1
|
Fang PP, Zhang HW, Hao XX, Shang ZX, Li J, Liu XS. Intraoperative electroencephalogram features related to frailty in older patients: an exploratory prospective observational study. J Clin Monit Comput 2024; 38:613-621. [PMID: 38252194 DOI: 10.1007/s10877-024-01126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
Frailty is an independent risk factor for the increased incidence of postoperative delirium (POD). To date, the effect of frailty on intraoperative electroencephalogram (EEG) changes remains unexplored. The present study, an exploratory analysis of a prospective cohort study, aimed to investigate the differences in EEG characteristics between frail and robust patients. This prospective observational study was conducted between December 2020 and November 2021. The preoperative frailty status was assessed using the FRAIL scale. The patients' baseline (before anesthesia) and intraoperative EEG data were collected using a brain function monitor. Finally, 20 robust and 26 frail older patients scheduled for elective spinal surgery or transurethral prostatectomy under propofol-based general anesthesia were included in the final analysis. Baseline and intraoperative EEG spectrogram and power spectra were compared between the frail and robust groups. No differences were observed in baseline EEG between the frail and robust groups. When the intraoperative EEG spectral parameters were compared, the alpha peak frequency (10.56 ± 0.49 vs. 10.14 ± 0.36 Hz, P = 0.002) and alpha peak, delta, theta, alpha, and beta powers were lower in the frail group. After adjusting for age, Charlson Comorbidity Index (CCI), and mini-mental state examination (MMSE) score, the FRAIL score was still negatively associated with total, delta, theta, alpha, and beta powers. Frail patients had reduced EEG (0-30 Hz) power after the induction of propofol-based general anesthesia. After adjusting for age, CCI, and MMSE score, frail patients still showed evidence of reduced δ, θ, α, and β power.
Collapse
Affiliation(s)
- Pan-Pan Fang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230022, P.R. China
| | - Hui-Wen Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230022, P.R. China
| | - Xi-Xi Hao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230022, P.R. China
| | - Zi-Xiang Shang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230022, P.R. China
| | - Jun Li
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230022, P.R. China
| | - Xue-Sheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230022, P.R. China.
| |
Collapse
|
2
|
Kempton H, Hall R, Hungerford SL, Hayward CS, Muller DWM. Frailty and transcatheter valve intervention: A narrative review. Catheter Cardiovasc Interv 2024. [PMID: 38819861 DOI: 10.1002/ccd.31076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/27/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024]
Abstract
Frailty is a common clinical syndrome that portends poor peri-procedural outcomes and increased mortality following transcatheter valve interventions. We reviewed frailty assessment tools in transcatheter intervention cohorts to recommend a pathway for preprocedural frailty assessment in patients referred for transcatheter valve procedures, and evaluated current evidence for frailty interventions and their efficacy in transcatheter intervention. We recommend the use of a frailty screening instrument to identify patients as frail, with subsequent referral for comprehensive geriatric assessment in these patients, to assist in selecting appropriate patients and then optimizing them for transcatheter valve interventions. Interventions to reduce preprocedural frailty are not well defined, however, data from limited cohort studies support exercise-based interventions to increase functional capacity and reduce frailty in parallel with preprocedural medical optimization.
Collapse
Affiliation(s)
- Hannah Kempton
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Rachael Hall
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sara L Hungerford
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher S Hayward
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - David W M Muller
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Li W, Wu Z, Liao X, Geng D, Yang J, Dai M, Talipti M. Nutritional management interventions and multi-dimensional outcomes in frail and pre-frail older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 125:105480. [PMID: 38776700 DOI: 10.1016/j.archger.2024.105480] [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: 01/26/2024] [Revised: 04/27/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Frailty, a prevalent geriatric syndrome, presents challenges exacerbated by malnutrition. Nutritional Management Interventions (NMIs) offer hope in frailty reversal, necessitating exploration of their multi-dimensional outcomes. OBJECTIVES Assess NMIs' impact on frail and pre-frail older adults across diverse outcomes. METHODS A systematic review and meta-analysis of 13 studies (2012-2023) evaluated NMIs' effects on physical, dietary, psychological, and frailty aspects. Literature quality was assessed, and data analyzed with Review Manager 5.3. RESULTS A total of 13 studies involving participants were included in the analysis. Participants numbered 968, with the intervention group averaging 77.05±0.77 years and the control group 78.75±0.8 years. Compared to control groups,NMIs significantly increased body weight (SMD = 0.26, P = 0.03) and improved gait speed (SMD = 0.18, P = 0.03). Protein intake showed significance for interventions≤12 weeks (SMD = 1.04, P < 0.001). No significant differences in energy intake (SMD = 0.20, P = 0.60), but >12 weeks NMIs reduced energy intake (SMD = -0.73, P = 0.006). No significant differences in depressive symptoms, frailty scores, BMI, TUG, Handgrip Strength, or SPPB. CONCLUSION This meta-analysis underscores NMIs' potential benefits for frail and pre-frail older adults. Personalized, multidimensional interventions are recommended despite study limitations, emphasizing extended interventions and diverse assessments for holistic care.
Collapse
Affiliation(s)
- Weina Li
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China
| | | | - Xiaoqin Liao
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China.
| | - Dandan Geng
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China
| | - Jiechao Yang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China
| | - Mengqiao Dai
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China
| | - Muksar Talipti
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China
| |
Collapse
|
4
|
Cagua Ardila YA, Portilla Díaz M, Martínez-Torres J. [Normative values for handgrip strength in Colombian older adults: Estimation by quantile regression]. Semergen 2024; 50:102123. [PMID: 37939524 DOI: 10.1016/j.semerg.2023.102123] [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: 08/18/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Handgrip strength is a robust indicator of the biological health of elderly. OBJECTIVE The purpose of this study is twofold: 1) estimate the normative values of absolute and relative handgrip strength, specific to adults over 60 years of age in Colombia, using quantile regression models: 2) compare the normative values of absolute and relative handgrip strength in Colombian older adults with those from different countries. METHODS A cross-sectional analysis of a sample of 5377 older adults. Handgrip strength was evaluated with a TKK 5101 digital dynamometer (Takei Scientific Instruments Co., Ltd., Tokyo, Japan). Relative handgrip strength was estimated by dividing by weight in kilograms. The absolute and relative handgrip strength normative values were estimated through quantile regression models for the percentiles P5, P10, P25, P50, P75, P90 and P95, they were developed independently for each sex; all analyzes were adjusted for the expansion factor. RESULTS Absolute handgrip strength values were considerably higher in men (P50 60-64 years = 32.0 kg, P50 >85 years = 18.0 kg) compared to women (P50 60-65 years = 19.0 kg; P50 >85 years = 12.0 kg), in all age groups. Additionally, as age increases in both sexes, there is a decrease in the values of absolute and relative manual grip strength. CONCLUSIONS The estimated normative values in the Colombian population were generally lower than those reported in other studies around the world. These results could be related with methodologies used variability to evaluate handgrip strength and the estimation methods, which could influence the discrepancies between the different reports.
Collapse
Affiliation(s)
- Y A Cagua Ardila
- Universidad de los Llanos. Escuela de Cuidado. Programa de Fisioterapia, Villavicencio, Colombia
| | - M Portilla Díaz
- Universidad de los Llanos. Escuela de Cuidado. Programa de Fisioterapia, Villavicencio, Colombia
| | - J Martínez-Torres
- Universidad de los Llanos. Escuela de Cuidado. Programa de Fisioterapia, Villavicencio, Colombia.
| |
Collapse
|
5
|
Nari F, Park EC, Nam CM, Jang SI. Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea. Sci Rep 2023; 13:21203. [PMID: 38040759 PMCID: PMC10692079 DOI: 10.1038/s41598-023-48403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/26/2023] [Indexed: 12/03/2023] Open
Abstract
Frailty has become increasingly relevant in a rapidly aging society, highlighting the need for its accurate identification and exploring associated clinical outcomes. Using a multidimensional framework to estimate frailty in a sample of community dwelling older adults, its effect on mortality, incurred healthcare costs and utilization were investigated. We obtained data from the 2008-2018 Korean Longitudinal Study of Aging (KLoSA). After excluding individuals aged < 65 years and those with missing data, a total of 3578 participants were included in our study. Cox proportional hazard analysis was conducted to investigate the impact of frailty on all-cause mortality by generating hazard ratios (HRs) and population attributable risks (PARs). Healthcare utilization and out-of-pocket costs incurred by frailty were examined using the Generalized Linear Mixed Model (GLMM). Subgroup analyses were conducted according to frailty components. Among 3578 older adults, 1052 individuals died during a 10-year follow up period. Compared to the low risk frailty group, the moderate risk group (HR: 1.52, 95% CI:1.37-1.69) and severe risk group (HR: 3.10, 95% CI: 2.55-3.77) had higher risks for all-cause mortality. 27.4% (95% CI: 19.0-35.3%) of all-cause mortality was attributable to frailty, and the PARs ranged from 0.5 to 22.6% for individual frailty components. Increasing frailty levels incurred higher total healthcare costs and cost per utilization, including inpatient and outpatient costs. Frailty also increased likelihood of inpatient use, longer length of stay and more frequent outpatient visits. Among the frailty components, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) in particular were linked to elevated mortality, higher incurred healthcare costs and utilization. Frailty-tailored interventions are of utmost relevance to policy makers and primary caregivers as frailty threatens the ability to maintain independent living and increases risk of detrimental outcomes such as mortality and increased utilization and out-of-pocket costs of healthcare in older adults.
Collapse
Affiliation(s)
- Fatima Nari
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-to, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Chung- Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-to, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-to, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
6
|
Calciolari S, Luini C. Effects of the bio-psycho-social frailty dimensions on healthcare utilisation among elderly in Europe: A cross-country longitudinal analysis. Soc Sci Med 2023; 339:116352. [PMID: 37952266 DOI: 10.1016/j.socscimed.2023.116352] [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: 03/27/2023] [Revised: 09/27/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023]
Abstract
Frailty represents an emerging challenge and has major implications for clinical practice, public health, and the sustainability of health systems. It is a geriatric condition, related to but distinct from disability and multimorbidity and characterized by a diminished physiological reserve of multiple organs. Despite limited consensus and evidence, it has been argued that cognitive and social aspects influence the condition. Therefore, we aim to provide evidence on the importance of taking a broader approach in defining frailty, by investigating the role of its physical, social, and psychological subdomains to predict healthcare utilisation in elderly Europeans. The study is based on the Survey of Health, Ageing and Retirement in Europe (SHARE), and uses 185,169 total observations from 12 European countries included in wave 4, 5, 6, and 8. The analysis investigates the influence of the physical frailty index (a proxy of the Frailty Phenotype definition), psychological and social frailty indexes (built to proxy the Tilburg Frailty Index) on the likelihood of hospitalisation and the number of doctor visits. We addressed missing values due to item non-response with fully conditional specification multivariate imputation and exploited the longitudinal structure of the data to control for time-fixed unobserved characteristics. In addition, our two multivariate models included regressors to correct for demand side factors (health status, socio-economic status, and behavioral risk) as well as for country-specific characteristics. Physical and psychological frailty positively influence the likelihood of hospitalisation (OR = 1.90 and OR = 1.31, respectively) and the number of doctor visits (IRR = 1.30 and IRR = 1.07), while social frailty reduces the two types of health services utilisation (OR = 0.53 and IRR = 0.90). The three frailty dimensions are relevant risk stratification factors in elderly Europeans, and health policies should focus more on the psycho-social aspects of this condition, as a strategy to both contain expenditures and avoid potential healthcare inequalities.
Collapse
Affiliation(s)
- Stefano Calciolari
- Università degli Studi di Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy; Università della Svizzera Italiana, Via G. Buffi 13, 6900, Lugano, Switzerland.
| | - Cecilia Luini
- Università della Svizzera Italiana, Via G. Buffi 13, 6900, Lugano, Switzerland
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Jolink C, Huijsman A, Dreschler WA, de Wolf MJF, Ebbens FA, van Spronsen E. Surgery for chronic otitis media in the elderly. Am J Otolaryngol 2023; 44:103698. [PMID: 36470009 DOI: 10.1016/j.amjoto.2022.103698] [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: 06/21/2022] [Revised: 10/07/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of surgery for chronic otitis media in elderly patients, compared to younger adults and children. METHODS Patients with chronic otitis media with and without cholesteatoma formation were assessed. Patients aged 65 years and older were included and compared to adults aged 35-55 and to children. Effectiveness was evaluated by comparing postoperative dry and safe ears in ages groups, safety was assessed by comparing postoperative adverse events. RESULTS Postoperative success and adverse events did not differ between age groups. Children had more recurrent cholesteatoma than adults. No difference in recurrent cholesteatoma between adults was observed. CONCLUSION Surgical treatment for chronic otitis media with and without cholesteatoma in elderly patients is safe and effective. Age has no influence on postoperative adverse events and treatment outcomes in chronic otitis media. Cholesteatoma recurrence was not different between adult age groups.
Collapse
Affiliation(s)
- Casper Jolink
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Ayla Huijsman
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Wouter A Dreschler
- Department of Clinical and Experimental Audiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten J F de Wolf
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Fenna A Ebbens
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik van Spronsen
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
9
|
De Luca V, Femminella GD, Leonardini L, Patumi L, Palummeri E, Roba I, Aronni W, Toccoli S, Sforzin S, Denisi F, Basso AM, Ruatta M, Obbia P, Rizzo A, Borgioli M, Eccher C, Farina R, Conforti D, Mercurio L, Salvatore E, Gentile M, Bocchino M, Sanduzzi Zamparelli A, Viceconte G, Gentile I, Ruosi C, Ferrara N, Fabbrocini G, Colao A, Triassi M, Iaccarino G, Liotta G, Illario M. Digital Health Service for Identification of Frailty Risk Factors in Community-Dwelling Older Adults: The SUNFRAIL+ Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3861. [PMID: 36900872 PMCID: PMC10001419 DOI: 10.3390/ijerph20053861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
This article reports the study protocol of a nationwide multicentric study in seven Italian regions aimed at assessing the effectiveness of a digitally supported approach for the early screening of frailty risk factors in community-dwelling older adults. SUNFRAIL+ is a prospective observational cohort study aimed at carrying out a multidimensional assessment of community-dwelling older adults through an IT platform, which allows to connect the items of the SUNFRAIL frailty assessment tool with a cascading multidimensional in-depth assessment of the bio-psycho-social domains of frailty. Seven centers in seven Italian regions will administer the SUNFRAIL questionnaire to 100 older adults. According to the answers provided by older adults, they will be subjected to one or more validated in-depth scale tests in order to perform further diagnostic or dimensional evaluations. The study aims to contribute to the implementation and validation of a multiprofessional and multistakeholder service model for the screening of frailty in community-dwelling older adult population.
Collapse
Affiliation(s)
- Vincenzo De Luca
- Dipartimento di Sanità Pubblica, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Grazia Daniela Femminella
- Dipartimento di Scienze Mediche Traslazionali, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Lisa Leonardini
- Programma Mattone Internazionale Salute, Azienda ULSS 4 Veneto Orientale, 30027 San Donà di Piave, Italy
| | - Lola Patumi
- Programma Mattone Internazionale Salute, Azienda ULSS 4 Veneto Orientale, 30027 San Donà di Piave, Italy
| | - Ernesto Palummeri
- A.li.sa. (Azienda Ligure Sanitaria), Regione Liguria, 16121 Genova, Italy
| | - Isabella Roba
- A.li.sa. (Azienda Ligure Sanitaria), Regione Liguria, 16121 Genova, Italy
| | - Walter Aronni
- Dipartimento di Cure Primarie e Attività Distrettuali, Azienda Sociosanitaria Ligure 4, 16043 Chiavari, Italy
| | - Stefano Toccoli
- Dipartimento Cure Primarie, Azienda Provinciale per i Servizi Sanitari di Trento, 38123 Trento, Italy
| | - Simona Sforzin
- Dipartimento Cure Primarie, Azienda Provinciale per i Servizi Sanitari di Trento, 38123 Trento, Italy
| | | | - Anna Maddalena Basso
- Direzione Professioni Sanitarie, Azienda Sanitaria Locale Cuneo 1, 12100 Cuneo, Italy
| | - Manuela Ruatta
- Rete Della Cronicità e Fragilità, Azienda Sanitaria Locale Cuneo 1, 12100 Cuneo, Italy
| | - Paola Obbia
- Dipartimento di Scienze Della Sanità Pubblica e Pediatriche, Università Degli Studi di Torino, 10126 Torino, Italy
| | - Alessio Rizzo
- Settore Sistemi Organizzativi e Risorse Umane Della Direzione Sanità e Welfare, Regione Piemonte, 10144 Torino, Italy
| | - Moira Borgioli
- Unità Operativa Complessa Progettazione, Sviluppo, Formazione e Ricerca, Azienda Unità Sanitaria Locale Nord-Ovest, 56121 Pisa, Italy
| | - Claudio Eccher
- eHealth Unit, Fondazione Bruno Kessler, 38123 Trento, Italy
| | - Riccardo Farina
- Dipartimento Salute e Politiche Sociali, Provincia Autonoma di Trento, 38122 Trento, Italy
| | - Diego Conforti
- Dipartimento Salute e Politiche Sociali, Provincia Autonoma di Trento, 38122 Trento, Italy
| | - Lorenzo Mercurio
- Dipartimento di Sanità Pubblica, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Elena Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maurizio Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Marialuisa Bocchino
- Dipartimento di Medicina Clinica e Chirurgia, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | | | - Giulio Viceconte
- Dipartimento di Medicina Clinica e Chirurgia, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Carlo Ruosi
- Dipartimento di Sanità Pubblica, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Nicola Ferrara
- Dipartimento di Scienze Mediche Traslazionali, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Gabriella Fabbrocini
- Dipartimento di Sanità Pubblica, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maria Triassi
- Dipartimento di Sanità Pubblica, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Guido Iaccarino
- Dipartimento di Scienze Biomediche Avanzate, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Giuseppe Liotta
- Dipartimento di Biomedicina e Prevenzione, Università Degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Maddalena Illario
- Dipartimento di Sanità Pubblica, Università Degli Studi di Napoli Federico II, 80131 Napoli, Italy
| |
Collapse
|
10
|
Huynh TQH, Pham TLA, Vo VT, Than HNT, Nguyen TV. Frailty and Associated Factors among the Elderly in Vietnam: A Cross-Sectional Study. Geriatrics (Basel) 2022; 7:geriatrics7040085. [PMID: 36005261 PMCID: PMC9407721 DOI: 10.3390/geriatrics7040085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Frailty syndrome is common among older people and can lead to various adverse consequences such as falls, cognitive decline, disability, dependent living, increased mortality, excessive drug use, and prolonged hospital stays. OBJECTIVES This research determined the prevalence of frailty and associated factors among older adults in Vietnam. METHODS A cross-sectional study was conducted on 584 older adults across five Ho Chi Minh City wards from November 2020 to January 2021. Based on the modified Fried frailty scale, the participants were divided into three categories: robust, pre-frail, and frail. A chi-square test (or Fisher's test) examined the relationship between frailty categories and other variables. Multivariable logistic regression used variates with a cut-off of p ≤ 0.05 in the univariate analysis. RESULTS The prevalence rates of frailty and pre-frailty were 19% and 64%, respectively. The most common frailty component was weak grip strength (63.9%), followed by slowness (36.1%), weight loss (21.6%), low physical activity (19.5%), and exhaustion (18.5%). In addition, the prevalence of frailty was significantly associated with age, BMI levels, living alone, and sarcopenia. CONCLUSION The community's prevalence of frailty among older adults is high. Frailty can lead to many adverse consequences for the elderly. As there were some modifiable factors associated with frailty, it should be assessed in older people through community-based healthcare programs for early diagnosis and management.
Collapse
Affiliation(s)
- Trung Quoc Hieu Huynh
- Department of Graduate Training, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
- Correspondence: ; Tel.: +84-973-555-567
| | - Thi Lan Anh Pham
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Van Tam Vo
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Ha Ngoc The Than
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Tan Van Nguyen
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| |
Collapse
|
11
|
Akan S, Aktas G. Relationship between frailty, according to three frail scores, and clinical and laboratory parameters of the geriatric patients with type 2 Diabetes Mellitus. Rev Assoc Med Bras (1992) 2022; 68:1073-1077. [PMID: 36000603 PMCID: PMC9574998 DOI: 10.1590/1806-9282.20220271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/30/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: Type 2 diabetes mellitus is associated with significant morbidity and mortality. The term “frailty in the elderly” has become increasingly important with the increase of the elderly population, especially in diabetic subjects. Frailty is established by various scoring scales, such as Edmonton, Frail, and Prisma-7 scores. We aimed to evaluate the association between frailty and clinical and laboratory parameters of the geriatric type 2 diabetic patients. METHODS: Diabetic patients over 65 years of age who presented to outpatient internal medicine clinics of our institution between June 2020 and January 2021 were enrolled to the study. Edmonton, Frail, and Prisma-7 scores were administered to the subjects. Study parameters were compared between well-controlled and poorly controlled diabetic groups according to diabetes control level and between frail and non-frail groups, according to each frailty scores. RESULTS: Frailty according to Edmonton score was associated with increased risks of hospitalization (p=0.005) and mortality (p=0.02). Frailty according to frail score was associated with increased risk of hospitalization (p=0.009). Frailty according to Prisma-7 score was associated with increased risk of mortality (p<0.001). CONCLUSION: We suggest that Edmonton frail score is superior to Frail and Prisma-7 scores in determining frailty in geriatric patients with type 2 diabetes mellitus, since it is associated with both increased risk of hospitalization and mortality within 6 months.
Collapse
Affiliation(s)
- Seyma Akan
- Abant Izzet Baysal University Hospital, Department of Internal Medicine - Bolu, Turkey
| | - Gulali Aktas
- Abant Izzet Baysal University Hospital, Department of Internal Medicine - Bolu, Turkey
| |
Collapse
|
12
|
Bally ELS, van Grieken A, Ye L, Ferrando M, Fernández-Salido M, Dix R, Zanutto O, Gallucci M, Vasiljev V, Carroll A, Darley A, Gil-Salmerón A, Ortet S, Rentoumis T, Kavoulis N, Mayora-Ibarra O, Karanasiou N, Koutalieris G, Hazelzet JA, Roozenbeek B, Dippel DWJ, Raat H. 'Value-based methodology for person-centred, integrated care supported by Information and Communication Technologies' (ValueCare) for older people in Europe: study protocol for a pre-post controlled trial. BMC Geriatr 2022; 22:680. [PMID: 35978306 PMCID: PMC9386998 DOI: 10.1186/s12877-022-03333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Older people receive care from multiple providers which often results in a lack of coordination. The Information and Communication Technology (ICT) enabled value-based methodology for integrated care (ValueCare) project aims to develop and implement efficient outcome-based, integrated health and social care for older people with multimorbidity, and/or frailty, and/or mild to moderate cognitive impairment in seven sites (Athens, Greece; Coimbra, Portugal; Cork/Kerry, Ireland; Rijeka, Croatia; Rotterdam, the Netherlands; Treviso, Italy; and Valencia, Spain). We will evaluate the implementation and the outcomes of the ValueCare approach. This paper presents the study protocol of the ValueCare project; a protocol for a pre-post controlled study in seven large-scale sites in Europe over the period between 2021 and 2023. Methods A pre-post controlled study design including three time points (baseline, post-intervention after 12 months, and follow-up after 18 months) and two groups (intervention and control group) will be utilised. In each site, (net) 240 older people (120 in the intervention group and 120 in the control group), 50–70 informal caregivers (e.g. relatives, friends), and 30–40 health and social care practitioners will be invited to participate and provide informed consent. Self-reported outcomes will be measured in multiple domains; for older people: health, wellbeing, quality of life, lifestyle behaviour, and health and social care use; for informal caregivers and health and social care practitioners: wellbeing, perceived burden and (job) satisfaction. In addition, implementation outcomes will be measured in terms of acceptability, appropriateness, feasibility, fidelity, and costs. To evaluate differences in outcomes between the intervention and control group (multilevel) logistic and linear regression analyses will be used. Qualitative analysis will be performed on the focus group data. Discussion This study will provide new insights into the feasibility and effectiveness of a value-based methodology for integrated care supported by ICT for older people, their informal caregivers, and health and social care practitioners in seven different European settings. Trial registration ISRCTN registry number is 25089186. Date of trial registration is 16/11/2021.
Collapse
Affiliation(s)
- E L S Bally
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A van Grieken
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L Ye
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Ferrando
- R&D+I Consultancy, Kveloce I+D+i (Senior Europa SL), Valencia, Spain
| | - M Fernández-Salido
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - R Dix
- Fundación de La Comunidad Valenciana Para La Promoción Estratégica, El Desarrollo Y La Innovación Urbana (Las Naves), Valencia, Spain
| | - O Zanutto
- European Project Office Department, Istituto Per Servizi Di Ricovero E Assistenza Agli Anziani (Institute for Hospitalization and Care for the Elderly), Treviso, Italy
| | - M Gallucci
- Local Health Authority N.2 Treviso, Centre for Cognitive Disease and Dementia, Treviso, Italy
| | - V Vasiljev
- Faculty of Medicine, Department of Social Medcine and Epidemiology, University of Rijeka, Rijeka, Croatia
| | - A Carroll
- School of Medicine, University College Dublin, Dublin, Ireland
| | - A Darley
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | - S Ortet
- Innovation Department, Cáritas Diocesana de Coimbra, Coimbra, Portugal
| | - T Rentoumis
- Alliance for Integrated Care, Athens, Greece
| | | | - O Mayora-Ibarra
- Center for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | | | | | - J A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Roozenbeek
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - D W J Dippel
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | | |
Collapse
|
13
|
Neighborhood resources associated with frailty trajectories over time among community-dwelling older adults in China. Health Place 2022; 74:102738. [DOI: 10.1016/j.healthplace.2021.102738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/18/2022]
|
14
|
Bastos RS, Sá LM, Velasco SRM, Teixeira DF, Paino LS, Vettore MV. Frailty and oral health-related quality of life in community-dwelling older adults: a cross-sectional study. Braz Oral Res 2021; 35:e139. [PMID: 34932668 DOI: 10.1590/1807-3107bor-2021.vol35.0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/14/2021] [Indexed: 12/26/2022] Open
Abstract
Poor oral health has been associated with frailty among older adults. However, limited evidence has been available on whether frailty can affect oral health-related quality of life (OHRQoL) in older adults. This study aimed to investigate the relationship between frailty and OHRQoL among community-dwelling older adults. A household-based cross-sectional study involving community-dwelling older adults aged 65 years and older was conducted in the city of Bauru, Brazil. Data on frailty status, sociodemographic characteristics, self-perceived dental care needs, and OHRQoL (OHIP-14) were collected through individual interviews. The use of and the need for total dental prostheses were assessed through clinical examinations. Logistic regression was used to determine whether frailty status and covariates were associated with OHRQoL prevalence measures (OHIP-14 total score ≥ 1 and OHIP-14 fairly/very often ≥ 1). The sample comprised 334 participants, among whom 58.7% and 41.3% were between 65-74 and 75-102 years old, respectively. The prevalence of moderate to severe frailty was 12.3%. Moderate to severe frailty (OR = 4.49; 95%CI 1.29-15.66), the need for lower dental prosthesis (OR = 2.20; 95%CI 1.27-3.81), and self-perceived dental care need (OR = 3.90; 95%CI 2.14-7.14) were associated with OHIP-14 total score ≥1. Moderate to severe frailty (OR = 2.95; 95%CI 1.33-6.55), being female (OR = 2.24; 95%CI 1.34-3.75), and self-perceived dental care need (OR = 4.80; 95%CI 2.86-8.03) were associated with OHIP-14 fairly/very often ≥1. Overall, our results showed that moderate to severe frailty was significantly associated with poor OHRQoL in community-dwelling older adults.
Collapse
Affiliation(s)
- Roosevelt Silva Bastos
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Pediatrics Dentistry, Orthodontics and Public Health, Bauru, SP, Brazil
| | - Leticia Marques Sá
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Pediatrics Dentistry, Orthodontics and Public Health, Bauru, SP, Brazil
| | | | - Debora Foger Teixeira
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Stomatology, Bauru, SP, Brazil
| | | | - Mario Vianna Vettore
- University of Agder - UiA, Department of Health and Nursing Sciences, Agder, Norway
| |
Collapse
|
15
|
Huang EY, Lam SC. Review of frailty measurement of older people: Evaluation of the conceptualization, included domains, psychometric properties, and applicability. Aging Med (Milton) 2021; 4:272-291. [PMID: 34964008 PMCID: PMC8711219 DOI: 10.1002/agm2.12177] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
The purposes of this review are to describe the existing research on frailty measurement of older people and to understand their characteristics, with a focus on conceptual definitions, psychometric properties, and diagnostic accuracies. We reviewed the published literature to explore if cross-cultural studies of different types of frailty measurements have been conducted and to determine their applicability in the community setting. Narrative review with limited electronic database search and cross reference searching of included studies was performed. Studies published after year 2001 were searched for using MEDLINE and CINAHL Plus databases with keywords. A total of 5144 search results were obtained, but only 42 frailty measurements were identified in 68 studies. For the type, three different measurements were indicated, namely, self-report instrument (n = 17), clinical observation assessment (n = 19), and mixed frailty assessment instrument (n = 6). Only 12 (29%) measurements examined reliability and validity. Nevertheless, over 35% did not perform any psychometric testing before applying. For diagnosis accuracies, 35 (83%) frailty measurements reported the cut-off value(s) for determining level of the frailty. However, the sensitivity (56%-89.5%) and specificity (52%-91.3%) varied. The applicability was also diverse and some frailty instruments should be only used in some specific population and mode of administration. This review provides an overview of three major types of frailty measurements used in different settings with different purposes. For estimating the prevalence of frailty of older people in a community, the self-report type may be appropriate. The psychometric properties of many reviewed instruments are reported insufficiently. The cut-off value(s) are usually suggested with diverse sensitivity and specificity. Self-report instruments, such as Groningen Frailty Indicator (GFI) and Tilburg Frailty Indicator (TFI), are the most extensively examined in terms of satisfactory psychometric properties. Thus, GFI and TFI, with the current evidence, are recommended to be used in the community setting for frailty screening tools.
Collapse
Affiliation(s)
- Emma Yun‐zhi Huang
- Department of Social WorkZhongshan PolytechnicZhongshan CityChina
- School of NursingThe Hong Kong Polytechnic UniversityKowloonHong Kong SAR
| | | |
Collapse
|
16
|
Salehi V, Hanson N, Smith D, McCloskey R, Jarrett P, Veitch B. Modeling and analyzing hospital to home transition processes of frail older adults using the functional resonance analysis method (FRAM). APPLIED ERGONOMICS 2021; 93:103392. [PMID: 33639319 DOI: 10.1016/j.apergo.2021.103392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/15/2021] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Abstract
The main purpose of this study was to model and analyze hospital to home transition processes of frail older adults in order to identify the challenges within this process. A multi-phase, multi-sited and mixed methods design was utilized, in which, Phase 1 included collecting semi-structured interviews and focus group data, and Phase 2 consisted of six patient/caregiver dyad prospective case studies. This study was conducted in three hospitals in three cities in a single province in Canada. The Functional Resonance Analysis Method (FRAM) was employed to model daily operations of the transition process. The perspectives of both healthcare providers and patients/caregivers were used to build the FRAM model. The transition model was then tested using a customized version of the FRAM. The six patient/caregiver cases were used in the process of testing the FRAM model. The results of building the FRAM model showed that five categories of functions contributed to the transition model, including admission, assessment, synthesis, decision-making, and readmission. The outcomes of using the customized version of the FRAM revealed challenges affecting the transition process including waitlists for geriatric units, team-based care, lack of a discharge planner, financial concerns, and follow-up plans. The findings of this study could assist managers and other decision makers to improve the transition processes of frail older adults by addressing these challenges. The FRAM method employed in this study can be applied widely to identify work practices that are more or less successful, so that procedures and practices can be adapted to nudge healthcare processes towards paths that will yield better outcomes.
Collapse
Affiliation(s)
- Vahid Salehi
- Faculty of Engineering and Applied Science, Memorial University of Newfoundland, St. John's, Canada.
| | - Natasha Hanson
- Research Services, Horizon Health Network, Saint John Regional Hospital, Saint John, Canada
| | - Doug Smith
- Faculty of Engineering and Applied Science, Memorial University of Newfoundland, St. John's, Canada
| | - Rose McCloskey
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, Canada
| | - Pamela Jarrett
- Department of Geriatric Medicine, Horizon Health Network, St. Joseph's Hospital, Saint John, Canada
| | - Brian Veitch
- Faculty of Engineering and Applied Science, Memorial University of Newfoundland, St. John's, Canada
| |
Collapse
|
17
|
Adja KYC, Lenzi J, Sezgin D, O'Caoimh R, Morini M, Damiani G, Buja A, Fantini MP. The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective. Front Public Health 2020; 8:599170. [PMID: 33282818 PMCID: PMC7689262 DOI: 10.3389/fpubh.2020.599170] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Across the world, life expectancy is increasing. However, the years of life gained do not always correspond to healthy life years, potentially leading to an increase in frailty. Given the extent of population aging, the association between frailty and age and the impact of frailty on adverse outcomes for older people, frailty is increasingly being recognized to be a significant public health concern. Early identification of the condition is important to help older adults regain function and to prevent the negative outcomes associated with the syndrome. Despite the importance of diagnosing frailty, there is no definitive evidence or consensus of whether screening should be routinely implemented. A broad range of screening and assessment instruments have been developed taking a biopsychosocial approach, characterizing frailty as a dynamic state resulting from deficits in any of the physical, psychological and social domains, which contribute to health. All these aspects of frailty should be identified and addressed using an integrated and holistic approach to care. To achieve this goal, public health and primary health care (PHC) need to become the fulcrum through which care is offered, not only to older people and those that are frail, but to all individuals, favoring a life-course and patient-centered approach centered around integrated, community-based care. Public health personnel should be trained to address frailty not merely from a clinical perspective, but also in a societal context. Interventions should be delivered in the individuals' environment and within their social networks. Furthermore, public health professionals should contribute to education and training on frailty at a community level, fostering community-based interventions to support older adults and their caregivers to prevent and manage frailty. The purpose of this paper is to offer an overview of the concept of frailty for a public health audience in order to raise awareness of the multidimensional aspects of frailty and on how these should be addressed using an integrated and holistic approach to care.
Collapse
Affiliation(s)
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Duygu Sezgin
- School of Nursing and Midwifery, College of Medicine Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Rónán O'Caoimh
- Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Research Facility Cork, University College Cork, Cork, Ireland
| | - Mara Morini
- Italian Scientific Society of Hygiene and Preventive Medicine - Primary Care Group, Bologna, Italy
| | - Gianfranco Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Buja
- Laboratory of Health Care Services and Health Promotion, Evaluation Unit of Hygiene and Public Health Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
18
|
Roller‐Wirnsberger R, Thurner B, Pucher C, Lindner S, Wirnsberger GH. The clinical and therapeutic challenge of treating older patients in clinical practice. Br J Clin Pharmacol 2020; 86:1904-1911. [PMID: 31321798 PMCID: PMC7495268 DOI: 10.1111/bcp.14074] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/18/2019] [Accepted: 07/12/2019] [Indexed: 01/08/2023] Open
Abstract
Due to the demographic shift complex care management of older multimorbid patients with changing functional capacities has become core clinical business for many stakeholders in western health care systems. It is the aim of the mini-review to summarise evidence to be translated into clinical practice for pharmacists and medical doctors and interested readers. The review is based upon a comprehensive literature review in PubMed and EMBASE from 2000 to 2018 and grey literature. Interprofessional exchange and discussion among stakeholders from geriatric medicine and the International Association for Pharmaceutical Technology during a meeting in Graz, Austria 2018, led to the narrowing of the review addressing complex care needs of geriatric patients. In this mini-review, attention is drawn to a comprehensive therapeutic goal setting according to evidence-based guidelines: clinical, disease-related care aspects, functional capacities, evaluated by comprehensive geriatric assessment, and patient's wishes and perspectives as main drivers for personalised complex care of geriatric patients.
Collapse
Affiliation(s)
| | - Bettina Thurner
- Department of Internal MedicineMedical University of GrazGrazAustria
| | - Christian Pucher
- Department of Internal MedicineMedical University of GrazGrazAustria
| | - Sonja Lindner
- Department of Internal MedicineMedical University of GrazGrazAustria
| | | |
Collapse
|
19
|
Bastone ADC, Ferriolli E, Pfrimer K, Moreira BDS, Diz JBM, Dias JMD, Dias RC. Energy Expenditure in Older Adults Who Are Frail: A Doubly Labeled Water Study. J Geriatr Phys Ther 2020; 42:E135-E141. [PMID: 28786908 DOI: 10.1519/jpt.0000000000000138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Frailty is a common and important geriatric syndrome, distinct from any single chronic disease, and an independent predictor of mortality. It is characterized by age-associated decline in physiological reserve and function across multiple systems, culminating in a vicious cycle of altered energy expenditure. The total energy expenditure (TEE) of an individual includes the resting metabolic rate (RMR), the thermic effect of feeding, and the energy expenditure in physical activity (PAEE). The investigation of the energy expenditure of older adults who are frail is essential for better understanding the syndrome. Therefore, we compared the RMR, the PAEE, the physical activity level (PAL), and the TEE of older adults who were frail with those who were not frail. METHODS A cross-sectional study was conducted with 26 community-dwelling older adults (66-86 years of age). Older adults in the frail and nonfrail groups were matched for age and gender, and the matched pairs were randomly selected to continue the study. The RMR was measured by indirect calorimetry. The TEE was obtained by the multipoint, doubly labeled water method. After collecting a baseline urine sample, each participant received an oral dose of doubly labeled water composed of deuterium oxide and oxygen-18 (H2O). Subsequently, urine samples were collected on the 1st, 2nd, 3rd, 7th, 12th, 13th, and 14th days after the baseline collection and analyzed by mass spectrometry. RESULTS AND DISCUSSION The older adults who were frail presented significantly lower PAEE (1453.7 [1561.9] vs 3336.1 [1829.3] kj/d, P < .01), PAL (1.4 [0.3] vs 1.9 [0.6], P = .04), and TEE (7919.0 [2151.9] vs 10442.4 [2148.0] kj/d, P < .01) than the older adults who were nonfrail. There was no difference in their RMRs (5673.3 [1569.2] vs 6062.0 [1891.7] kj/d, P = .57). Frailty has been associated with a smaller lean body mass and with a disease-related hypermetabolic state, which might explain the lack of difference in the RMR. The PAL of the older adults who were frail was below the recommended level for older adults and determined a lower PAEE and TEE when compared with older adults who were not frail. CONCLUSION This study showed that low energy expenditure in physical activity is a main component of frailty. The PAL of the older adults who were frail was far below the recommended level for older adults.
Collapse
Affiliation(s)
| | - Eduardo Ferriolli
- Division of General Internal and Geriatric Medicine, School of Medicine-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karina Pfrimer
- Division of General Internal and Geriatric Medicine, School of Medicine-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Bruno de Souza Moreira
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliano Bergamaschine Mata Diz
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - João Marcos Domingues Dias
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosângela Corrêa Dias
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
20
|
Paredes-Arturo Y, Aguirre-Acevedo D, Martínez Torres J. Síndrome de fragilidad y factores asociados en adulto mayor indígena de Nariño, Colombia. Semergen 2020; 46:153-160. [DOI: 10.1016/j.semerg.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 11/28/2022]
|
21
|
Sezgin D, Liew A, O'Donovan MR, O'Caoimh R. Pre-frailty as a multi-dimensional construct: A systematic review of definitions in the scientific literature. Geriatr Nurs 2020; 41:139-146. [DOI: 10.1016/j.gerinurse.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
|
22
|
Qin W, Xu L, Sun L, Li J, Ding G, Wang Q, Zhang J, Shao H. Association between frailty and life satisfaction among older people in Shandong, China: the differences in age and general self-efficacy. Psychogeriatrics 2020; 20:172-179. [PMID: 31680393 DOI: 10.1111/psyg.12482] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 08/19/2019] [Accepted: 09/12/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Frailty and other functional declines may be related to life satisfaction (LS) in the general elderly population. This study aims to investigate the association between frailty and LS among older individuals (age ≥60) and the impacts of age and general self-efficacy on the relationships. METHODS Using data from the 2017 Survey of the Shandong elderly Family Health Service, a cross-sectional study was conducted and 7070 older people aged 60+ were analysed. LS was measured using the Satisfaction with Life Scale. A Frailty Index (ranged 0~1) was determined as a proportion of accumulated deficits over 51 categories. General self-efficacy was measured using the Chinese version of the General Self-Efficacy Scale. Multiple weighted linear regression was used to examine possible relationships between the research variables. RESULTS There was a negative association between frailty and LS. A dose-response-type relationship between net income and LS was observed. The interaction between frailty and age was found to be significantly associated with LS. Frailty has a stronger negative impact on LS among the young-old (60-69 years) than among the middle-old (70-79 years) and old-old (80+ years), which suggests a protective effect of ageing on LS reduction due to frailty. However, this protective effect was observed among individuals with low and medium level self-efficacy. CONCLUSIONS The relationship between frailty and LS generally weaken with age. The higher level of general self-efficacy may provide a partial buffer against the negative impact of frailty on LS. Interventions that target to prevent and manage frailty should consider being prioritised among the young-old population. Development of self-efficacy could serve as an important strategy to buffer the negative effect of frailty on LS among older people.
Collapse
Affiliation(s)
- Wenzhe Qin
- Department of Social Medicine and Health Services Management, Shandong University School of Public Health, Jinan, China
| | - Lingzhong Xu
- Department of Social Medicine and Health Services Management, Shandong University School of Public Health, NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Long Sun
- Department of Social Medicine and Health Services Management, Shandong University School of Public Health, Jinan, China
| | - Jiajia Li
- Department of Social Medicine and Health Services Management, Shandong University School of Public Health, Jinan, China
| | - Gan Ding
- Department of Social Medicine and Health Services Management, Shandong University School of Public Health, Jinan, China
| | - Qian Wang
- Department of Social Medicine and Health Services Management, Shandong University School of Public Health, Jinan, China
| | - Jiao Zhang
- Department of Social Medicine and Health Services Management, Shandong University School of Public Health, Jinan, China
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
23
|
Figueredo OMC, Câmara-Souza MB, Carletti TM, de Sousa MDLR, Rodrigues Garcia RCM. Mastication and oral sensory function in frail edentulous elderly: a case-control study. Int Dent J 2020; 70:85-92. [PMID: 31916591 DOI: 10.1111/idj.12529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the maximum bite force (MBF), masticatory performance and oral sensory function (OSF) of frail edentulous elderly. The correlation of MBF with maximum grip strength (MGS) was also assessed. METHODS Twenty edentulous elderly [10 with and 10 without the frailty phenotype (FP)] were selected to participate in this case-control study. The FP was diagnosed using the criteria of Fried et al., which consider weight loss, exhaustion, physical activity level, weakness and slowness to the evaluation. All volunteers received new complete dentures (CDs) to standardise the occlusal status, and after 2 months of use with no complaint, all variables were assessed. MBF was measured by pressure sensors positioned bilaterally on the first artificial molars. Masticatory performance was assessed using the sieving method and was expressed as the median particle size (X50 ) of Optocal after 40 masticatory cycles. OSF was evaluated using the oral stereognosis test, and MGS was measured using a dynamometer. Groups were compared using one-way analysis of variance. The Pearson coefficient of correlation between MBF and MGS was calculated. RESULTS Frail elderly people showed reduced MBF (P = 0.0431) and larger X50 values (P = 0.0053) than did non-frail elders, while OSF did not differ between the groups. MBF had a moderate positive correlation with MGS (r = 0.690, P = 0.003). CONCLUSIONS Frail elderly had reduced MBF and impaired mastication. On the other hand, OSF does not seem to be affected by frailty. MBF was moderately correlated with MGS.
Collapse
Affiliation(s)
- Olívia Maria Costa Figueredo
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Mariana Barbosa Câmara-Souza
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Talita Malini Carletti
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | | |
Collapse
|
24
|
Clark S, Shaw C, Padayachee A, Howard S, Hay K, Frakking TT. Frailty and hospital outcomes within a low socioeconomic population. QJM 2019; 112:907-913. [PMID: 31386153 DOI: 10.1093/qjmed/hcz203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Clinical frailty scales (CFS) predict hospital-related outcomes. Frailty is more common in areas of higher socioeconomic disadvantage, but no studies exclusively report on the impact of CFS on hospital-related outcomes in areas of known socioeconomic disadvantage. AIMS To evaluate the association of the CFS with hospital-related outcomes. DESIGN Retrospective observational study in a community hospital within a disadvantaged area in Australia (Social Economic Index for Areas = 0.1%). METHODS The CFS was used in the emergency department (ED) for people aged ≥ 75 years. Frailty was defined as a score of ≥4. Associations between the CFS and mortality, admission rates, ED presentations and length of stay (LOS) were analysed using regression analyses. RESULTS Between 11 July 2017 and 31 March 2018, there were 5151 ED presentations involving 3258 patients aged ≥ 75 years. Frail persons were significantly more likely to be older, represent to the ED and have delirium compared with non-frail persons. CFS was independently associated with 28-day mortality, with odds of mortality increasing by 1.5 times per unit increase in CFS (95% CI: 1.3-1.7). Frail persons with CFS 4-6 were more likely to be admitted (OR: 1.2; 95% CI: 1.0-1.5), have higher geometric mean LOS (1.43; 95% CI 1.15-1.77 days) and higher rates of ED presentations (IRR: 1.12; 95% CI 1.04-1.21) compared with non-frail persons. CONCLUSIONS The CFS predicts community hospital-related outcomes in frail persons within a socioeconomic disadvantage area. Future intervention and allocation of resources could consider focusing on CFS 4-6 as a priority for frail persons within a community hospital setting.
Collapse
Affiliation(s)
- S Clark
- Emergency Department, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - C Shaw
- Emergency Department, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - A Padayachee
- Projects and Service Partnerships, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - S Howard
- Nursing Informatics, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - K Hay
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - T T Frakking
- Caboolture Hospital, Research Development Unit, Queensland Health, McKean St, Caboolture, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|
25
|
Chang HY, Fang HL, Ting TT, Liang J, Chuang SY, Hsu CC, Wu CY, Pan WH. The Co-Occurrence Of Frailty (Accumulation Of Functional Deficits) And Depressive Symptoms, And Its Effect On Mortality In Older Adults: A Longitudinal Study. Clin Interv Aging 2019; 14:1671-1680. [PMID: 31631988 PMCID: PMC6775497 DOI: 10.2147/cia.s210072] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose The co-occurrence of frailty and depression in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality have rarely been investigated. We aimed to examine the co-occurrence of frailty and depressive symptoms in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality using all the information from a longitudinal study. Patients and methods We used the Taiwan Longitudinal Study of Aging (TLSA) for this study. TLSA was initiated in 1989 and followed periodically. We included participants from 1989 to 2007, who had data on frailty and depressive symptoms. Frailty was assessed by accumulation of functional deficits in 6 dimensions including disease status, sensory dysfunction, balance, functional limitations, health risk behaviors, and life satisfaction. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). A multistate model with interval censoring was used to examine the transition between states of frailty with or without depressive symptoms, and finally to death. A mixed model was used to examine the relationships between frailty and depressive symptoms. Results The coexistence of frailty and depressive symptoms was associated with higher mortality. Individuals with depressive symptom had a lower probability of reversal to a better state. Previous depression score predicted current frailty, but the coefficient was smaller than that of previous frailty. Previous frailty predicted current depression score, and the coefficient was stronger than that of previous depression. Conclusion Depressive symptoms increased the mortality and decreased the probability of reversal in the frail older adults.
Collapse
Affiliation(s)
- Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Ling Fang
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan
| | - Te-Tien Ting
- School of Big Data Management, Soochow University, Taipei, Taiwan
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan
| | - Chin-Yin Wu
- Institute of Sociology, Academia Sinica, Taipei, Taiwan
| | - Wen-Harn Pan
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| |
Collapse
|
26
|
Abstract
Frailty is a term that presents many difficulties for policy makers and clinicians due to the lack of consensus in defining frailty in a way that meets the needs of older people. A principle-based concept analysis was used to examine the scientific literature across four perspectives: medicine, nursing, social sciences, and occupational and physiotherapy. The purpose was to identify the conceptual components of frailty as revealed by analysis of the literature, and to develop a theoretical definition of frailty. The findings exposed commonalities in implied meanings both within and across perspectives. The strengths of frailty as a concept are revealed in the implications for clinical practice and relevance to health professionals. The limitations reflect a concept that is still evolving and further research is recommended but this should not stop health professionals engaging in this process. The definition developed in this study will enhance existing knowledge and promote a shared understanding to unite different disciplines in recognising frailty as an important concept.
Collapse
Affiliation(s)
- Mandy Waldon
- Advanced Nurse Practitioner, Berkshire Health Care Foundation Trust
| |
Collapse
|
27
|
Chu NM, Deng A, Ying H, Haugen CE, Garonzik Wang JM, Segev DL, McAdams-DeMarco MA. Dynamic Frailty Before Kidney Transplantation: Time of Measurement Matters. Transplantation 2019; 103:1700-1704. [PMID: 31348438 PMCID: PMC6679826 DOI: 10.1097/tp.0000000000002563] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Frail kidney transplant (KT) recipients have higher risk of adverse post-KT outcomes. Yet, there is interest in measuring frailty at KT evaluation and then using this information for post-KT risk stratification. Given long wait times for KT, frailty may improve or worsen between evaluation and KT. Patterns, predictors, and post-KT adverse outcomes associated with these changes are unclear. METHODS Five hundred sixty-nine adult KT candidates were enrolled in a cohort study of frailty (November 2009-September 2017) at evaluation and followed up at KT. Patterns of frailty transitions were categorized as follows: (1) binary state change (frail/nonfrail), (2) 3-category state change (frail/intermediate/nonfrail), and (3) raw score change (-5 to 5). Adjusted Cox proportional hazard and logistic regression models were used to test whether patterns of frailty transitions were associated with adverse post-KT outcomes. RESULTS Between evaluation and KT, 22.0% became more frail, while 24.4% became less frail. Black race (relative risk ratio, 1.98; 95% confidence interval [CI], 1.07-3.67) was associated with frail-to-nonfrail transition, and diabetes (relative risk ratio, 2.56; 95% CI, 1.22-5.39) was associated with remaining stably frail. Candidates who became more frail between 3-category states (hazard ratio, 2.27; 95% CI, 1.11-4.65) and frailty scores (hazard ratio, 2.36; 95% CI, 1.12-4.99) had increased risk of post-KT mortality and had higher odds of length of stay ≥2 weeks (3-category states: odds ratio, 2.02; 95% CI, 1.20-3.40; frailty scores: odds ratio, 1.92; 95% CI, 1.13-3.25). CONCLUSIONS Almost half of KT candidates experienced change in frailty between evaluation and KT, and those transitions were associated with mortality and longer length of stay. Monitoring changes in frailty from evaluation to admission may improve post-KT risk stratification.
Collapse
Affiliation(s)
- Nadia M. Chu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Arlinda Deng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hao Ying
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine E. Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mara A. McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
28
|
Richards SJG, D’Souza J, Pascoe R, Falloon M, Frizelle FA. Prevalence of frailty in a tertiary hospital: A point prevalence observational study. PLoS One 2019; 14:e0219083. [PMID: 31260483 PMCID: PMC6602419 DOI: 10.1371/journal.pone.0219083] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/15/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Frailty is an important concept in modern healthcare due to its association with adverse outcomes. Its prevalence varies in the literature and there is a paucity of literature looking at the prevalence of frailty in an inpatient setting. Its significance lies on its impact on resource utilisation and costs. AIM To determine the prevalence of frailty in the adult population in a tertiary New Zealand hospital. METHODS Eligible patients aged 18 years and over were invited to participate, and frailty assessment was performed using the Reported Edmonton Frail Scale. A score of 8 or more was considered frail. Factors associated with frailty were assessed. RESULTS Of 640 occupied inpatient beds, 420 patients were assessed. 220 patients were excluded, of which 89 were absent from their bed-space, 73 declined and 41 were critically unwell. The overall prevalence of frailty across assessed patients was 48.8%. The prevalence of frailty increased significantly with age; patients aged 85 and over were significantly more likely to be frail compared to those aged under 65 (OR 6.25, 95% CI 3.17-12.7). Maori patients were significantly more likely to be frail (OR 4.0, 95% CI 1.45-11.9). When compared to those patients admitted to a medical specialty, patients admitted to surgical specialty were less likely to be frail (OR 0.52 95% CI 0.31-0.86) and those admitted for rehabilitation were more likely to be frail (OR 1.86 95% CI 1.03-3.41). Frail patients were more likely to come from a rest home (OR 2.81, 95% CI 1.38-6.14) or hospital level care (OR 9.62, 95% CI 2.68-61.6). CONCLUSION Frailty is highly prevalent in the hospital setting with 48.8% of all inpatients classified as frail. This high number of frail patients has significant resource implications and an increased understanding of the burden of frailty in this population may aid targeting of interventions towards this vulnerable population.
Collapse
Affiliation(s)
| | - Joel D’Souza
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Rebecca Pascoe
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Michelle Falloon
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Frank A. Frizelle
- Department of Surgery, University of Otago, Christchurch, New Zealand
| |
Collapse
|
29
|
Assessment of Cytokines, Biochemical Markers of Malnutrition and Frailty Syndrome Patients Considered for Lung Transplantation. Transplant Proc 2019; 51:2009-2013. [DOI: 10.1016/j.transproceed.2019.04.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/05/2019] [Indexed: 11/21/2022]
|
30
|
Lyndon H, Latour JM, Marsden J, Campbell S, Stevens K, Kent B. The holistic assessment and care planning in partnership intervention study (HAPPI): A protocol for a feasibility, cluster randomized controlled trial. J Adv Nurs 2019; 75:3078-3087. [PMID: 31222778 DOI: 10.1111/jan.14106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/25/2019] [Accepted: 05/21/2019] [Indexed: 11/29/2022]
Abstract
AIM During an initial phase of this research, an e-Delphi survey was conducted to gain consensus among stakeholders on the components of a nurse-led assessment and care planning intervention for older people who live with frailty in primary care. This feasibility randomized controlled trial (fRCT) will test the proposed intervention and its implementation and determine methods for the design of a conclusive randomized controlled trial. METHODS The fRCT, with embedded qualitative study, aims to recruit 60 participants. Moderately and severely frail older people will be identified using the electronic frailty index (eFI) and the intervention will be delivered by senior community nurses. The control participants will receive usual primary care for frailty. The study is funded by the National Institute of Health Research (NIHR; funding granted in May 2016, ref: ICA-CDRF-2016-02-018) and received NHS and University Research Ethics Committee approval in 2018. DISCUSSION There is evidence that the delivery of complex interventions for community-dwelling older people can reduce care home and hospital admissions and falls, there is less evidence for the benefit of any specific type or intensity of intervention or the additional benefits of targeting the frail population. This trial will determine feasibility of the intervention, define recruitment and retention parameters and trial logistics, and decide outcome measures. IMPACT This study aims to address the limitations of current research by using a systematic method of frailty diagnosis and participant identification, trialling implementation of a person-centred intervention, and testing of feasibility parameters. TRIAL REGISTRATION NUMBER ISRCTN: 74345449.
Collapse
Affiliation(s)
| | - Jos M Latour
- University of Plymouth, Plymouth, UK.,Curtin University, Perth, WA, Australia
| | | | - Sarah Campbell
- Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, UK
| | - Kara Stevens
- Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, UK
| | - Bridie Kent
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| |
Collapse
|
31
|
Jansen-Kosterink S, van Velsen L, Frazer S, Dekker-van Weering M, O'Caoimh R, Vollenbroek-Hutten M. Identification of community-dwelling older adults at risk of frailty using the PERSSILAA screening pathway: a methodological guide and results of a large-scale deployment in the Netherlands. BMC Public Health 2019; 19:504. [PMID: 31053090 PMCID: PMC6500037 DOI: 10.1186/s12889-019-6876-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Among community-dwelling older adults, frailty is highly prevalent and recognized as a major public health concern. To prevent frailty it is important to identify those at risk of becoming frail, but at present, no accepted screening procedure is available. Methods The screening process developed as part of the PERSSILAA project is a two-step screening pathway. First, older adults are asked to complete a self-screening questionnaire to assess their general health status and their level of decline on physical, cognitive and nutritional domains. Second, older adults who, according to step one, are at risk of becoming frail, are invited for a face-to-face assessment focusing on the domains in depth. We deployed the PERSSILAA screening procedure in primary care in the Netherlands. Results In total, baseline data were available for 3777 community-dwelling older adults (mean age 69.9 (SD ± 3.8)) who completed first step screening. Based on predefined cut-off scores, 16.8% of the sample were classified as frail (n = 634), 20.6% as pre-frail (n = 777), and 62.3% as robust (n = 2353). Frail subjects were referred back to their GP without going through the second step. Of the pre-frail older adults, 69.7% had evidence of functional decline on the physical domain, 67% were overweight or obese and 31.0% had evidence of cognitive decline. Conclusion Pre-frailty is common among community-dwelling older adults. The PERSSILAA screening approach is a multi-factor, two-step screening process, potentially useful for primary prevention to identify those at risk of frailty and who will benefit most from preventive strategies.
Collapse
Affiliation(s)
- Stephanie Jansen-Kosterink
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands. .,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands.
| | - Lex van Velsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Sanne Frazer
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Marit Dekker-van Weering
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, Cork City, Ireland.,Clinical Sciences Institute, National University of Ireland Galway, Galway City, Ireland
| | - Miriam Vollenbroek-Hutten
- University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands.,ZiekenhuisGroep Twente (ZGT), scientific office ZGT academie, Almelo, the Netherlands
| |
Collapse
|
32
|
Abreu W, Tolson D, Jackson GA, Staines H, Costa N. The relationship between frailty, functional dependence, and healthcare needs among community-dwelling people with moderate to severe dementia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:642-653. [PMID: 30402986 DOI: 10.1111/hsc.12678] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/16/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
This paper examines the healthcare needs of community-dwelling older people living in Porto, Portugal, diagnosed with moderate or severe dementia, linked to functional dependency, cognitive decline, limitations in the activities of daily life, and frailty levels. A sample of 83 participants was recruited. Data were collected between 2013 and 2017. A sociodemographic questionnaire, the Clinical Dementia Rating (CDR), the Barthel Index (BI), the Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale, and the Edmonton Frail Scale (EFS) were used. A set of 26 healthcare needs was defined to support the assessment. The Pearson chi-square or Fisher's exact test (as appropriate) was used to examine the association of the needs (unmet and met) with the levels of dementia and frailty. Participants were diagnosed previously with moderate or severe dementia and benefited from a structured home-care program. There was a high number rated as "severe dementia," "fully dependent," "severely or fully dependent in the activities of daily living (ADL)," and "severe frailty." There were statistically significant differences among needs identified in people with moderate or severe dementia and moderate or severe frailty. The most prevalent healthcare needs in the sample were food preparation, medication/taking pills, looking after their home, toilet use, sensory problems, communication/interaction, bladder, bowels, eating and drinking, memory, sleeping, and falls prevention. In particular, the study identifies a set of needs that are present simultaneously in both frailty and dementia stages. This study underlines that despite well-structured home-care programs for people with dementia, unmet health needs remain. Timely healthcare needs assessment may help professionals to avoid fragmented care and to tailor quality-integrated interventions, including the emotional and psychological balance of the caregiver.
Collapse
Affiliation(s)
- Wilson Abreu
- Porto School of Nursing/CINTESIS (Center for Research in Health Technologies and Services), Porto, Portugal
| | - Debbie Tolson
- Alzheimer Scotland Centre for Policy and Practice, The University of the West of Scotland, Hamilton, UK
| | - Graham A Jackson
- Alzheimer Scotland Centre for Policy and Practice, The University of the West of Scotland, Hamilton, UK
| | - Harry Staines
- The University of the West of Scotland, Hamilton, UK
| | - Nilza Costa
- University of Aveiro - Campus Universitário de Santiago, Aveiro, Portugal
| |
Collapse
|
33
|
Sezgin D, O’Donovan M, Cornally N, Liew A, O’Caoimh R. Defining frailty for healthcare practice and research: A qualitative systematic review with thematic analysis. Int J Nurs Stud 2019; 92:16-26. [DOI: 10.1016/j.ijnurstu.2018.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 12/22/2022]
|
34
|
Bethell J, Puts MTE, Sattar S, Andrew MK, Choate AS, Clarke B, Cowan K, DeAngelis C, Elliott J, Fitch MI, Frank C, Hominick K, Keatings M, McElhaney JE, McKay SM, Pitters E, Ploeg J, Sidani S, McGilton KS. The Canadian Frailty Priority Setting Partnership: Research Priorities for Older Adults Living with Frailty. Can Geriatr J 2019; 22:23-33. [PMID: 31501680 PMCID: PMC6707135 DOI: 10.5770/cgj.22.336] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Patient engagement in research priority-setting is intended to democratize research and increase impact. The objectives of the Canadian Frailty Priority Setting Partnership (PSP) were to engage people with lived or clinical experience of frailty, and produce a list of research priorities related to care, support, and treatment of older adults living with frailty. Methods The Canadian Frailty PSP was supported by the Canadian Frailty Network, coordinated by researchers in Toronto, Ontario and followed the methods of the James Lind Alliance, which included establishing a Steering Group, inviting partner organizations, gathering questions related to care, support and treatment of older adults living with frailty, processing the data and prioritizing the questions. Results In the initial survey, 799 submissions were provided by 389 individuals and groups. The 647 questions that were within scope were categorized, merged, and summarized, then checked against research evidence, creating a list of 41 unanswered questions. Prioritization took place in two stages: first, 146 individuals and groups participated in survey and their responses short-listed 22 questions; and second, an in-person workshop was held on September 26, 2017 in Toronto, Ontario where these 22 questions were discussed and ranked. Conclusion Researchers and research funders can use these results to inform their agendas for research on frailty. Strategies are needed for involving those with lived experience of frailty in research.
Collapse
Affiliation(s)
- Jennifer Bethell
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
| | - Schroder Sattar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
| | - Melissa K Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS
| | - Andrew S Choate
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON.,Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS.,Department of Family Medicine, Dalhousie University, Halifax, NS.,James Lind Alliance, Southampton, UK.,Sunnybrook Health Sciences Centre, Toronto, ON.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON.,Canadian Partnership Against Cancer, Toronto, ON.,Department of Medicine, Queen's University, Kingston, ON.,Providence Care, Kingston, ON.,Seniors' Health, Nova Scotia Health Authority, Halifax, NS.,Health Sciences North Research Institute, Sudbury, ON.,Northern Ontario School of Medicine, Laurentian University, Sudbury, ON.,VHA Home HealthCare, Toronto, ON.,Department of Physical Therapy, University of Toronto, Toronto, ON.,School of Nursing, and Aging, Community and Health Research Unit, McMaster University, Hamilton, ON.,Ryerson University, Toronto, ON
| | - Barry Clarke
- Department of Family Medicine, Dalhousie University, Halifax, NS
| | - Katherine Cowan
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
| | | | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Margaret I Fitch
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON.,Canadian Partnership Against Cancer, Toronto, ON
| | - Chris Frank
- Department of Medicine, Queen's University, Kingston, ON.,Providence Care, Kingston, ON
| | | | - Margaret Keatings
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON.,Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS.,Department of Family Medicine, Dalhousie University, Halifax, NS.,James Lind Alliance, Southampton, UK.,Sunnybrook Health Sciences Centre, Toronto, ON.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON.,Canadian Partnership Against Cancer, Toronto, ON.,Department of Medicine, Queen's University, Kingston, ON.,Providence Care, Kingston, ON.,Seniors' Health, Nova Scotia Health Authority, Halifax, NS.,Health Sciences North Research Institute, Sudbury, ON.,Northern Ontario School of Medicine, Laurentian University, Sudbury, ON.,VHA Home HealthCare, Toronto, ON.,Department of Physical Therapy, University of Toronto, Toronto, ON.,School of Nursing, and Aging, Community and Health Research Unit, McMaster University, Hamilton, ON.,Ryerson University, Toronto, ON
| | - Janet E McElhaney
- Health Sciences North Research Institute, Sudbury, ON.,Northern Ontario School of Medicine, Laurentian University, Sudbury, ON
| | - Sandra M McKay
- VHA Home HealthCare, Toronto, ON.,Department of Physical Therapy, University of Toronto, Toronto, ON
| | - Eric Pitters
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON.,Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS.,Department of Family Medicine, Dalhousie University, Halifax, NS.,James Lind Alliance, Southampton, UK.,Sunnybrook Health Sciences Centre, Toronto, ON.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON.,Canadian Partnership Against Cancer, Toronto, ON.,Department of Medicine, Queen's University, Kingston, ON.,Providence Care, Kingston, ON.,Seniors' Health, Nova Scotia Health Authority, Halifax, NS.,Health Sciences North Research Institute, Sudbury, ON.,Northern Ontario School of Medicine, Laurentian University, Sudbury, ON.,VHA Home HealthCare, Toronto, ON.,Department of Physical Therapy, University of Toronto, Toronto, ON.,School of Nursing, and Aging, Community and Health Research Unit, McMaster University, Hamilton, ON.,Ryerson University, Toronto, ON
| | - Jenny Ploeg
- School of Nursing, and Aging, Community and Health Research Unit, McMaster University, Hamilton, ON
| | | | - Katherine S McGilton
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
| |
Collapse
|
35
|
Abdelhafiz AH, Sinclair AJ. Cognitive Frailty in Older People with Type 2 Diabetes Mellitus: the Central Role of Hypoglycaemia and the Need for Prevention. Curr Diab Rep 2019; 19:15. [PMID: 30806826 DOI: 10.1007/s11892-019-1135-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To highlight the central role of hypoglycaemia in the causation of cognitive frailty and explore ways of recognition and prevention of hypoglycaemia. RECENT FINDINGS Cognitive frailty is an emerging new concept defined as the concomitant presence of physical frailty and cognitive impairment. In older people with diabetes, cognitive frailty is associated with an increased risk of mortality greater than from either physical frailty or cognitive impairment alone. Hypoglycaemia is directly associated with increased risk of cognitive impairment and physical frailty which are the two components of cognitive frailty. The incidence of hypoglycaemia in older people with diabetes is rising and hypoglycaemia-related hospitalisation has overtaken that of hyperglycaemia. Recognition of hypoglycaemic episodes in old age remains challenging which leads to misdiagnoses and under-reporting. Therefore, hypoglycaemia prevention strategies are needed. Research is still required to investigate whether prevention of hypoglycaemia would lead to a reduction in the incidence of cognitive frailty.
Collapse
Affiliation(s)
- A H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, S60 2UD, UK.
| | - A J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa, WR9 0QH, UK
- Kings College, London, SE1 9NH, UK
| |
Collapse
|
36
|
Nguyen AT, Nguyen TX, Nguyen TN, Nguyen THT, Pham T, Cumming R, Hilmer SN, Vu HTT. The impact of frailty on prolonged hospitalization and mortality in elderly inpatients in Vietnam: a comparison between the frailty phenotype and the Reported Edmonton Frail Scale. Clin Interv Aging 2019; 14:381-388. [PMID: 30863032 PMCID: PMC6388754 DOI: 10.2147/cia.s189122] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aims To investigate the impact of frailty on outcomes in older hospitalized patients, including prolonged length of stay and all-cause mortality 6 months after admission, using both the frailty phenotype and the Reported Edmonton Frail Scale (REFS). Patients and methods This study is the follow-up phase of a study designed to investigate the prevalence of frailty and its impact on adverse outcomes in older hospitalized patients at the National Geriatric Hospital in Hanoi, Vietnam. Results A total of 461 participants were included, with a mean age 76.2±8.9 years, and 56.8% were female. The prevalence of frailty was 31.9% according to the REFS and 35.4% according to Fried's criteria. The kappa coefficient was 0.57 (95% CI =0.49-0.66) between the two frailty criteria in identifying frail and non-frail participants. There was a trend toward increasing the likelihood of prolonged hospitalization in participants with frailty defined by Fried's criteria (adjusted OR =1.49, 95% CI =0.94-2.35) or by REFS (adjusted OR =1.43, 95% CI =0.89-2.29). During 6 months of follow-up, 210 were lost and 18/251 (7.2%) participants died. Mortality was higher in those with frailty defined by either Fried's criteria or REFS. On multivariable survival analysis, adjusted HRs for mortality were 2.65 (95% CI =1.02-6.89) for Fried's criteria and 4.19 (95% CI =1.59-10.99) for REFS. Conclusion Fried's frailty phenotype or REFS can be used as a screening tool to detect frailty in older inpatients in Vietnam and predict mortality. Frailty screening can help prioritize targeted frailty-tailored treatments, such as nutrition, early mobility and medication review, for these vulnerable patients to improve clinical outcomes.
Collapse
Affiliation(s)
- Anh Trung Nguyen
- The National Geriatric Hospital, Hanoi, Vietnam, .,Department of Geriatrics and Gerontology, Hanoi Medical University, Hanoi, Vietnam,
| | - Thanh Xuan Nguyen
- The National Geriatric Hospital, Hanoi, Vietnam, .,Department of Geriatrics and Gerontology, Hanoi Medical University, Hanoi, Vietnam,
| | - Tu N Nguyen
- The National Geriatric Hospital, Hanoi, Vietnam, .,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Thu Hoai Thi Nguyen
- The National Geriatric Hospital, Hanoi, Vietnam, .,Department of Geriatrics and Gerontology, Hanoi Medical University, Hanoi, Vietnam, .,Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam
| | - Thang Pham
- The National Geriatric Hospital, Hanoi, Vietnam, .,Department of Geriatrics and Gerontology, Hanoi Medical University, Hanoi, Vietnam,
| | - Robert Cumming
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital and Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Huyen Thi Thanh Vu
- The National Geriatric Hospital, Hanoi, Vietnam, .,Department of Geriatrics and Gerontology, Hanoi Medical University, Hanoi, Vietnam,
| |
Collapse
|
37
|
Chu NM, Gross AL, Shaffer AA, Haugen CE, Norman SP, Xue QL, Sharrett AR, Carlson MC, Bandeen-Roche K, Segev DL, McAdams-DeMarco MA. Frailty and Changes in Cognitive Function after Kidney Transplantation. J Am Soc Nephrol 2019; 30:336-345. [PMID: 30679381 PMCID: PMC6362628 DOI: 10.1681/asn.2018070726] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 11/14/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Restoration of kidney function after kidney transplant generally improves cognitive function. It is unclear whether frail recipients, with higher susceptibility to surgical stressors, achieve such post-transplant cognitive improvements or whether they experience subsequent cognitive decline as they age with a functioning graft. METHODS In this two-center cohort study, we assessed pretransplant frailty (Fried physical frailty phenotype) and cognitive function (Modified Mini-Mental State Examination) in adult kidney transplant recipients. To investigate potential short- and medium-term effects of frailty on post-transplant cognitive trajectories, we measured cognitive function up to 4 years post-transplant. Using an adjusted mixed effects model with a random slope (time) and intercept (person), we characterized post-transplant cognitive trajectories by pretransplant frailty, accounting for nonlinear trajectories. RESULTS Of 665 recipients (mean age 52.0 years) followed for a median of 1.5 years, 15.0% were frail. After adjustment, pretransplant cognitive scores were significantly lower among frail patients compared with nonfrail patients (89.0 versus 90.8 points). By 3 months post-transplant, cognitive performance improved for both frail (slope =0.22 points per week) and nonfrail (slope =0.14 points per week) recipients. Between 1 and 4 years post-transplant, improvements plateaued among nonfrail recipients (slope =0.005 points per week), whereas cognitive function declined among frail recipients (slope =-0.04 points per week). At 4 years post-transplant, cognitive scores were 5.8 points lower for frail recipients compared with nonfrail recipients. CONCLUSIONS On average, both frail and nonfrail recipients experience short-term cognitive improvement post-transplant. However, frailty is associated with medium-term cognitive decline post-transplant. Interventions to prevent cognitive decline among frail recipients should be identified.
Collapse
Affiliation(s)
- Nadia M Chu
- Departments of Epidemiology,
- Department of Surgery and
| | | | | | | | - Silas P Norman
- Division of Nephrology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Qian-Li Xue
- Departments of Epidemiology
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | | | | | - Karen Bandeen-Roche
- Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dorry L Segev
- Departments of Epidemiology
- Department of Surgery and
| | | |
Collapse
|
38
|
Ye B, Gao J, Fu H. Associations between lifestyle, physical and social environments and frailty among Chinese older people: a multilevel analysis. BMC Geriatr 2018; 18:314. [PMID: 30547760 PMCID: PMC6295038 DOI: 10.1186/s12877-018-0982-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/14/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Frailty represents a public health priority and an increasingly prevalent condition in the ageing population. It is seen as reflecting an interaction among individual factors and a range of environmental elements. This study aims to examine the association between frailty and individual factors, physical and social environments among Chinese older people. METHODS The data were from the Shanghai Healthy City Survey in 2017, which sampled 2559 older people aged ≥60 years from 67 neighbourhoods. The FRAIL scale was used to assess frailty, and social and physical environments were assessed using validated and psychometrically tested instruments. Individual factors included age, gender, education, employment, marital status, smoking, drinking, physical exercise, organization participation, self-rated health and psychological well-being. A multilevel analysis was conducted to examine whether physical and social environments were associated with frailty. RESULTS The prevalence of pre-frailty and frailty were 39.5 and 16.9%, respectively. The prevalence of frailty increased with age from 14.6% (60-64 years) to 26.5% (≥75 years). After adjusting for age and/or gender, older age, women, and those with low education, alcohol dependence, physical inactivity, poor self-rated health, or psychological disorders had a higher prevalence of frailty. The multilevel analysis indicated that after controlling for individual covariates, compared to the 1st quartile of aesthetic quality, the odds ratio (OR) of frailty for the 4th quartile was 0.65 (0.47-0.89); compared to the 1st quartile of walking environment, the OR of frailty for the 4th quartile was 0.43 (0.19-0.95); compared to the 1st quartile of social cohesion, the OR of frailty for the 4th quartile was 0.73 (0.54-0.99); compared to the 1st quartile of social participation, the ORs of frailty for the 2nd, 3rd and 4th quartiles were 0.76 (0.59-0.97), 0.59 (0.45-0.77) and 0.59 (0.45-0.77), respectively. CONCLUSIONS Frailty is a highly prevalent health condition among the aged population in China. Healthcare should focus on frail elderly who are older age, women, those with low education, and those with mental health problems. It may decrease frailty among Chinese older people to encourage social participation and healthy behaviours and to build aesthetic, walkable and cohesive neighbourhoods.
Collapse
Affiliation(s)
- Bo Ye
- School of Public Health, Fudan University, Shanghai, China
| | - Junling Gao
- School of Public Health, Fudan University, Shanghai, China
| | - Hua Fu
- Fudan Health Communication Institute, School of Public Health, Fudan University, PO Box 248, 138 Yixueyuan Road, Shanghai, 200032 China
| |
Collapse
|
39
|
Junius-Walker U, Onder G, Soleymani D, Wiese B, Albaina O, Bernabei R, Marzetti E. The essence of frailty: A systematic review and qualitative synthesis on frailty concepts and definitions. Eur J Intern Med 2018; 56:3-10. [PMID: 29861330 DOI: 10.1016/j.ejim.2018.04.023] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND One of the major threats looming over the growing older population is frailty. It is a distinctive health state characterised by increased vulnerability to internal and external stressors. Although the presence of frailty is well acknowledged, its concept and operationalisation are hampered by the extraordinary phenotypical and biological complexity. Yet, a widely accepted conception is needed to offer tailored policies and approaches. The ADVANTAGE Group aims to analyse the diverse frailty concepts to uncover the essence of frailty as a basis for a shared understanding. METHOD A systematic literature review was performed on frailty concepts and definitions from 2010 onwards. Eligible publications were reviewed using concept analysis that led to the extraction of text data for the themes "definition", "attributes", "antecedents", "consequences", and "related concepts". Qualitative description was used to further analyse the extracted text passages, leading to inductively developed categories on the essence of frailty. RESULTS 78 publications were included in the review, and 996 relevant text passages were extracted for analysis. Five components constituted a comprehensive definition: vulnerability, genesis, features, characteristics, and adverse outcomes. Each component is described in more detail by a set of defining and explanatory criteria. An underlying functional perspective of health or its impairments is most compatible with the entity of frailty. DISCUSSION The recent findings facilitate a focus on the relevant building blocks that define frailty. They point to the commonalities of the diverse frailty concepts and definitions. Based on these components, a widely accepted broad definition of frailty comes into range.
Collapse
Affiliation(s)
- Ulrike Junius-Walker
- Institute of General Practice, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
| | - Graziano Onder
- Department of Geriatrics, Neurosciences and Orthopaedics, Teaching Hospital "Agostino Gemelli", L.go A. Gemelli 8, 00168 Rome, Italy.
| | - Dagmar Soleymani
- Santé publique France, 14 rue du Val d'Osne, 94140 Saint-Maurice, France.
| | - Birgitt Wiese
- Institute of General Practice, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
| | - Olatz Albaina
- Association Centre of International Excellence on Research in Chronicity (Kronikgune), Bilbao Exhibition Centre, Ronda de Azkue 1, Barakaldo 48902, Basque Country, Spain.
| | - Roberto Bernabei
- Department of Geriatrics, Neurosciences and Orthopaedics, Teaching Hospital "Agostino Gemelli", L.go A. Gemelli 8, 00168 Rome, Italy.
| | - Emanuele Marzetti
- Department of Geriatrics, Neurosciences and Orthopaedics, Teaching Hospital "Agostino Gemelli", L.go A. Gemelli 8, 00168 Rome, Italy.
| |
Collapse
|
40
|
Jarach CM, Cesari M. Frailty beyond the clinical dimension: discussion about the underlying aspect of the social capital. Minerva Med 2018; 109:472-478. [PMID: 30221910 DOI: 10.23736/s0026-4806.18.05821-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is repeatedly advocated in the medical literature the need of reshaping the care process in order to better address the unmet clinical needs of the highly vulnerable and complex ageing population. In the past twenty years, frailty has assumed the role of an arising and independent geriatric condition, different from disability and multimorbidity. Frailty is highly prevalent in older persons. The proper management of frailty relies on the accurate collection and interpretation of a wide spectrum of information about the health status of the individual. However, the optimal intervention plan cannot be correctly designed and implemented without the evaluation of the social characteristics of the frail older person. Unfortunately, this aspect has frequently been overlooked and research is still lagging on the topic. The main scope of this review is to present current evidence and propose possible axes of investigation in this field.
Collapse
Affiliation(s)
- Carlotta M Jarach
- Laboratory of Quality Assessment of Geriatric Therapies Services, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy -
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
41
|
Buch A, Carmeli E, Shefer G, Keinan-Boker L, Berner Y, Marcus Y, Goldsmith R, Stern N. Cognitive impairment and the association between frailty and functional deficits are linked to abdominal obesity in the elderly. Maturitas 2018; 114:46-53. [PMID: 29907246 DOI: 10.1016/j.maturitas.2018.05.009] [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: 01/27/2018] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To evaluate whether specific obesity phenotypes in community-dwelling elderly: (a) affect differently the relationship between frailty and functional impairment and (b) are related to cognitive impairment. STUDY DESIGN A post-hoc cross-sectional analysis of the last Israeli national health and nutrition survey of the elderly (≥ 65 yrs.; n = 1619). MAIN OUTCOME MEASURES We implemented a previously validated frailty model based on frailty-related variables that were obtained in the survey. Mild cognitive impairment was defined using the Mini-Mental State Examination (a score <24 and >17). The Katz's scale of activities of daily living was used for functional assessment. Data were clustered according to different obesity phenotypes using measured body mass index (BMI) and waist circumference (WC). RESULTS The link between frailty and disability was most prominent in subjects with abdominal obesity who were non-obese by BMI: compared with non-obese subjects as defined by WC and BMI, the odds ratio (OR) for functional limitations in this phenotype was 8.34 (95 % CI, 2.14-32.48) for pre-frail subjects and 69.26 (10.58-453.55) for frail subjects. The rate of cognitive impairment was 3.3 times higher (p = .023) in women who were obese by WC but not by BMI. CONCLUSIONS In elderly people with a large WC and BMI < 30 kg/m2, disability is more tightly linked to frailty than for any other form of obesity. Cognitive impairment was more prominent in women with central obesity and BMI < 30 kg/m2 than in the other anthropometric phenotypes. WC should be used for early detection of individuals at risk of progression of frailty to functional incapacity.
Collapse
Affiliation(s)
- Assaf Buch
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Israel.
| | - Eli Carmeli
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; The Department of Physical Therapy, University of Haifa, Haifa, Israel
| | - Gabi Shefer
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Lital Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel; Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Yitshal Berner
- The Sackler Faculty of Medicine, Tel-Aviv University, Israel; Meir Medical Center, Kfar Saba, Israel
| | - Yonit Marcus
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | | | - Naftali Stern
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Israel
| |
Collapse
|
42
|
Buch A, Keinan-Boker L, Berner Y, Carmeli E, Goldsmith R, Stern N. Estimated frailty prevalence among Israeli elderly - results from a cross sectional national survey. Isr J Health Policy Res 2018; 7:18. [PMID: 29642949 PMCID: PMC5896076 DOI: 10.1186/s13584-018-0212-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/12/2018] [Indexed: 01/10/2023] Open
Abstract
Background Increasing longevity presents new social and medical challenges in developed countries. The prevalence of frailty is of interest because of its association with health prognosis and outcomes, but so far there is no single best diagnostic tool for this entity. Therefore, estimated prevalence of frailty in countries varies considerably and ranges between 5% and 58%. In Israel, the nation-wide prevalence of frailty in the elderly population is presently unknown. The objective of our study was to assess the rate of the frailty in elderly Israelis. Methods A post-hoc analysis based on the results of a national Health and Nutrition Survey in Israeli elderly (MABAT Zahav). A non-direct model to estimate frailty was based on five components that were most similar to the common frailty assessment suggested by Morley et al. The frailty state was then reclassified according to different explanatory variables. Results Data collected from 1619 subjects (F/M = 52.9/47.1%) with an average age of 74.6 years were analyzed. Estimated frailty prevalence in the elderly population was 4.9%. Frail people were more likely to have a lower income, be unemployed and have a lower education level. Frailty rates were higher in women, in Jews and in subjects more prone to low physical function. Conclusions The estimated frailty prevalence in the Israeli elderly population, while relatively low, is comparable to some of the rates suggested in the literature. The factors associated with frailty in the Israeli population are in accordance with the existing literature. The suggested model may be helpful in identifying frailty in Israeli elderly.
Collapse
Affiliation(s)
- Assaf Buch
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Lital Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel. .,Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel.
| | - Yitshal Berner
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Meir Medical Center, Kfar Saba, Israel
| | - Eli Carmeli
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The Department of Physical Therapy, University of Haifa, Haifa, Israel
| | | | - Naftali Stern
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
43
|
Skaper SD, Facci L, Zusso M, Giusti P. An Inflammation-Centric View of Neurological Disease: Beyond the Neuron. Front Cell Neurosci 2018; 12:72. [PMID: 29618972 PMCID: PMC5871676 DOI: 10.3389/fncel.2018.00072] [Citation(s) in RCA: 275] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022] Open
Abstract
Inflammation is a complex biological response fundamental to how the body deals with injury and infection to eliminate the initial cause of cell injury and effect repair. Unlike a normally beneficial acute inflammatory response, chronic inflammation can lead to tissue damage and ultimately its destruction, and often results from an inappropriate immune response. Inflammation in the nervous system (“neuroinflammation”), especially when prolonged, can be particularly injurious. While inflammation per se may not cause disease, it contributes importantly to disease pathogenesis across both the peripheral (neuropathic pain, fibromyalgia) and central [e.g., Alzheimer disease, Parkinson disease, multiple sclerosis, motor neuron disease, ischemia and traumatic brain injury, depression, and autism spectrum disorder] nervous systems. The existence of extensive lines of communication between the nervous system and immune system represents a fundamental principle underlying neuroinflammation. Immune cell-derived inflammatory molecules are critical for regulation of host responses to inflammation. Although these mediators can originate from various non-neuronal cells, important sources in the above neuropathologies appear to be microglia and mast cells, together with astrocytes and possibly also oligodendrocytes. Understanding neuroinflammation also requires an appreciation that non-neuronal cell—cell interactions, between both glia and mast cells and glia themselves, are an integral part of the inflammation process. Within this context the mast cell occupies a key niche in orchestrating the inflammatory process, from initiation to prolongation. This review will describe the current state of knowledge concerning the biology of neuroinflammation, emphasizing mast cell-glia and glia-glia interactions, then conclude with a consideration of how a cell's endogenous mechanisms might be leveraged to provide a therapeutic strategy to target neuroinflammation.
Collapse
Affiliation(s)
- Stephen D Skaper
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Laura Facci
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Morena Zusso
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Pietro Giusti
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| |
Collapse
|
44
|
Khezrian M, Myint PK, McNeil C, Murray AD. A Review of Frailty Syndrome and Its Physical, Cognitive and Emotional Domains in the Elderly. Geriatrics (Basel) 2017; 2:geriatrics2040036. [PMID: 31011046 PMCID: PMC6371193 DOI: 10.3390/geriatrics2040036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Frailty, a very important complication of increasing age, is a well-recognised concept although it has not been accurately measured in the clinical setting. The aim of this literature review is to summarise commonly used frailty screening tools, and to describe how new measurement methods have been developed recently. Methods: Several frailty measurement tools including the most cited and newly developed scales have been described in this review. We searched the MEDLINE using the search terms; “frailty score, scale, tool, instrument, index, phenotype” and then summarised selected tools for physical, cognitive, emotional and co-morbidity domains. Results: The most cited frailty measurement methods developed from 1999 to 2005 are primarily criteria for physical frailty (e.g., frailty phenotype). More recently developed tools (e.g., triad of impairment and multidimensional frailty score) consider cognitive and emotional domains in addition to physical deficit in measuring frailty. Co-morbidity has also been considered as a domain of frailty in several measurement tools. Conclusion: Although frailty tools have traditionally assessed physical capability, cognitive and emotional impairment often co-exist in older adults and may have shared origins. Therefore, newer tools which provide a composite measure of frailty may be more relevant for future use.
Collapse
Affiliation(s)
- Mina Khezrian
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen AB25 2ZD, UK.
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.
| | - Christopher McNeil
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen AB25 2ZD, UK.
| | - Alison D Murray
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen AB25 2ZD, UK.
| |
Collapse
|
45
|
Amanzio M, Palermo S, Zucca M, Rosato R, Rubino E, Leotta D, Bartoli M, Rainero I. Neuropsychological Correlates of Pre-Frailty in Neurocognitive Disorders: A Possible Role for Metacognitive Dysfunction and Mood Changes. Front Med (Lausanne) 2017; 4:199. [PMID: 29188218 PMCID: PMC5694746 DOI: 10.3389/fmed.2017.00199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022] Open
Abstract
Background Recent studies have suggested that cognitive functions in patients with neurocognitive disorders have a significant role in the pathogenic mechanisms of frailty. Although pre-frailty is considered an intermediate, preclinical state, epidemiological research has begun to dislodge cognition and frailty into their specific subcomponents to understand the relationship among them. We aim to analyse the possible association between pre-frailty and neuropsychological variables to outline which factors can contribute to minor and major neurocognitive disorders. Methods 60 subjects complaining of different cognitive deficits underwent a deep-in-wide frailty and neuropsychological assessment. We conducted three multiple linear regression analyses adjusted for a combination of demographic measures and involving several neuropsychological–behavioural parameters selected by the literature on physical frailty. Results We found a significant association between frailty—as measured by the multidimensional prognostic index (MPI)—and action monitoring and monetary gain (cognitive domain), depression and disinhibition (behavioural domain). Moreover, an association between MPI and impaired awareness for instrumental activities disabilities exists. Conclusion We propose a novel framework for understanding frailty associated with metacognitive–executive dysfunction.
Collapse
Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy
| | - Milena Zucca
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy.,Unit of Cancer Epidemiology, "Città della Salute e della Scienza" Hospital and CPO Piemonte, Turin, Italy
| | - Elisa Rubino
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | | | - Innocenzo Rainero
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| |
Collapse
|
46
|
Carneiro JA, Ramos GCF, Barbosa ATF, Mendonça JMGD, Costa FMD, Caldeira AP. Prevalence and factors associated with frailty in non-institutionalized older adults. Rev Bras Enferm 2017; 69:435-42. [PMID: 27355291 DOI: 10.1590/0034-7167.2016690304i] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 11/28/2015] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE to investigate the prevalence and factors associated with frailty in non-institutionalized older adults living in northern Minas Gerais, Brazil. METHOD data were collected in their homes, in 2013, based on a census cluster sampling. Demographic and socioeconomic variables, morbidities, utilization of health care services, and scores on the Edmonton Fragility Scale were analyzed. The adjusted prevalence ratios were obtained using the Poisson regression multiple analysis with robust variance. RESULTS the prevalence of frailty was 41.3%. The variables associated with frailty were: female gender, very old age, education of less than four years, not having been hospitalized in the last 12 months, having a caregiver, falling in the prior year, diabetes mellitus, cardiac disease, and osteoarticular disease. CONCLUSION the prevalence of frailty was high. Some factors consist of modifiable conditions, which should encourage health actions aimed at this group.
Collapse
Affiliation(s)
- Jair Almeida Carneiro
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil
| | | | - Ana Teresa Fernandes Barbosa
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil
| | | | - Fernanda Marques da Costa
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil
| | - Antônio Prates Caldeira
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil
| |
Collapse
|
47
|
Dovjak P, Heinze G, Rainer A, Sipos W, Pietschmann P. Serum levels of Dickkopf-1 are a potential negative biomarker of survival in geriatric patients. Exp Gerontol 2017; 96:104-109. [DOI: 10.1016/j.exger.2017.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 04/25/2017] [Accepted: 06/02/2017] [Indexed: 12/15/2022]
|
48
|
Vu HTT, Nguyen TX, Nguyen TN, Nguyen AT, Cumming R, Hilmer S, Pham T. Prevalence of frailty and its associated factors in older hospitalised patients in Vietnam. BMC Geriatr 2017; 17:216. [PMID: 28923012 PMCID: PMC5603186 DOI: 10.1186/s12877-017-0609-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 09/06/2017] [Indexed: 02/07/2023] Open
Abstract
Background Frailty is an emerging issue in geriatrics and gerontology. The prevalence of frailty is increasing as the population ages. Like many developing countries, Vietnam has a rapidly ageing population. However, there have been no studies about frailty in older people in Vietnam. This study aims to investigate the prevalence of frailty and its associated factors in older hospitalised patients at the National Geriatric Hospital in Hanoi, Vietnam. Methods Prospective observational study in inpatients aged ≥60 years at the National Geriatric Hospital in Hanoi, Vietnam from 4/2015 to 10/2015. Frailty was assessed using the Reported Edmonton Frail Scale (REFS) and Fried frailty phenotype. Results A total of 461 patients were recruited (56.8% female, mean age 76.2 ± 8.9 years). The prevalence of frailty was 31.9% according to the REFS. Using the Fried frailty criteria, the percentages of non-frail, pre-frail and frail participants were 24.5, 40.1 and 35.4%, respectively. Factors associated with frailty defined by REFS were age (OR 1.05 per year, 95% CI 1.03–1.08), poor reported nutritional status (OR 4.51, 95% CI 2.15–9.44), and not finishing high school (OR 2.18, 95% CI 1.37–3.46). Factors associated with frailty defined by the Fried frailty criteria included age (OR 1.07 per year, 95% CI 1.05–1.10), poor reported nutritional status (OR 2.96, 95%CI 1.43–6.11), not finishing high school (OR 1.58, 95% CI 1.01–2.46) and cardiovascular disease (OR 1.76, 95% CI 1.16–2.67). Conclusions While further studies are needed to examine the impact of frailty on outcomes in Vietnam, the observed high prevalence of frailty in older inpatients is likely to have implications for health policy and planning for the ageing population in Vietnam.
Collapse
Affiliation(s)
- Huyen Thi Thanh Vu
- Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam. .,The National Geriatric Hospital, 01 Ton That Tung, Hanoi, Vietnam.
| | | | - Tu N Nguyen
- Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam.,The National Geriatric Hospital, 01 Ton That Tung, Hanoi, Vietnam
| | - Anh Trung Nguyen
- The National Geriatric Hospital, 01 Ton That Tung, Hanoi, Vietnam
| | - Robert Cumming
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Sarah Hilmer
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital and Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Thang Pham
- Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam.,The National Geriatric Hospital, 01 Ton That Tung, Hanoi, Vietnam
| |
Collapse
|
49
|
Taube E, Kristensson J, Midlöv P, Jakobsson U. The use of case management for community-dwelling older people: the effects on loneliness, symptoms of depression and life satisfaction in a randomised controlled trial. Scand J Caring Sci 2017; 32:889-901. [PMID: 28895175 DOI: 10.1111/scs.12520] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 08/15/2017] [Indexed: 12/21/2022]
Abstract
AIM To investigate the effects of a case management intervention for community-dwelling frail older people, with functional dependency and repeated contacts with the healthcare services, focusing on loneliness, depressive symptoms and life satisfaction. DESIGN A two-armed, nonblinded, randomised control trial with repeated follow-ups, of N = 153 participants at baseline allocated to an intervention (n = 80) and control (n = 73) group. METHOD Inclusion criteria were the following: ≥65 years of age, living in ordinary housing, in need of assistance in two or more self-reported activities of daily living, having at least two hospital admissions or at least four visits in outpatient care 12 months prior to enrolment. Case managers (nurses and physiotherapists) provided an intervention of general case management, general information, specific information and continuity and safety. The intervention ranged over 12 months with one or more home visit(s) being conducted per month. An intention-to-treat analysis was applied for the primary outcomes of loneliness, depressive symptoms and life satisfaction, along with complete case and sensitivity analyses. RESULTS During the trial period n = 12 died and n = 33 dropped out. No significant difference was found between the groups at baseline regarding sociodemographic characteristics, subjective health or primary outcomes. The intention-to-treat analysis did not result in any significant effects for the primary outcomes at any of the follow-ups (6 and 12 months). The complete case analysis resulted in a significant difference in favour of the intervention regarding loneliness (RR = 0.49, p = 0.028) and life satisfaction (ES = 0.41, p = 0.028) at 6 months and for depressive symptoms (ES = 0.47, p = 0.035) at 12 months. CONCLUSIONS The use of case management for frail older people did not result in clear favourable effects for the primary outcomes. However, the study indicates that case management may be beneficial in terms of these outcomes. Due to the complexity of the outcomes, an elaboration of the components and assessments is suggested.
Collapse
Affiliation(s)
- Elin Taube
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jimmie Kristensson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Ulf Jakobsson
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| |
Collapse
|
50
|
Patterns of Frailty and Quality of Life among Older Adults: Comparative Analysis Using SAGE States of India. JOURNAL OF POPULATION AGEING 2017. [DOI: 10.1007/s12062-017-9201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|