.494 (p = 0.040), respectively. Our findings indicate that frailty is associated with the NLR and RDW in elderly patients with CHD.
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Affiliation(s)
- Ping Hou
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Hui-Ping Xue
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Xin-E Mao
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Yong-Nan Li
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Lin-Feng Wu
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Yong-Bing Liu
- School of Nursing, Yangzhou University, Yangzhou 225000, China
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Akın S, Ozer FF, Ertürk Zararsız G, Şafak ED, Mucuk S, Göçer Ş, Mazıcıoğlu M. Validity of simplified nutritional appetite questionnaire for Turkish community-dwelling elderly and determining cut-off according to mini nutritional assessment. Arch Gerontol Geriatr 2019; 83:31-36. [PMID: 30939362 DOI: 10.1016/j.archger.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/17/2019] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of this study was to determine a cut-off value for the SNAQ according to both the MNA long and MNA short forms and to assess whether the SNAQ can predict malnutrition or risk of malnutrition in the elderly. SUBJECTS/METHODS Nutritional status was assessed both by the Mini Nutritional Assessment (MNA) long and short forms. All demographic characteristics, mental status, depressive mood, functional status, and frailty were determined. Receiver operating characteristic (ROC) curves were used to calculate the cut-off of the SNAQ according to both the MNA long and short forms for malnutrition or risk of malnutrition. Reliability and validation of the SNAQ was analysed. RESULTS We included 905 community-dwelling elderly, but those with middle-stage dementia (MMSE score <18, n = 30) were excluded. The mean age ± standard deviation (SD) was 71.4 ± 5.5 years (49.3% female and 50.7% male). The prevalence of well-nourished, risk of malnutrition or malnutrition were 55.2%, 44.8%, respectively according to the MNA-long form. The prevalence of elderly at risk of future weight loss (SNAQ score of ≤14) was 31.0% (n = 268; 66.0% female, 34.0% male). The area under the curve (AUC) for SNAQ was 0.725 (95% CI 0.690-0.760). The cut-off value of the SNAQ, according to both the MNA long and short forms, was 14 (sensitivity; 50%, 50% and specificity; 84%, 82%, respectively). The Cronbach's alpha reliability coefficient of SNAQ for internal consistency was 0.639. CONCLUSION The SNAQ was reliable and valid as an appetite screening tool in community-dwelling Turkish elderly.
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Affiliation(s)
- Sibel Akın
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Melikgazi 38090, Turkey.
| | - Firuzan Fırat Ozer
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Melikgazi 38090, Turkey
| | - Gözde Ertürk Zararsız
- Department of Biostatistics, Erciyes School of Medicine, Erciyes University, Melikgazi 38090, Turkey
| | - Elif Deniz Şafak
- Department of Family Medicine, Erciyes School of Medicine, Erciyes University, Melikgazi 38090, Turkey
| | - Salime Mucuk
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Turkey
| | | | - Mümtaz Mazıcıoğlu
- Department of Family Medicine, Erciyes School of Medicine, Erciyes University, Melikgazi 38090, Turkey
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RETRACTED ARTICLE: Rapid Screening for Frailty and Sarcopenia in Daily Clinical Practice. J Nutr Health Aging 2018. [DOI: 10.1007/s12603-018-1057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Yaman H, Ünal Z. The validation of the PRISMA-7 questionnaire in community-dwelling elderly people living in Antalya, Turkey. Electron Physician 2018; 10:7266-7272. [PMID: 30258559 PMCID: PMC6140991 DOI: 10.19082/7266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background The screening of frailty in older adults is an important issue in the preventive approach in medicine. Frailty is one of the leading causes of morbidity and premature mortality in older adults. Objective The aim of this study was to validate the PRISMA-7 questionnaire in community-dwelling elderly people living in Antalya, Turkey. Methods This study was cross-sectional and observational in nature and was conducted in Antalya (Turkey) from February 2016 to April 2017. One hundred fifty patients participated in this study. PRISMA-7 and the CSHA Clinical Frailty Scale were applied to these patients along with a questionnaire on socio-demographics. No translations were available for the PRISMA-7 or the CSHA in Turkish language. The PRISMA-7 and the CSHA Clinical Frailty Scale were translated by two translators to Turkish language; after compilation and agreeing to one Turkish translation, the text was translated back by two translators to English. The translation was then compiled to one text and compared with the original text. After agreement on the translation, both translations were piloted in 10 elderly people. The final form has been applied in this study. Data of the ten piloted patients have not been included into the dataset. Data were analyzed by IBM-SPSS version 22, using descriptive statistics, Pearson product-moment correlation, and receiver operator characteristic (ROC) analysis. The level of significance was set at 0.05. Results Our study showed that participants were in average vulnerability to frailty. The test-retest reliability score for the PRISMA-7 Scale and for the CSHA Clinical Frailty Scale were (r= 99.2; p<0.001) and (r=97.5; p<0.05), respectively. After using CSHA Clinical Frailty Scale as a reference standard, PRISMA-7 showed that the area under ROC curve (AUC) was 0.903; which is the best accuracy; and medium level for internal consistency (Cronbach’s α =0.714) as a measure for reliability. A cut-off point of 4 or higher for PRISMA-7revealed high sensitivity (81.5%) and specificity (88.2%) for frailty. Conclusion We would recommend PRISMA-7 as a reliable and valid instrument, with high-level accuracy in the screening process of frailty.
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Affiliation(s)
- Hakan Yaman
- MD in Family Medicine, Former Professor of Akdeniz University, Konyaaltı-Antalya, Turkey
| | - Zeynep Ünal
- MSC of Bioinformatics; PhD Candidate in Econometrics, Institute of Social Sciences, Akdeniz University, Antalya, Turkey
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Gok Metin Z, Karadas C, Balci C, Cankurtaran M. The Perceived Caregiver Burden Among Turkish Family Caregivers Providing Care for Frail Older Adults. J Transcult Nurs 2018; 30:222-230. [DOI: 10.1177/1043659618790041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose: The older population has reached to 8.5%, and the prevalence of frailty is reported as 39.2% in Turkey. The purpose of the study was to assess caregiver burden in families who care for frail older adults in Turkish culture. Method: This descriptive study was conducted in Turkey between June and October 2017. Frail older adults who had no severe cognitive impairment were included. Data were measured using the Older Adult Information Form, Edmonton Frailty Scale, Caregiver Information Form, and Zarit Burden Interview. Results: In total, 131 older person/caregiver dyads were analyzed; the Zarit Burden Interview mean score was 37.59 ± 18.20. Caregivers with less education and providing care more than 8 hours experienced a higher burden ( p < .05). The severity of frailty significantly correlated with the caregiver scores ( R = .36, p < .01). Conclusion: The caregiver burden in Turkish family caregivers was found mild to moderate and correlated with the degree of frailty. Policymakers should focus on culture-specific formal caregiver services.
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Mohd Hamidin FA, Adznam SN, Ibrahim Z, Chan YM, Abdul Aziz NH. Prevalence of frailty syndrome and its associated factors among community-dwelling elderly in East Coast of Peninsular Malaysia. SAGE Open Med 2018; 6:2050312118775581. [PMID: 29872529 PMCID: PMC5977425 DOI: 10.1177/2050312118775581] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/16/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Frailty is a clinical syndrome with increased risk of poor health outcomes and particularly prevalent in older adults and community population. The study's aim was therefore to determine the prevalence of frailty and its association with sociodemographic and socioeconomic characteristics, health-related status, and anthropometric measurements among community-dwelling older adults. METHODS A total of 279 older adults aged 60 years and above were randomly selected. Respondents were classified as non-frail (<2 criteria) or frail (≥3 criteria) based on the 'phenotype of frailty'. A binary logistic regression was used to determine predictors of frailty. RESULTS The prevalence of frailty was 18.3%. The frail older adults were positively associated with advanced age, being unmarried, hospitalisation in the previous year, poor self-rated health, and lower body mass index. DISCUSSION These results give an overview on underlying effects and guiding actions for prevention programmes functioning to reverse and minimise the adverse effects of frailty syndrome.
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Affiliation(s)
- Fairus Asma Mohd Hamidin
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Siti Nur’Asyura Adznam
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Malaysia
| | - Zuriati Ibrahim
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Yoke Mun Chan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nur Hafizah Abdul Aziz
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Howrey BT, Al Snih S, Markides KS, Ottenbacher KJ. Frailty and diabetes among Mexican American older adults. Ann Epidemiol 2018; 28:421-426.e1. [PMID: 29778652 DOI: 10.1016/j.annepidem.2018.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/15/2018] [Accepted: 04/19/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Progressive physical frailty in older adults is associated with increased risk of falls, disability, institutionalization, and mortality. Although associations between diabetes and frailty have been observed, the impact of diabetes on frailty in older Hispanics is largely unexplored. We examine the association of diabetes on the odds of frailty among older Mexican Americans. METHODS Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly from 1995 until 2012, frailty was assessed by slow gait, weak hand grip strength, exhaustion, and unexplained weight loss (n = 1327). RESULTS Logistic regression showed a large magnitude of effect of diabetes on the odds of frailty (odds ratio 1.47, 95% confidence interval 1.14-1.90). Other contributors to frailty included arthritis, heart attack, and hip fracture. Positive and negative effects had significant and opposing associations. Ordinal logit models assessed the odds of frail compared to nonfrail and prefrail. In these models, diabetes was associated with a 32% increase in the odds of a higher level of frailty. CONCLUSIONS Diabetes is a significant contributor to increased frailty in older Mexican Americans. Interventions to reduce frailty rates should focus on mitigating the effects of diabetes and shifting away from negative and toward positive effect.
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Affiliation(s)
- Bret T Howrey
- Department of Family Medicine, University of Texas Medical Branch, Galveston.
| | - Soham Al Snih
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston
| | - Kyriakos S Markides
- Department of Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston
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Siriwardhana DD, Hardoon S, Rait G, Weerasinghe MC, Walters KR. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 2018; 8:e018195. [PMID: 29496895 PMCID: PMC5855322 DOI: 10.1136/bmjopen-2017-018195] [Citation(s) in RCA: 279] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/24/2017] [Accepted: 01/05/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To systematically review the research conducted on prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries (LMICs) and to estimate the pooled prevalence of frailty and prefrailty in community-dwelling older adults in LMICs. DESIGN Systematic review and meta-analysis. PROSPERO registration number is CRD42016036083. DATA SOURCES MEDLINE, EMBASE, AMED, Web of Science, CINAHL and WHO Global Health Library were searched from their inception to 12 September 2017. SETTING Low-income and middle-income countries. PARTICIPANTS Community-dwelling older adults aged ≥60 years. RESULTS We screened 7057 citations and 56 studies were included. Forty-seven and 42 studies were included in the frailty and prefrailty meta-analysis, respectively. The majority of studies were from upper middle-income countries. One study was available from low-income countries. The prevalence of frailty varied from 3.9% (China) to 51.4% (Cuba) and prevalence of prefrailty ranged from 13.4% (Tanzania) to 71.6% (Brazil). The pooled prevalence of frailty was 17.4% (95% CI 14.4% to 20.7%, I2=99.2%) and prefrailty was 49.3% (95% CI 46.4% to 52.2%, I2=97.5%). The wide variation in prevalence rates across studies was largely explained by differences in frailty assessment method and the geographic region. These findings are for the studies with a minimum recruitment age 60, 65 and 70 years. CONCLUSION The prevalence of frailty and prefrailty appears higher in community-dwelling older adults in upper middle-income countries compared with high-income countries, which has important implications for healthcare planning. There is limited evidence on frailty prevalence in lower middle-income and low-income countries. PROSPERO REGISTRATION NUMBER CRD42016036083.
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Affiliation(s)
- Dhammika D Siriwardhana
- Research Department of Primary Care and Population Health, University College London, London, UK
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Sarah Hardoon
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Manuj C Weerasinghe
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Kate R Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
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Dong L, Qiao X, Tian X, Liu N, Jin Y, Si H, Wang C. Cross-Cultural Adaptation and Validation of the FRAIL Scale in Chinese Community-Dwelling Older Adults. J Am Med Dir Assoc 2018; 19:12-17. [DOI: 10.1016/j.jamda.2017.06.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 01/17/2023]
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Kurkcu M, Meijer RI, Lonterman S, Muller M, de van der Schueren MAE. The association between nutritional status and frailty characteristics among geriatric outpatients. Clin Nutr ESPEN 2017; 23:112-116. [PMID: 29460785 DOI: 10.1016/j.clnesp.2017.11.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/18/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Frailty is a common clinical syndrome in older adults and is associated with an increased risk of poor health outcomes, e.g. falls, disability, hospitalization, and mortality. Nutritional status might be an important factor contributing to frailty. This study aims to describe the association between nutritional status and characteristics of frailty in patients attending a geriatric outpatient clinic. METHODS Clinical data was collected of 475 patients who visited the geriatric outpatient department of a Dutch hospital between 2005 and 2010. Frailty was determined by: incontinence, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Geriatric Depression Scale (GDS) and Mini Mental State Exam (MMSE). Nutritional status was represented by the Mini Nutritional Assessment (MNA) and plasma concentrations of several micronutrients, whereby MNA< 17 indicated malnutrition and MNA 17-23.5 indicated risk of malnutrition. 'More frail' patients (≥3 frailty characteristics) were compared to 'less frail' patients (<3 frailty characteristics) with logistic regression analyses, adjusted for age, sex and other important covariates. RESULTS Of 404 patients with complete data, mean age (SD) was 80 (7) years and 34% was male. Prevalence of 'more frail' patients was 47%. Prevalence of malnutrition and risk of malnutrition was 16% and 56% respectively. Malnutrition and risk of malnutrition were both independently related to being 'more frail', with ORs (95% CI) of 8.1 [3.5-18.8] and 3.1 [1.7-5.5] respectively. This association was driven by functional decline (ADL, IADL and mobility) and depression (GDS), but not by cognitive impairment (MMSE). None of the micronutrient plasma concentrations were related to frailty. CONCLUSION In geriatric outpatients, malnutrition is independently related to having ≥3 frailty characteristics. Assessing nutritional status could prove usefulness in early clinical detection and prevention of frailty.
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Affiliation(s)
- M Kurkcu
- Department of Internal Medicine, Section Geriatric Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - R I Meijer
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - S Lonterman
- Department of Psychiatry, GGZ-Centraal, MC Zuiderzee, Lelystad, The Netherlands
| | - M Muller
- Department of Internal Medicine, Section Geriatric Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M A E de van der Schueren
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
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Moreira BDS, Sampaio RF, Diz JBM, Bastone ADC, Ferriolli E, Neri AL, Lourenço RA, Dias RC, Kirkwood RN. Factors associated with fear of falling in community-dwelling older adults with and without diabetes mellitus: Findings from the Frailty in Brazilian Older People Study (FIBRA-BR). Exp Gerontol 2017; 89:103-111. [DOI: 10.1016/j.exger.2017.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/23/2016] [Accepted: 01/02/2017] [Indexed: 11/29/2022]
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Verlaan S, Ligthart-Melis GC, Wijers SLJ, Cederholm T, Maier AB, de van der Schueren MAE. High Prevalence of Physical Frailty Among Community-Dwelling Malnourished Older Adults-A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2017; 18:374-382. [PMID: 28238676 DOI: 10.1016/j.jamda.2016.12.074] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/23/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Malnutrition and frailty are two geriatric syndromes that significantly affect independent living and health in community-dwelling older adults. Although the pathophysiology of malnutrition and physical frailty share common pathways, it is unknown to what extent these syndromes overlap and how they relate to each other. METHODS A systematic review was performed resulting in a selection of 28 studies that assessed both malnutrition and frailty in community-dwelling older adults. Furthermore, a meta-analysis was performed on 10 studies that used Mini- Nutritional Assessment and the Fried frailty phenotype to estimate the prevalence of malnutrition within physical frailty and vice versa. RESULTS In the systematic review, 25 of the 28 studies used the Mini-Nutritional Assessment (long or short form) for malnutrition screening. For frailty assessment, 23 of the 28 studies focused on the physical frailty phenotype, of which 19 followed the original Fried phenotype. Fifteen studies analyzed the association between malnutrition and frailty, which was significant in 12 of these. The meta-analysis included 10 studies with a total of 5447 older adults. In this pooled population of community-dwelling older adults [mean (standard deviation) age: 77.2 (6.7) years], 2.3% was characterized as malnourished and 19.1% as physically frail. The prevalence of malnutrition was significantly associated with the prevalence of physical frailty (P < .0001). However, the syndromes were not interchangeable: 68% of the malnourished older adults was physically frail, whereas only 8.4% of the physical frail population was malnourished. CONCLUSIONS The systematic review and meta-analysis revealed that malnutrition and physical frailty in community-dwelling older adults are related, but not interchangeable geriatric syndromes. Two out of 3 malnourished older adults were physically frail, whereas close to 10% of the physically frail older adults was identified as malnourished.
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Affiliation(s)
- Sjors Verlaan
- Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands; Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands.
| | - Gerdien C Ligthart-Melis
- Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands; Department of Health and Kinesiology, Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, TX
| | - Sander L J Wijers
- Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Department of Geriatric Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Andrea B Maier
- Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Department of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University, Amsterdam, The Netherlands
| | - Marian A E de van der Schueren
- Department of Internal Medicine, Section Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition, Sports and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Morley JE, Little MO, Berg-Weger M. Rapid Geriatric Assessment: A Tool for Primary Care Physicians. J Am Med Dir Assoc 2017; 18:195-199. [PMID: 28108203 DOI: 10.1016/j.jamda.2016.11.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 01/16/2023]
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO.
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - Marla Berg-Weger
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Reinders I, Visser M, Schaap L. Body weight and body composition in old age and their relationship with frailty. Curr Opin Clin Nutr Metab Care 2017; 20:11-15. [PMID: 27749713 DOI: 10.1097/mco.0000000000000332] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Aging is associated with various changes in body composition, including changes in weight, loss of muscle mass, and increase in fat mass. This article describes the role of body weight and body composition, and their changes, in the risk of frailty in old age. RECENT FINDINGS Based on current literature, observational studies on obesity and high waist circumference show most convincing results for an association with frailty. The independent role of muscle mass and muscle fat infiltration remains unclear, mainly due to a lack of studies and a lack of accurate measurement of body composition by computed tomography or MRI. Weight loss and exercise training intervention studies can be of benefit to frail older adults. SUMMARY Obesity and high waist circumference may be important determinants of frailty in old age, whereas the role of muscle mass and muscle fat infiltration is still unclear. More prospective studies that will specifically focus on frailty as an outcome measure are needed to identify specific body composition components as potential targets for the prevention of frailty in old age.
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Affiliation(s)
- Ilse Reinders
- aDepartment of Nutrition and Dietetics, Internal Medicine, VU University Medical Center bDepartment of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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Morley JE. The Future of Long-Term Care. J Am Med Dir Assoc 2017; 18:1-7. [DOI: 10.1016/j.jamda.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023]
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Vitorino LM, Teixeira CAB, Boas ELV, Pereira RL, Santos NOD, Rozendo CA. Fear of falling in older adults living at home: associated factors. Rev Esc Enferm USP 2017; 51:e03215. [DOI: 10.1590/s1980-220x2016223703215] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 01/05/2017] [Indexed: 11/22/2022] Open
Abstract
Abstract OBJECTIVE To identify the factors associated with the fear of falling in the older adultliving at home. METHOD Cross-sectional study with probabilistic sampling of older adultenrolled in two Family Health Strategies (FHS). The fear of falling was measured by the Brazilian version of the Falls Efficacy Scale-International and by a household questionnairethat contained the explanatory variables. Multiple Linear Regression using the stepwise selection technique and the Generalized Linear Models were used in the statistical analyses. RESULTS A total of170 older adultsparticipated in the research, 85 from each FHS. The majority (57.1%) aged between 60 and 69; 67.6% were female; 46.1% fell once in the last year. The majority of the older adults(66.5%) had highfear of falling. In the final multiple linear regression model, it was identified that a higher number of previous falls, female gender, older age, and worse health self-assessment explained 37% of the fear of falling among the older adult. CONCLUSION The findings reinforce the need to assess the fear of falling among the older adultliving at home, in conjunction with the development and use ofstrategies based on modifiable factors by professionalsto reduce falls and improve health status, which may contribute to the reduction of the fear of falling among the older adult.
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Morley JE. Frailty and sarcopenia in elderly. Wien Klin Wochenschr 2016; 128:439-445. [PMID: 27670855 DOI: 10.1007/s00508-016-1087-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/23/2016] [Indexed: 12/18/2022]
Abstract
Frailty is a pre-disability syndrome where an older person can be identified as being at risk when exposed to stressors associated with high risk for disability or needing to be hospitalized. Two major frailty definitions exist. The physical phenotype of frailty and the multiple deficit model. A simple frailty screening tool-FRAIL-has been validated. Treatment of frailty involves resistance exercise, optimization of nutrition, and treatment of fatigue (sleep apnea, depression), treatable causes of weight loss and adjustment of polypharmacy. Sarcopenia (decline in function with low muscle mass) is a major cause of frailty. A simple sarcopenia screening tool-SARC-F-has been validated. The multiple causes of sarcopenia are reviewed. Optimal treatment is resistance exercise, leucine-enriched essential amino acids and vitamin D replacement.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, 63104, St. Louis, MO, USA.
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Morley JE. Aging Successfully: The Key to Aging in Place. J Am Med Dir Assoc 2015; 16:1005-7. [DOI: 10.1016/j.jamda.2015.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/23/2015] [Indexed: 12/16/2022]
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