Early physical rehabilitation effectiveness in frail older patients hospitalized for community-acquired pneumonia: analysis of a nationwide database in Japan

Inflammatory parameters mediates the relationship between dietary index for gut microbiota and frailty in middle-aged and older adults in the United States: findings from a large-scale population-based study

Background

Frailty is a prevalent geriatric syndrome marked by diminished physiological reserves and heightened vulnerability to stressors, leading to adverse health outcomes and imposing significant economic burdens on healthcare systems.

Methods

This study investigates the relationship between the Dietary Index for Gut Microbiota (DI-GM) and the risk of frailty in middle-aged and older adults, using data from the National Health and Nutrition Examination Survey (NHANES) collected from 2007 to 2018. Weighted logistic regression, subgroup analysis, and restricted cubic splines (RCS) were performed to evaluate the relationship between DI-GM and frailty risk. Additionally, a mediation analysis was conducted to investigate the influence of relevant inflammatory parameters from complete blood count, including leukocyte count, neutrophil count, the neutrophil to lymphocyte ratio (NLR), and the systemic inflammatory response index (SIRI), to elucidate how DI-GM may influence the onset and progression of frailty.

Results

In this cross-sectional analysis of 8,695 participants with a mean age of 65.56 years, 3,173 individuals were classified as frail. After adjusting for all covariates, a significant inverse relationship was observed between DI-GM and the risk of frailty. Quartile analysis revealed that participants in the highest quartile of DI-GM had significantly lower odds of frailty compared to those in the lowest quartile (OR: 0.80, 95% CI: 0.65-0.99, p = 0.04). Trend analyses across all models demonstrated a consistent inverse relationship between higher DI-GM quartiles and frailty odds (p < 0.0001 for the crude model; p = 0.001 for Model 1; p = 0.04 for Model 2). Subgroup analyses confirmed the stability of the impact of DI-GM on frailty risk across various subgroups. RCS showed that the risk of frailty decreased linearly with increasing DI-GM levels. Mediation analysis indicated significant effects for leukocyte count, neutrophil count, NLR, and SIRI, with mediation proportions of 5.7, 7.9, 4.4, and 5.5%, respectively (all p < 0.001).

Conclusion

The levels of DI-GM are inversely associated with the risk of frailty, with part of this association mediated by inflammatory parameters.

Barriers to and facilitators of rehabilitation according to socio-economic status, after acute respiratory distress syndrome due to COVID-19: A qualitative study in the RECOVIDS cohort

BACKGROUND

The COVID-19 pandemic may have compounded social disparities in access to healthcare, with possible deleterious consequences on the functional prognosis of patients after a stay in the intensive care unit (ICU). In the previous RECOVIDS study, we reported that despite comparable pulmonary sequelae and similar access to rehabilitation, socio-economically "vulnerable" patients had lower quality of life at 6 months after an ICU stay. We aimed to describe the barriers to, and facilitators of participation in rehabilitation, among patients from the RECOVIDS study, regardless of their socio-economic situation.

METHODS

Qualitative study using semi-structured interviews with adult patients admitted to ICU for PCR-proven SARS-CoV-2 infection, and who had acute respiratory distress syndrome (ARDS) or had received high flow nasal oxygen. In addition, patients had to have been living at home for the month prior to the interview and had to be proficient in French. Eligible patients were randomly selected, aiming to select the same number of socially deprived and non-socially-deprived patients. Interviews were transcribed for thematic analysis.

RESULTS

In total, 31 interviews were performed from 10/2021 to 01/2022; 16 with socially deprived, and 15 with non-deprived participants. Average age was 65.2 (±11.6) years. Four themes emerged from the analysis of the interviews, namely: (1) the impact of the patient's professional and socio-economic situation; (2) the feeling that age and socio-economic situation influence access to rehabilitation; (3) a perception that the healthcare system was saturated, and that inequalities exist in access to rehabilitation resources; (4) perception of previous own health and expectations of post-resuscitation health status.

CONCLUSION

A precarious socio-economic situation has a substantial impact on access to rehabilitation after ICU admission for ARDS caused by COVID-19. It represents a barrier to rehabilitation through the combined action of various social determinants that deserve to be detected early, in order to take appropriate action to ensure that the most socially vulnerable individuals can benefit from access to rehabilitation.

Hospitalization-associated disability prediction using Hospital Frailty Risk Score in older patients undergoing pancreatectomy

PURPOSE

Frailty and hospitalization-associated disabilities (HAD) are geriatric conditions that should be managed in older patients undergoing pancreatectomy. The Hospital Frailty Risk Score (HFRS) can evaluate frailty based on medical records and could predict postoperative activities of daily living (ADL) decline. This study aimed to investigate whether HFRS affects the postoperative incidence of HAD in older patients who underwent pancreatectomy.

METHODS

This retrospective, observational study used data from a nationwide hospital-based database. We included consecutive patients aged ≥ 65 years who were diagnosed with pancreatic cancer (International Statistical Classification of Diseases, 10th revision code C25) and underwent curative pancreatectomy between April 2014 and August 2020. We evaluated preoperative frailty using HFRS. The primary outcome was HAD following pancreatectomy. Logistic regression analysis was performed for analyzing the impact of frailty on HAD following pancreatectomy.

RESULTS

We included 671 patients for the analysis (mean age 74.3 ± 5.6, male 54.8%). The prevalence of intermediate and high risk of frailty with HFRS ≥ 5 was 2.7%. The incidence of HAD was significantly higher in the intermediate- and high-risk groups compared to that in the low-risk group (33.3% vs. 8.4%, p < 0.001). Logistic regression analysis demonstrated that intermediate and high risks of frailty increased the likelihood of HAD (odds ratio, 3.55; 95% confidence interval: 1.12-11.2).

CONCLUSIONS

The risk of frailty evaluated using the HFRS increased the likelihood of developing HAD in older patients undergoing pancreatectomy. Future research on effective perioperative interventions for preventing postoperative HAD and enhancing postoperative ADL recovery is warranted.