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Titou H, Bichra A, Bouhamidi A. Assessment, Prevalence, and Correlates of Frailty among Moroccan People Aged 50 and above Living with HIV. Int J Mycobacteriol 2024; 13:15-21. [PMID: 38771274 DOI: 10.4103/ijmy.ijmy_142_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/29/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Persons living with HIV experience many challenges, such as premature aging and geriatric syndromes. Frailty has become an important determinant of a series of adverse health outcomes. This research aimed to evaluate the prevalence and risk factors for frailty in this population. METHODS A cross-sectional outpatient investigation was conducted in an urban HIV clinic. Patients aged 50 and older living with HIV were included. Frailty phenotype was evaluated using the original Fried criteria, and we calculated the Veterans Aging Cohort Study (VACS) index, Charlson Comorbidity Index, Fracture Risk Assessment Tool scores, and Mini-mental State Exam scores. RESULTS One hundred and nine individuals were studied. Ninety-two (84.4%) were men, with a mean age of 57.65.2 years. Fourteen (12.8%) participants were frail. Frail participants were older (P = 0.001) and less likely to be virally suppressed (P = 0.01). Having ≥3 comorbidities, VACS index, polypharmacy, and 5-year mortality risk was significantly greater in the frail group. Frailty was significantly associated with poorer quality of life (P = 0.02). The cognitive impairment, falls, and malnutrition risk were significantly associated with a risk to manifest a frail phenotype. CONCLUSION Frailty is common among Moroccans with HIV, and it is associated with greater morbidity and mortality rates. Our findings should serve as a warning sign to standardize frailty and geriatric syndrome screening in this population.
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Affiliation(s)
- Hicham Titou
- Department of Dermatology-Venereology, Avicenne Military Hospital, Cadi Ayyad University, Marrakech, Morocco
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Chi CY, Wang J, Lee SY, Chao CT, Hung KY, Chien KL. The Impact of Glucose-Lowering Strategy on the Risk of Increasing Frailty Severity among 49,519 Patients with Diabetes Mellitus: A Longitudinal Cohort Study. Aging Dis 2023; 14:1917-1926. [PMID: 37196125 PMCID: PMC10529743 DOI: 10.14336/ad.2023.0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/25/2023] [Indexed: 05/19/2023] Open
Abstract
Patients with diabetes mellitus (DM) have a higher risk of incident and aggravating frailty over time. Frailty-initiating risk factors have been identified, but modulators of frail severity over time remain poorly defined. We aimed to explore the influences of glucose-lowering drug (GLD) strategy on DM patients' risk of increasing frail severity. We retrospectively identified type 2 DM patients between 2008 and 2016, dividing them into "no GLD", oral GLD (oGLD) monotherapy, oGLD combination, and those receiving insulin without or with oGLD at baseline. Increasing frail severity, defined as ≥1 FRAIL component increase, was the outcome of interest. Cox proportional hazard regression was utilized to analyze the risk of increasing frail severity associated with GLD strategy, accounting for demographic, physical data, comorbidities, medication, and laboratory panel. After screening 82,208 patients with DM, 49,519 (no GLD, 42.7%; monotherapy, 24.0%; combination, 28.5%; and insulin user, 4.8%) were enrolled for analysis. After 4 years, 12,295 (24.8%) had increasing frail severity. After multivariate adjustment, oGLD combination group exhibited a significantly lower risk of increasing frail severity (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.86 - 0.94), while the risk of insulin users increased (HR 1.11, 95% CI 1.02 - 1.21) than no GLD group. Users receiving more oGLD exhibited a trend of less risk reduction relative to others. In conclusion, we discovered that the strategy of oral glucose lowering drugs combination might reduce the risk of frail severity increase. Accordingly, medication reconciliation in frail diabetic older adults should take into account their GLD regimens.
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Affiliation(s)
- Chun-Yi Chi
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin County, Taiwan.
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Szu-Ying Lee
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin County, Taiwan.
| | - Chia-Ter Chao
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yu Hung
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Liu J, Cao Y, Wang Q, Wang Z, Luan X. Prevalence and influencing factors of frailty in older patients with diabetes in China: a system review and meta-analysis. Front Med (Lausanne) 2023; 10:1199203. [PMID: 37809331 PMCID: PMC10551624 DOI: 10.3389/fmed.2023.1199203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background and aims To systematically evaluate the relevant literature to explore the prevalence and influencing factors of frailty in older patients with diabetes in China. Methods Cochrane Library, PubMed, Embase, Medline, CINAHL, Scopus, Proquest Central, Web of Science, SinoMed, CNKI, VIP and Wan fang Databases were searched to collect Chinese and English literatures about frailty in older diabetic patients. RevMan 5.4 software was used to extract data for systematic review. Results Seventeen studies involving 23,070 older patients with diabetes were included. The results showed that the prevalence of frailty in older Chinese diabetic patients was 30%. The main influencing factors were HbA1c level, number of complications, age, depression, exercise, and nutritional status. Conclusion The prevalence of frailty in Chinese elderly diabetic patients is high and there are many influencing factors. However, the quality of relevant literature is general and the number is limited, so high-quality prospective studies should be carried out in the future to further verify the conclusions.
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Affiliation(s)
- Jian Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yanjun Cao
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qingjie Wang
- Endocrinology Department, Feicheng People's Hospital, Feicheng, Shandong, China
| | - Zhiwei Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaorong Luan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Infection Control, Qilu Hospital, Shandong University, Jinan, Shandong, China
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Keegan GL, Bhardwaj N, Abdelhafiz AH. The outcome of frailty in older people with diabetes as a function of glycaemic control and hypoglycaemic therapy: a review. Expert Rev Endocrinol Metab 2023; 18:361-375. [PMID: 37489773 DOI: 10.1080/17446651.2023.2239907] [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: 05/25/2023] [Revised: 07/08/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Frailty is an emerging and newly recognized complication of diabetes in older people. However, frailty is not thoroughly investigated in diabetes outcome studies. AREAS COVERED This manuscript reviews the effect of glycemic control and hypoglycemic therapy on the incidence of frailty in older people with diabetes. EXPERT OPINION Current studies show that both low glycemia and high glycemia are associated with frailty. However, most of the studies, especially low glycemia studies, are cross-sectional or retrospective, suggesting association, rather than causation, of frailty. In addition, frail patients in the low glycemia studies are characterized by lower body weight or lower body mass index (BMI), contrary to those in the high glycemia studies, who are either overweight or obese. This may suggest that frailty has a heterogeneous metabolic spectrum, starting with an anorexic malnourished (AM) phenotype at one end, which is associated with low glycemia and a sarcopenic obese (SO) phenotype on the other end, which is associated with high glycemia. The current little evidence suggests that poor glycemic control increases the risk of frailty, but there is a paucity of evidence to suggest that tight glycemic control would reduce the risk of incident frailty. Metformin is the only well-studied hypoglycemic agent, so far, to have a protective effect against frailty independent of glycemic control in the non-frail older people with diabetes. However, once frailty is developed, the choice of the best hypoglycemic agent for these patients will be affected by the metabolic phenotype of frailty. For example, sodium glucose transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RA) are appropriate in the SO phenotype due to their weight losing properties, while insulin therapy may be considered early in the AM phenotype due to its anabolic and weight gaining benefits. Future studies are still required to further investigate the metabolic effects of frailty on older people with diabetes, determine the most appropriate HbA1c target, and explore the most suitable hypoglycemic agent in each metabolic phenotype of frailty.
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Affiliation(s)
- Grace L Keegan
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
| | - Namita Bhardwaj
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
| | - Ahmed H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
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Azzoug C, Nuémi G, Menu D, De Maistre E, Boulin M, Putot A, Manckoundia P. Direct Oral Anticoagulants versus Vitamin K Antagonists in Individuals Aged 80 Years and Older: An Overview in 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1448. [PMID: 36674204 PMCID: PMC9859400 DOI: 10.3390/ijerph20021448] [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: 12/03/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Two main types of oral anticoagulants are available in France: vitamin K antagonists (VKA) and, more recently, direct oral anticoagulants (DOAC). The benefit−risk profile appears to be favorable for DOAC, which is as effective as VKA but safer (fewer cases of severe and cerebral bleeding). In a study in 2017, we observed that older adults did not seem to receive the same modalities of oral anticoagulants as younger individuals for various reasons. To assess anticoagulation prescribing practices over time, we repeated this cross-sectional study by comparing very old individuals taking DOAC to those taking VKA. Ambulatory individuals aged 80 years and older were included. They were affiliated with the Mutualité Sociale Agricole of Burgundy and were refunded for a medical prescription of oral anticoagulation in March 2021. The demographic characteristics, registered chronic diseases (RCD), number and types of prescribed drugs, and mortality of the DOAC group and the VKA group were compared. A total of 4275 subjects were included in the study: 67.44% (2883) received DOAC and 32.56% (1392) received VKA. The two groups were similar in age. In the DOAC group, there were more women (54.98% vs. 46.98%) (p < 0.001), fewer RCD (91.47% vs. 93.68%) (p = 0.014), and lower rates of venous thromboembolism (2.53% vs. 6.75%) (p < 0.001), severe heart failure (56.50% vs. 68.03%) (p < 0.001), and severe kidney diseases (1.38% vs. 3.59%) (p < 0.001), but there were more subjects with Alzheimer’s disease (7.49% vs. 4.31%) (p = 0.001). Individuals in the DOAC group had fewer prescriptions of furosemide (48.53% vs. 55.75%) (p < 0.001) and fibrates (2.32% vs. 3.88%) (p = 0.044). They also had more prescriptions of proton pump inhibitors (43.95% vs. 39.44%) (p = 0.006) and antirheumatics (1.60% vs. 0.65%) (p = 0.009) than those in the VKA group. There was no difference in mortality. This study revealed that prescribing practices for DOAC have changed over time.
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Affiliation(s)
- Chana Azzoug
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France
| | - Gilles Nuémi
- Medical Information Department, University Hospital, 21079 Dijon, France
| | - Didier Menu
- “Mutualité Sociale Agricole” of Burgundy Franche Comté, 21000 Dijon, France
| | | | - Mathieu Boulin
- Pharmacy Department, University Hospital, 21079 Dijon, France
| | - Alain Putot
- Department of Internal Medicine and Infectious Diseases, Pays du Mont Blanc Hospital, 74700 Sallanches, France
- Physiopathologie et Épidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy, 21000 Dijon, France
| | - Patrick Manckoundia
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France
- INSERM U-1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy, 21000 Dijon, France
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Barba C, Downer B, Clay OJ, Kennedy R, Ballard E, Crowe M. Healthcare utilization among pre-frail and frail Puerto Ricans. PLoS One 2023; 18:e0280128. [PMID: 36634091 PMCID: PMC9836292 DOI: 10.1371/journal.pone.0280128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Frailty is associated with adverse health outcomes and greater healthcare utilization. Less is known about the relationship between frailty and healthcare utilization in Puerto Rico, where high rates of chronic conditions and limited healthcare may put this group at a higher likelihood of using healthcare resources. This study examined the association between pre-frailty and frailty with healthcare utilization at baseline and 4-year follow-up among a cohort of community dwelling Puerto Ricans living on the island. We examined data from 3,040 Puerto Ricans (mean age 70.6 years) from The Puerto Rican Elderly: Health Conditions (PREHCO) study between 2002-2003 and 2006-2007. We used a modified version of the Fried criteria defined as 3 or more of the following: shrinking, weakness, poor energy, slowness, and low physical activity. Pre-frailty was defined as 1-2 components. The number of emergency room visits, hospital stays, and doctor visits within the last year were self-reported. Zero-inflated negative binomial regression models were used for ER visits and hospital stays. Negative binomial models were used for doctor visits. Pre-frailty was associated with a higher rate of doctor visits with a rate ratio of 1.11 (95% CI = 1.01-1.22) at baseline. Frailty was associated with a higher rate of ER visits (1.48, 95% CI = 1.13-1.95), hospital stays (1.69, 95% CI = 1.08-2.65), and doctor visits (1.24, 95% CI = 1.10-1.39) at baseline. Pre-frailty and frailty were not associated with any healthcare outcomes at follow-up. Pre-frailty and frailty are associated with an increased rate of healthcare services cross-sectionally among Puerto Rican adults, which may cause additional burdens on the already pressured healthcare infrastructure on the island.
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Affiliation(s)
- Cheyanne Barba
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, Unites States of America
| | - Brian Downer
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, Birmingham, Alabama, Unites States of America
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, Unites States of America
| | - Richard Kennedy
- Division of Gerontology, Geriatrics, & Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, Unites States of America
| | - Erin Ballard
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, Unites States of America
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, Unites States of America
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Abdelhafiz AH. Effects of hypoglycaemic therapy on frailty: a multi-dimensional perspective. Expert Rev Endocrinol Metab 2023; 18:53-65. [PMID: 36650694 DOI: 10.1080/17446651.2023.2168644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The prevalence of diabetes is increasing in older people. With increasing age, frailty emerges as a new complication leading to disability. Frailty does not only include physical dysfunction but also involves negative impact on cognition and mood. Triad of impairments (TOI) is a new concept that includes physical frailty, dementia and depression to reflect the wider spectrum of frailty. AREAS COVERED Little is known about effects of hypoglycaemic agents on frailty syndrome. A literature search was performed on studies, which reported effects of hypoglycaemic agents on the component of the TOI. EXPERT OPINION It appears that most hypoglycaemic agents have some effects on frailty, although the results of clinical studies are inconsistent. Metformin seems to have a consistent and a positive effect on physical frailty. Its effects on cognitive function, however, are inconclusive but tend to be positive. Metformin appeared to improve depressive symptoms. Other agents such as incretins, thiazolidinediones, and sodium glucose transporter-2 inhibitors have some positive effects on cognition and depression. Sulfonylureas, glinides, or insulin have either negative or neutral effects on TOI components. The negative effects of insulin could be partially explained by the negative psychological factors and the frequent episodes of hypoglycemia associated with such therapy.
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Affiliation(s)
- Ahmed H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, UK
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Liu H, Zhou W, Liu Q, Yu J, Wang C. Global Prevalence and Factors Associated with Frailty among Community-Dwelling Older Adults with Hypertension: A Systematic Review and Meta-Analysis. J Nutr Health Aging 2023; 27:1238-1247. [PMID: 38151875 DOI: 10.1007/s12603-023-2035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/06/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Frailty may increase the risk of adverse outcomes and the presence of comorbidities in hypertension. Understanding the prevalence of frailty in older adults with hypertension is of great importance, whereas estimates of the prevalence of frailty in this population vary greatly. OBJECTIVES A systematic review and meta-analysis was conducted to estimate the pooled prevalence of frailty and prefrailty among community-dwelling older adults with hypertension, and to examine the risk factors associated with (pre)frailty in this population. METHODS PubMed, Web of Science, The Cochrane Library, EMBASE, and CINAHL were searched from the inception to May 10, 2023. Investigators assessed eligibility, extracted data, and evaluated methodological quality. The pooled prevalence of frailty and prefrailty was calculated using the random-effects model. Meta-regression analysis and subgroup analysis were conducted to explore sources of heterogeneity. Sensitivity analysis was undertaken by the leave-one-out method and by removing studies with moderate/high risk of bias. The Mantel-Haenszel or inverse variance method was used to estimate risk factors of frailty. RESULTS A total of 14 studies met the inclusion criteria, involving 185,249 participants. The pooled prevalence in older adults with hypertension was 23% (95% CI 0.09-0.36) for frailty and 46% (95% CI 0.38-0.54) for prefrailty. The pooled prevalence of frailty was greater in studies with a higher proportion of females (24%, 95% CI 0.05-0.50), using multidimensional tools to define frailty (30%, 95% CI 0.10-0.51) and conducted in Western Pacific (27%, 95% CI 0.17-0.39). Age, female sex, depression, and previous hospitalizations were risk factors of frailty among older adults with hypertension. CONCLUSION Frailty and prefrailty are prevalent in community-dwelling older adults with hypertension, and limited risk factors are identified. This implicates the importance of frailty assessment integrated into the routine primary care for older adults with hypertension in community settings as well as the understanding of potential factors.
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Affiliation(s)
- H Liu
- Cuili Wang, PhD, is a senior research scientist, School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (C. Wang)
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Sinclair AJ, Abdelhafiz AH. Multimorbidity, Frailty and Diabetes in Older People-Identifying Interrelationships and Outcomes. J Pers Med 2022; 12:1911. [PMID: 36422087 PMCID: PMC9695437 DOI: 10.3390/jpm12111911] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 08/11/2023] Open
Abstract
Multimorbidity and frailty are highly prevalent in older people with diabetes. This high prevalence is likely due to a combination of ageing and diabetes-related complications and other diabetes-associated comorbidities. Both multimorbidity and frailty are associated with a wide range of adverse outcomes in older people with diabetes, which are proportionally related to the number of morbidities and to the severity of frailty. Although, the multimorbidity pattern or cluster of morbidities that have the most adverse effect are not yet well defined, it appears that mental health disorders enhance the multimorbidity-related adverse outcomes. Therefore, comprehensive diabetes guidelines that incorporate a holistic approach that includes screening and management of mental health disorders such as depression is required. The adverse outcomes predicted by multimorbidity and frailty appear to be similar and include an increased risk of health care utilisation, disability and mortality. The differential effect of one condition on outcomes, independent of the other, still needs future exploration. In addition, prospective clinical trials are required to investigate whether interventions to reduce multimorbidity and frailty both separately and in combination would improve clinical outcomes.
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Affiliation(s)
- Alan J. Sinclair
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Rotherham General Hospital Foundation Trust, Rotherham S60 2UD, UK
| | - Ahmed H. Abdelhafiz
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham S60 2UD, UK
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Abd.Ghafar MZA, O’Donovan M, Sezgin D, Moloney E, Rodríguez-Laso Á, Liew A, O’Caoimh R. Frailty and diabetes in older adults: Overview of current controversies and challenges in clinical practice. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:895313. [PMID: 36992729 PMCID: PMC10012063 DOI: 10.3389/fcdhc.2022.895313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Mohd Zaquan Arif Abd.Ghafar
- Faculty of Medicine, Universiti Teknologi MARA (Sungai Buloh), Selangor, Malaysia
- Geriatrics Unit, Selayang Hospital, Selangor, Malaysia
- *Correspondence: Mohd Zaquan Arif Abd.Ghafar,
| | - Mark O’Donovan
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
- Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
| | - Duygu Sezgin
- School of Nursing and Midwifery, Aras Moyola, National University of Ireland Galway, Galway, Ireland
| | - Elizabeth Moloney
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
- Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
| | - Ángel Rodríguez-Laso
- CIBERFES (Área temática de Fragilidad y Envejecimiento Saludable del Centros de Investigación Biomédica en Red), Instituto de Salud Carlos III, Madrid, Spain
| | - Aaron Liew
- Department of Endocrinology, National University of Ireland Galway, Galway, Ireland
| | - Rónán O’Caoimh
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
- Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
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Daou T, Abi Kharma J, Daccache A, Bassil M, Naja F, Rahi B. Association between Lebanese Mediterranean Diet and Frailty in Community-Dwelling Lebanese Older Adults-A Preliminary Study. Nutrients 2022; 14:nu14153084. [PMID: 35956260 PMCID: PMC9370448 DOI: 10.3390/nu14153084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023] Open
Abstract
Discrepancies in the characteristics of the food components of a Mediterranean diet exist based on the country of origin. In Lebanon, a traditional Mediterranean diet emphasizes the high intakes of fruits (including dried), vegetables, burghol, and dairy products. Therefore, this cross-sectional study aimed to explore the association between adherence to the Lebanese Mediterranean diet (LMD) and frailty among older adults in Lebanon. A total of 112 community-dwelling older adults aged ≥65 years were recruited. Demographic and clinical characteristics were collected through face-to-face interviews. A 61-item food frequency questionnaire (FFQ) was used to collect dietary intake data, and adherence to LMD was calculated. Physical frailty was defined by the presence of three out of the five criterion: weight loss, weakness, exhaustion, slowness, and low activity. Binary logistic regression was used to examine the relationship between LMD adherence and frailty while adjusting for several confounders. The participants’ mean age was 73 ± 12.8 and 65% were females. Sixteen (14.3%) individuals were identified as frail. Frail individuals were significantly older (p = 0.001), depressed (p < 0.001), at risk of cognitive impairment (p = 0.006), and reported polypharmacy (p = 0.003). No significant association was found between LMD adherence and frailty in fully adjusted models (OR = 0.195; 95% CI: 0.033−1.154; p = 0.071 when categorical and OR = 0.856; 95% CI: 0.668−1.097; p = 0.218 when continuous). We also performed additional analyses with a modified frailty index where house chores were not considered as part of leisure activities of the physical activity criterion. The results showed that a higher LMD adherence was associated with a significantly decreased frailty prevalence (OR = 0.123, 95% CI: 0.022−0.676, p = 0.016 when categorical and OR = 0.773, 95% CI 0.608−0.983, p = 0.036). Larger, longitudinal studies are needed to clarify the relationship between the adherence to the Lebanese Mediterranean diet and frailty in Lebanese older adults.
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Affiliation(s)
- Tracy Daou
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut 1102 2801, Lebanon; (T.D.); (J.A.K.); (A.D.)
| | - Joelle Abi Kharma
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut 1102 2801, Lebanon; (T.D.); (J.A.K.); (A.D.)
| | - Alexandra Daccache
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut 1102 2801, Lebanon; (T.D.); (J.A.K.); (A.D.)
| | - Maya Bassil
- Department of Human Nutrition, College of Health Sciences, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Farah Naja
- Department of Clinical Nutrition and Dietetics, Research Institute of Medical & Health Sciences (RIMHS), College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Berna Rahi
- Department of Family and Consumer Sciences, College of Health Sciences, Sam Houston State University, Huntsville, TX 77304, USA
- Correspondence: ; Tel.: +1-936-294-1986
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Wylie TAF, Morris A, Robertson E, Middleton A, Newbert C, Andersen B, Maltese G, Stocker R, Weightman A, Sinclair A, Bain SC. Ageing well with diabetes: A workshop to co-design research recommendations for improving the diabetes care of older people. Diabet Med 2022; 39:e14795. [PMID: 35064591 PMCID: PMC9303664 DOI: 10.1111/dme.14795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Abstract
AIMS To identify key research questions where answers could improve care for older people living with diabetes (PLWD), and provide detailed recommendations for researchers and research funders on how best to address them. METHODS A series of online research workshops were conducted, bringing together a range of PLWD and an acknowledged group of academic and clinical experts in their diabetes care to identify areas for future research. Throughout the pre-workshop phase, during each workshop, and in manuscript preparation and editing, PLWD played an active and dynamic role in discussions as part of both an iterative and narrative process. RESULTS The following key questions in this field were identified, and research recommendations for each were developed: How can we improve our understanding of the characteristics of older people living with diabetes (PLWD) and their outcomes, and can this deliver better person-centred care? How are services to care for older PLWD currently delivered, both for their diabetes and other conditions? How can we optimise and streamline the process and ensure everyone gets the best care, tailored to their individual needs? What tools might be used to evaluate the level of understanding of diabetes in the older population amongst non-specialist Healthcare Professionals (HCPs)? How can virtual experts or centres most effectively provide access to specialist multi-disciplinary team (MDT) expertise for older PLWD and the HCPs caring for them? Is a combination of exercise and a nutrition-dense, high protein diet effective in the prevention of the adverse effects of type 2 diabetes and deterioration in frailty, and how might this be delivered in a way which is acceptable to people with type 2 diabetes? How might we best use continuous glucose monitoring (CGM) in older people and, for those who require support, how should the data be shared? How can older PLWD be better empowered to manage their diabetes in their own home, particularly when living with additional long-term conditions? What are the benefits of models of peer support for older PLWD, both when living independently and when in care? CONCLUSIONS This paper outlines recommendations supported by PLWD through which new research could improve their diabetes care and calls on the research community and funders to address them in future research programmes and strategies.
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Affiliation(s)
| | | | | | | | | | | | - Giuseppe Maltese
- Epsom and St Helier University Hospitals, and King's CollegeLondonUK
| | - Rachel Stocker
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Andrew Weightman
- Department of MechanicalAerospace and Civil EngineeringThe University of ManchesterManchesterUK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People (fDROP) and King's CollegeLondonUK
| | - Stephen C. Bain
- Diabetes Research UnitSwansea University Medical SchoolSwanseaUK
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Hypoglycaemic therapy in frail older people with type 2 diabetes mellitus-a choice determined by metabolic phenotype. Aging Clin Exp Res 2022; 34:1949-1967. [PMID: 35723859 PMCID: PMC9208348 DOI: 10.1007/s40520-022-02142-8] [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: 12/27/2021] [Accepted: 04/21/2022] [Indexed: 11/01/2022]
Abstract
Frailty is a newly emerging complication of diabetes in older people and increasingly recognised in national and international clinical guidelines. However, frailty remains less clearly defined and frail older people with diabetes are rarely characterised. The general recommendation of clinical guidelines is to aim for a relaxed glycaemic control, mainly to avoid hypoglycaemia, in this often-vulnerable group of patients. With increasing age and development of frailty, body composition changes are characterised by an increase in visceral adipose tissue and a decrease in body muscle mass. Depending on the overall body weight, differential loss of muscle fibre types and body adipose/muscle tissue ratio, the presence of any associated frailty can be seen as a spectrum of metabolic phenotypes that vary in insulin resistance of which we have defined two specific phenotypes. The sarcopenic obese (SO) frail phenotype with increased visceral fat and increased insulin resistance on one side of spectrum and the anorexic malnourished (AM) frail phenotype with significant muscle loss and reduced insulin resistance on the other. In view of these varying metabolic phenotypes, the choice of hypoglycaemic therapy, glycaemic targets and overall goals of therapy are likely to be different. In the SO phenotype, weight-limiting hypoglycaemic agents, especially the new agents of GLP-1RA and SGLT-2 inhibitors, should be considered early on in therapy due to their benefits on weight reduction and ability to achieve tight glycaemic control where the focus will be on the reduction of cardiovascular risk. In the AM phenotype, weight-neutral agents or insulin therapy should be considered early on due to their benefits of limiting further weight loss and the possible anabolic effects of insulin. Here, the goals of therapy will be a combination of relaxed glycaemic control and avoidance of hypoglycaemia; and the focus will be on maintenance of a good quality of life. Future research is still required to develop novel hypoglycaemic agents with a positive effect on body composition in frailty and improvements in clinical outcomes.
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Perazza LR, Brown-Borg HM, Thompson LV. Physiological Systems in Promoting Frailty. Compr Physiol 2022; 12:3575-3620. [PMID: 35578945 DOI: 10.1002/cphy.c210034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Frailty is a complex syndrome affecting a growing sector of the global population as medical developments have advanced human mortality rates across the world. Our current understanding of frailty is derived from studies conducted in the laboratory as well as the clinic, which have generated largely phenotypic information. Far fewer studies have uncovered biological underpinnings driving the onset and progression of frailty, but the stage is set to advance the field with preclinical and clinical assessment tools, multiomics approaches together with physiological and biochemical methodologies. In this article, we provide comprehensive coverage of topics regarding frailty assessment, preclinical models, interventions, and challenges as well as clinical frameworks and prevalence. We also identify central biological mechanisms that may be at play including mitochondrial dysfunction, epigenetic alterations, and oxidative stress that in turn, affect metabolism, stress responses, and endocrine and neuromuscular systems. We review the role of metabolic syndrome, insulin resistance and visceral obesity, focusing on glucose homeostasis, adenosine monophosphate-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), and nicotinamide adenine dinucleotide (NAD+ ) as critical players influencing the age-related loss of health. We further focus on how immunometabolic dysfunction associates with oxidative stress in promoting sarcopenia, a key contributor to slowness, weakness, and fatigue. We explore the biological mechanisms involved in stem cell exhaustion that affect regeneration and may contribute to the frailty-associated decline in resilience and adaptation to stress. Together, an overview of the interplay of aging biology with genetic, lifestyle, and environmental factors that contribute to frailty, as well as potential therapeutic targets to lower risk and slow the progression of ongoing disease is covered. © 2022 American Physiological Society. Compr Physiol 12:1-46, 2022.
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Affiliation(s)
- Laís R Perazza
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Holly M Brown-Borg
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - LaDora V Thompson
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
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15
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Abdelhafiz AH, Sinclair AJ. Metabolic phenotypes explain the relationship between dysglycaemia and frailty in older people with type 2 diabetes. J Diabetes Complications 2022; 36:108144. [PMID: 35151546 DOI: 10.1016/j.jdiacomp.2022.108144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/17/2022] [Accepted: 01/29/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dysglycaemia (hyperglycaemia and hypoglycaemia) increase the risk of frailty in older people with diabetes, which appears contradictory. However, the characteristics of patients included in these studies are different and may reflect different metabolic phenotypes of frailty that may explain this apparent contradiction. AIMS To review the characteristics of frail patients included in clinical studies that reported an association between dysglycaemia and frailty in order to explore whether there is any metabolic differences in the profile of these patients. METHODS A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Key words around older people, type 2 diabetes mellitus, frailty, hyperglycaemia and low glycaemia were used in the literature search. RESULTS Only 8 studies met the inclusion criteria. Four studies investigated the risk of frailty associated with low glycaemia. Two studies showed that hypoglycaemia increased the risk of frailty by 44% (HR 1.60, 95% CI 1.14 to 2.42) and predicted greater level of dependency (p < 0.001), respectively. The other two studies reported that HbA1c inversely correlated with clinical frailty scale (r = -0.31, p < 0.01) and HbA1c < 6.0% was associated with increased risk of disability (3.45, 1.02 to 11.6), respectively. Compared with non-frail patients, those with frailty tended to have lower body weight or body mass index (BMI), have features of malnutrition such as low serum albumin or low total cholesterol and suffer from more comorbidities including dementia. Four studies explored the association of high glycaemia with frailty. Higher HbA1c predicted frailty (OR 1.43, 95% CI 1.045 to 1.97) and positively correlated with Edmonton frail score (r = 0.44, p < 0.001), respectively in two studies. The other two studies found that subjects with HbA1c ≥ 6.5% had the greatest prevalence of frailty (70.3%) and subjects with higher HbA1c at baseline to have a higher frailty level throughout later life, respectively. Compared with non-frail patients, those with frailty tended to have higher body weight, waist circumference and BMI. They also have less physical activity, higher cholesterol level and have more comorbidities. CONCLUSIONS Dysglycaemia increases the risk of frailty but the characteristics of patients in these studies suggest different metabolic phenotypes of frailty. Therefore, these metabolic differences in frailty should be taken into consideration in the management of older people with diabetes.
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Affiliation(s)
- A H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK
| | - A J Sinclair
- King's College, London, UK; Foundation for Diabetes Research in Older People (fDROP), Droitwich Spa WR9 0QH, UK.
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Study on Influencing Factors of Frailty in Elderly Patients with Type II Diabetes. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7244847. [PMID: 35132360 PMCID: PMC8817860 DOI: 10.1155/2022/7244847] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to analyze the influencing factors of frailty in elderly patients with type II diabetes. 332 elderly patients with type II diabetes admitted to our hospital from May 2018 to December 2019 were selected as the study subjects. The degree of frailty was evaluated by the Fried fragility phenotype scale, and the general information and the clinical data of patients were collected by inquiry and questionnaire survey. After that, all the data were analyzed by SPSS 20.0. Univariate analysis showed that there were significant differences in age, medication types, dietary habits, exercise tolerance, exercise capacity, body balance, coordination ability, urinary incontinence, anxiety, etc., in elderly patients with type II diabetes who suffered from different degrees of frailty (P < 0.01). In addition, there were significant differences in the presence of coronary heart disease, heart failure, atrial fibrillation, pulmonary diseases, osteoarticular diseases, anemia, and other blood diseases of elderly patients with type II diabetes who suffered from different degrees of frailty (P < 0.01). Multiple Logistic regression analyses indicated that weakened exercise tolerance, reduced exercise capacity, atrial fibrillation, anemia, and other blood diseases were the influencing factors of the frailty in elderly patients with type II diabetes. The degree of frailty in elderly patients with diabetes is affected by many factors, such as exercise tolerance, exercise capacity, atrial fibrillation, anemia, and other blood diseases; thus, reasonable intervention should be implemented for elderly patients with type II diabetes according to the influencing factors so as to effectively relieve frailty.
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Abstract
The increasing incidence of type 2 diabetes in the general population as well as enhanced life expectancy has resulted in a rapid rise in the prevalence of diabetes in the older population. Diabetes causes significant morbidity and impairs quality of life. Managing diabetes in older adults is a daunting task due to unique health and psychosocial challenges. Medical management is complicated by polypharmacy, cognitive impairment, urinary incontinence, injurious falls, and persistent pain. Health care providers now have several traditional and contemporary pharmacologic agents to manage diabetes. Avoidance of hypoglycemia is critical; however, evidence-based guidelines are lacking due to the paucity of clinical trials in older adults. For many in this population, maintaining independence is more important than adherence to published guidelines to prevent diabetes complications. The goal of diabetes care in older adults is to enhance the quality of life without subjecting these patients to intrusive and complicated interventions. Recent technological advancements such as continuous glucose monitoring systems can have crucial supplementary benefits in the geriatric population.
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Leme DEDC, Neri AL, Fattori A. How do the factors associated with frailty change with sex? An exploratory network analysis. J Gerontol A Biol Sci Med Sci 2021; 77:2023-2031. [PMID: 34893847 DOI: 10.1093/gerona/glab366] [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: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is important to study multiple social, physical and psychosocial factors associated with frailty in populations characterized by social and health disparities, such as men and women. METHODS This was a cross-sectional population-based study with older adults ≥65 years from the FIBRA (Frailty in Brazilian Older Adults) 2008-2009 study. We carried out a comparative analysis of the factors associated with the frailty phenotype in older men (N=706) and women (N=1.251) using networks based on mixed graphical models (MGM) according to sex. RESULTS In the male network, frailty was most strongly associated with years of schooling, overall satisfaction with life and falls; in the female network, the syndrome was associated with satisfaction with problem solving, depression and diabetes in addition to years of schooling. Furthermore, permutation tests showed that the networks for males and females were statistically different in terms of their structure, the global strength of the relationships and the strength of the relationships between frailty and diabetes; frailty and falls; frailty and depression; frailty and overall satisfaction with life; and frailty and satisfaction with problem solving (p<0.05). The walktrap network cluster detection algorithm revealed that in men, frailty was in a physical and social dimension while in women the syndrome was in a cardiometabolic and psychosocial dimension. CONCLUSIONS Network analysis showed that different factors are associated with frailty for each sex. The findings suggest that different strategies for dealing with frailty should be adopted for men and women so that care and prevention efforts can be directed appropriately.
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Affiliation(s)
| | - Anita Liberalesso Neri
- Graduate Program in Gerontology, School of Medical Sciences, UNICAMP, Campinas, São Paulo, Brazil
| | - André Fattori
- Graduate Program in Gerontology, School of Medical Sciences, UNICAMP, Campinas, São Paulo, Brazil
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19
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Abdelhafiz AH, Peters S, Sinclair AJ. Low glycaemic state increases risk of frailty and functional decline in older people with type 2 diabetes mellitus - Evidence from a systematic review. Diabetes Res Clin Pract 2021; 181:109085. [PMID: 34634389 DOI: 10.1016/j.diabres.2021.109085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/18/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
AIMS To explore risk of frailty and functional decline associated with low glycaemia in older people with type 2 diabetes. METHODS Systematic review. RESULTS 11 studies included. Six studies investigated risk of frailty or physical decline with hypoglycaemia. Hypoglycaemia increased risk of incident frailty (HR 1.60, 95% CI 1.14 to 2.42) in one study and risk of fractures in four studies (2.24, 1.56 to 3.21, 1.24, 1.13 to 1.37, 1.94, 1.67 to 2.24 and 1.71, 1.35 to 2.16 respectively). In sixth study, hypoglycaemia associated with dependency (P < 0.001). Five studies explored association of low blood glucose/HbA1c with frailty. One study showed that mean blood glucose decreased with increasing frailty (p = 0.003). Two studies reported that HbA1c inversely correlated with clinical frailty scale (r = -0.31, p < 0.01) and HbA1c < 6.9% increased risk of frailty (HR, 1.41 95% CI 1.12 to 1.78) respectively. Last two studies showed that HbA1c < 6.5% associated with risk of any fracture (HR 1.08, 95% CI 1.06 to 1.11) and HbA1c < 6.0% associated with increased risk of care need (3.45, 1.02 to 11.6) respectively. CONCLUSIONS Low glycaemia increases risk of frailty and functional decline in older people with type 2 diabetes. Management should minimise incidence of low glycaemia in these patients.
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Affiliation(s)
- A H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, United Kingdom
| | - S Peters
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, United Kingdom
| | - A J Sinclair
- King's College, London, United Kingdom; Foundation for Diabetes Research in Older People (fDROP), Droitwich Spa WR9 0QH, UK.
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Aliberti MJR, Szlejf C, Lima-Costa MF, de Andrade FB, Alexandre TS, Ferri CP, Suemoto CK. Frailty Modifies the Association of Hypertension With Cognition in Older Adults: Evidence From the ELSI-Brazil. J Gerontol A Biol Sci Med Sci 2021; 76:1134-1143. [PMID: 33420508 DOI: 10.1093/gerona/glaa303] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The relationship between hypertension and cognition in later life is controversial. We investigated whether the association of hypertension with cognition differs in older adults according to the frailty status using cross-sectional data from the Brazilian Longitudinal Study of Aging, a nationally representative sample of adults aged ≥50 years. METHOD Hypertension was defined by a medical diagnosis or measured blood pressure ≥140/90 mm Hg. Frailty status was assessed using the Cardiovascular Health Study criteria. We estimated the association of hypertension and systolic and diastolic blood pressure with global cognition, orientation, memory, and verbal fluency z-scores, using multiple linear regression models. We also investigated interactions between hypertension and frailty on cognitive performance and impairment. RESULTS We evaluated 8609 participants (mean age = 61.9 ± 9.6 years, 53% women). Participants with hypertension (59% of adults aged 50-64 and 77% of those aged ≥65 years) had poorer scores for global cognitive performance than those without hypertension, especially among adults aged 50-64 years (β = -0.09; 95% confidence interval = -0.15, -0.04; p = .001). However, frailty modified the associations of hypertension with cognitive performance and impairment in those aged ≥65 years (p-values for interaction = .01 and .02, respectively). Among nonfrail older adults, hypertension was associated with cognitive impairment. In contrast, among frail older adults, hypertension was related to better global and memory cognitive z-scores. CONCLUSIONS Hypertension was associated with worse cognitive performance. Among older adults, hypertension was related to cognitive impairment only in nonfrail participants. Frailty evaluation may help clinicians offer personalized hypertension management in older adults.
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Affiliation(s)
- Márlon J R Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil.,Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Claudia Szlejf
- Department of Diagnostic and Ambulatory Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Fabíola B de Andrade
- Rene Rachou Research Institute, Oswaldo Cruz Foundation (FIOCRUZ), Minas Gerais, Brazil
| | - Tiago S Alexandre
- Department of Gerontology, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Cleusa P Ferri
- Department of Psychiatry, Universidade Federal de Sao Paulo, Brazil
| | - Claudia K Suemoto
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
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Abdelhafiz AH, Emmerton D, Sinclair AJ. Impact of frailty metabolic phenotypes on the management of older people with type 2 diabetes mellitus. Geriatr Gerontol Int 2021; 21:614-622. [PMID: 34151494 DOI: 10.1111/ggi.14214] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/08/2021] [Accepted: 05/27/2021] [Indexed: 12/25/2022]
Abstract
AIMS To provide a pathophysiological basis for distinguishing metabolic variants of the frailty phenotype in older adults with type 2 diabetes. METHODS We have made an in-depth review of the possible mechanisms in diabetes, ageing and frailty that will alter allow us to describe phenotypic changes which might assist in predicting responses to particular glucose-lowering therapy. RESULTS Our review has enable us to describe with some confidence a sarcopenic obese phenotype and an anorexic malnourished phenotype. CONCLUSIONS By identifying these two phenotypes we can predict which would be most responsive to certain classes of therapy and where therapies may be ill-advised. This represents the first novel approach in this area. Further work is being planned to develop this hypothesis. Geriatr Gerontol Int 2021; 21: 614-622.
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Affiliation(s)
- Ahmed H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
| | - Demelza Emmerton
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
| | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa, UK
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22
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Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients Aged 80 Years and Older. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094443. [PMID: 33922331 PMCID: PMC8122810 DOI: 10.3390/ijerph18094443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
The effectiveness of direct oral anticoagulants (DOAC) is non-inferior to vitamin K antagonists (VKA) to treat atrial fibrillation and venous thromboembolism (VTE). In this cross-sectional study, we compared older persons taking DOACs to those taking VKAs. We included ambulatory individuals ≥80 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for a medical prescription in September 2017. The demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs were compared in the DOAC group and VKA group. Of the 3190 included individuals, 1279 (40%) were prescribed DOACs and 1911 (60%) VKAs. Individuals taking VKAs were older than those taking DOACs (87.11 vs. 86.35 years). In the DOAC group, there were more women (51.92% vs. 48.25%) (p = 0.043), less RCD (89.60% vs. 92.73%) (p = 0.002), less VTE (1.80% vs. 6.59%), less severe heart failure (58.09% vs. 67.87%), less severe hypertension (18.22% vs. 23.60%), less severe kidney diseases (1.49% vs. 3.82%), and fewer drugs per prescription (6.15 vs. 6.66) (p < 0.01 for all). The DOAC group were also less likely to be taking angiotensin receptor blockers (10.79% vs. 13.97%), furosemide (40.81% vs. 49.66%) or digoxin (10.32% vs. 13.66%) than the VKA group (p = 0.009, p < 0.001, and p = 0.005). DOACs were less prescribed than VKAs. Individuals taking VKAs were older and had more severe comorbidities and more drugs per prescription than those taking DOACs.
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Emmerton D, Abdelhafiz A. Newer anti-diabetic therapies with low hypoglycemic risk-potential advantages for frail older people. Hosp Pract (1995) 2021; 49:164-175. [PMID: 33729898 DOI: 10.1080/21548331.2021.1905414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The prevalence of diabetes is increasing due to increasing aging of the population. Hypoglycemia is a common diabetes-related complication in old age especially in patients with multiple comorbidities and frailty. Hypoglycemia and frailty appear to have a bidirectional relationship reenforcing each other in a negative downhill spiral that leads to an increased risk of adverse events including disability and mortality. The incidence of hypoglycemia in this age group is usually underestimated due to its atypical clinical presentation and difficult recognition by health care professionals. Guidelines generally recommend a relaxed glycemic control in frail older people with diabetes mainly due to the fear of anti-diabetic medications-induced hypoglycemia. The new anti-diabetic therapies of sodium-glucose co-transporter-2 (SGLT-2) inhibitors and glucagon like peptide-1 receptor agonists (GLP-1RA) have consistently shown a cardio-renal protective effect independent of their glycemic control. Contrary to the traditional hypoglycemic agents that either increase insulin stimulation or insulin sensitization with a potential hypoglycemic risk especially sulfonylureas, the new therapies have a novel anti-diabetic mechanisms of action that have a negligible risk of hypoglycemia. The new therapies appear to be both effective and well tolerated in old age. With appropriate patients' selection, most older people will be eligible for the new therapies if well tolerated and no contraindications. In frail older people, we suggest a pragmatic approach of the use of the new therapies based on the concept of the weight status rather than the frailty status. Frail patients with normal or excess weight are likely to gain most from the new therapies due to its favorable metabolic properties in this group, while the use in the underweight frail patients should be largely avoided especially in those with persistent anorexia and weight loss.
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Affiliation(s)
- Demelza Emmerton
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, United Kingdom of Great Britain and Northern Ireland
| | - Ahmed Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, United Kingdom of Great Britain and Northern Ireland
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Association between Frailty and Mortality, Falls, and Hospitalization among Patients with Hypertension: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2690296. [PMID: 33575325 PMCID: PMC7861941 DOI: 10.1155/2021/2690296] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 12/05/2020] [Accepted: 01/20/2021] [Indexed: 12/19/2022]
Abstract
Objective Chronological age alone does not adequately reflect the difference in health status of a patient with hypertension. Frailty is closely associated with biological age, and its assessment is clinically useful in addressing the heterogeneity of health status. The purpose of our study is to comprehensively examine the predictive value of frailty for negative health outcomes in hypertensive patients through a systematic review and meta-analysis. Methods Multiple English and Chinese databases were searched from inception to 04.11.2020. All cross-sectional and longitudinal studies that examined the association between frailty and relevant clinical outcomes among hypertensive patients were included. The NOS was used to assess the risk of bias of studies included in the analysis. Hazard ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were pooled for outcomes associated with frailty. Results Six longitudinal studies and one cross-sectional study involving 17403 patients with hypertension were included in the meta-analysis. The risk of bias of all included studies was rated as low or moderate. The pooled HR of frailty related to mortality was 2.45 (95% CI: 2.08-2.88). The pooled HR of prefrailty and frailty-related injurious falls was 1.07 (95% CI: 0.83-1.37) and 1.89 (95% CI: 1.56-2.27), respectively. The pooled HR of prefrailty and frailty-related hospitalization was 1.54 (95% CI: 1.38-1.71) and 1.94 (95% CI: 1.17-3.24), respectively. Conclusions This systematic review suggests that frailty was a strong predictor of mortality, hospitalization, and injurious falls among patients with hypertension. Our findings indicate that assessment of frailty in patients with hypertension to guide their management may be necessary in clinical setting. However, our finding was based on very limited amount studies; thus, future studies are required to further validate the role of frailty in prediction of negative health outcomes in hypertensive patients as well as pay more attention to the following knowledge gaps: (1) the association between frailty and hypertension-related outcomes, (2) the significance of the association between different frailty models and relevant clinical outcomes, and (3) the predictive value of prefrailty for the negative health outcomes in people with hypertension.
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Sinclair AJ, Abdelhafiz AH. Challenges and Strategies for Diabetes Management in Community-Living Older Adults. Diabetes Spectr 2020; 33:217-227. [PMID: 32848343 PMCID: PMC7428661 DOI: 10.2337/ds20-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The prevalence of diabetes is increasing, especially in older people, mainly because of an increase in life expectancy. The number of comorbidities also increases with increasing age, leading to a unique diabetes phenotype in old age that includes vascular disease, physical and neuropathic complications, and mental dysfunction. These three categories of complications appear to have a synergistic effect that can lead to a vicious cycle of deterioration into disability. Early assessment and appropriate, timely interventions may delay adverse outcomes. However, this complex phenotype constitutes a great challenge for health care professionals. This article reviews the complex diabetes phenotype in old age and explores management strategies that are predominantly based on the overall functional status of patients within this heterogeneous age-group.
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Affiliation(s)
- Alan J. Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd., Droitwich Spa, UK
- Kings College, London, UK
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McMillan JM, Gill MJ, Power C, Fujiwara E, Hogan DB, Rubin LH. Comorbidities in Older Persons with Controlled HIV Infection: Correlations with Frailty Index Subtypes. AIDS Patient Care STDS 2020; 34:284-294. [PMID: 32639207 DOI: 10.1089/apc.2020.0051] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Frailty is prevalent in persons with human immunodeficiency virus (PWH), but factors predisposing older PWH to frailty remain uncertain. We examined factors associated with frailty and determined whether there were multiple frailty subtypes in older adults with controlled HIV infection. This was a cross-sectional outpatient study in an urban HIV clinic. Twenty-nine clinical indicators were extracted from medical records to compute a Frailty Index (FI) for 389 older (age 50+) PWH (range = 50-93; mean = 61.1, standard deviation = 7.2; 85% men) receiving HIV treatment in Calgary, Canada. We used regressions to identify factors associated with FI values. Latent class analysis was used to identify FI subtypes. Age, employment status, and duration of known HIV infection were the strongest predictors of FI (p's < 0.05). Four FI subtypes were identified. Subtype 1 (severe metabolic dysfunction+polypharmacy) had the highest mean FI (0.30). Subtype 2 (less severe metabolic dysfunction+polypharmacy) and Subtype 3 (lung and liver dysfunction+polypharmacy) had lower but equivalent mean FIs (0.20 for each). Subtype 4 (least severe metabolic dysfunction) had the lowest mean FI (0.13; p's < 0.001). Sociodemographic and behavioral characteristics differed among the subtypes. Individuals with Subtype 1 were older and more frequently unemployed/retired, whereas those with Subtype 3 were more likely to smoke, use crack/cocaine, have heavy alcohol use, and live in temporary/unstable housing. The clinical presentation of frailty in older PWH is heterogeneous. The metabolic syndrome, hepatitis C virus coinfection, cirrhosis, lung disease, and polypharmacy were associated with frailty as were unemployment/retirement, unstable housing, and substance use.
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Affiliation(s)
- Jacqueline M. McMillan
- Section of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Canada
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael John Gill
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Christopher Power
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Esther Fujiwara
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - David B. Hogan
- Section of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Leah H. Rubin
- Department of Neurology and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Hironaka S, Kugimiya Y, Watanabe Y, Motokawa K, Hirano H, Kawai H, Kera T, Kojima M, Fujiwara Y, Ihara K, Kim H, Obuchi S, Kakinoki Y. Association between oral, social, and physical frailty in community-dwelling older adults. Arch Gerontol Geriatr 2020; 89:104105. [PMID: 32480111 DOI: 10.1016/j.archger.2020.104105] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Oral frailty (OF) has been shown to be a predictor of disability. Therefore, it is important to be able to identify factors associated with OF in order to prevent long-term dependence. The purpose of this study was to clarify the relationships between OF, social frailty (SF), and physical frailty (PF) in community-dwelling older adults, with the overarching aim of informing the future development of effective measures to prevent frailty. METHODS Oral, physical, and social function, nutritional and psychological status, and medical history were examined in 682 community-dwelling individuals (267 men, 415 women) aged ≥ 65 years. Ordinal logistic regression analysis with SF and PF as independent variables was performed with pass analysis to determine the relationship between the different types of frailty. RESULTS Logistic regression analysis revealed significant associations between OF and decline in social function, physical function, and nutritional status, and an increase in the number of medications used. Path analysis showed that SF was directly related to OF and that OF and SF were directly related to PF. CONCLUSIONS These findings suggest that a decline in social function may directly influence a decline in oral and physical function. The results of this study provide initial evidence, that may guide the future development of measures that aim to prevent and manage OF.
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Affiliation(s)
- Sanae Hironaka
- Department of Special Needs and Geriatric Dentistry, Kyushu Dental University, Kitakyushu, Japan; Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yoshihiro Kugimiya
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Yutaka Watanabe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan.
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Department of Oral Surgery and Dentistry, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Hisashi Kawai
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takeshi Kera
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Department of Physical Therapy, Takasaki University of Health and Welfare, Gunma, Japan
| | - Motonaga Kojima
- Department of Physical Therapy, University of Tokyo Health Sciences, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hunkyung Kim
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shuichi Obuchi
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yasuaki Kakinoki
- Department of Special Needs and Geriatric Dentistry, Kyushu Dental University, Kitakyushu, Japan
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Bilgin S, Aktas G, Kurtkulagi O, Atak BM, Duman TT. Edmonton frail score is associated with diabetic control in elderly type 2 diabetic subjects. J Diabetes Metab Disord 2020; 19:511-514. [PMID: 32550203 DOI: 10.1007/s40200-020-00542-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/29/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022]
Abstract
Purpose We aimed to observe clinical and laboratory indices of the diabetic subjects who were either frail or not according to Edmonton frail score. We also aimed to study whether Edmonton frail score was correlated with metabolic and other parameters of the diabetic subjects. Methods Patients with T2DM visited our clinic were enrolled to the study and grouped as either frail or not frail according to the Edmonton score. Clinical and laboratory parameters of the groups were compared. Results Serum triglyceride (p = 0.04), serum albumin (p = 0.006) and Glomerular Filtration Rate (GFR) (p = 0.01) were significantly lower, while fasting blood glucose (FBG) (p = 0.02), HDL cholesterol (p = 0.005) and glycated hemoglobin (HbA1c) (p = 0.04) were significantly higher in frail group compared to the not frail patients. Edmonton frail score was positively correlated with HbA1c, age, duration of T2DM, FBG, and negatively correlated with serum albumin and GFR levels. Conclusions We think that frailty is associated with poor glucose control in subjects with T2DM and better control of the disease may prevent or slow down the development of frailty, as well as microvascular complications in subjects with type 2 diabetes mellitus.
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Affiliation(s)
- Satilmis Bilgin
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Golkoy, Bolu, 14280 Turkey
| | - Gulali Aktas
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Golkoy, Bolu, 14280 Turkey
| | - Ozge Kurtkulagi
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Golkoy, Bolu, 14280 Turkey
| | - Burcin M Atak
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Golkoy, Bolu, 14280 Turkey
| | - Tuba T Duman
- Department of Internal Medicine, Abant Izzet Baysal University Hospital, Golkoy, Bolu, 14280 Turkey
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Abdelhafiz AH, Davies PC, Sinclair AJ. Triad of impairment in older people with diabetes-reciprocal relations and clinical implications. Diabetes Res Clin Pract 2020; 161:108065. [PMID: 32044347 DOI: 10.1016/j.diabres.2020.108065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 12/25/2022]
Abstract
Frailty is emerging as a new category complication of diabetes in older people. Clinically, frailty is still not well defined and mostly viewed as a decline in solely the physical domain. However, frailty is a multidimensional syndrome and the newly introduced concept of "triad of impairment" (physical, cognitive and emotional) may be a more representative of the broad nature of frailty. The components of the triad of impairment (TOI) commonly coexist and demonstrate a reciprocal relation. Diabetes in old age appears to increase the risk of the triad of impairment, which may eventually progress to disability. Therefore, older people with diabetes should be regularly assessed for the presence of these three key components. Adequate nutrition and regular resistance exercise training have been shown to have a positive impact on the long-term outcome in this population. However, the role of good glycaemic control and the use of current hypoglycaemic medications in reducing the incidence of this triad are less clear. Future research is needed to develop novel hypoglycaemic medications that not only focus on glycaemic control and cardiovascular safety but also on reducing the risk of the triad of impairment.
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Affiliation(s)
- A H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK.
| | - P C Davies
- 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
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Sugimoto K, Rakugi H, Kojima T, Ishii S, Akishita M, Tamura Y, Araki A, Kozaki K, Senda K, Fukuoka H, Satake S, Arai H. Chapter 4 Frailty and specific diseases. Geriatr Gerontol Int 2020; 20 Suppl 1:25-37. [PMID: 32050299 DOI: 10.1111/ggi.13833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ken Sugimoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Shinya Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Kyorin University, School of Medicine, Mitaka, Japan
| | - Kazuyoshi Senda
- Department of Clinical Research Promotion, Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hideki Fukuoka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shosuke Satake
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Gray CA, Sims OT, Oh H. Prevalence and Predictors of Co-occurring Hypertension and Depression Among Community-Dwelling Older Adults. J Racial Ethn Health Disparities 2020; 7:365-373. [DOI: 10.1007/s40615-019-00665-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022]
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Pérez-Zepeda MU, García-Peña C, Carrillo-Vega MF. Individual and cumulative association of commonly used biomarkers on frailty: a cross-sectional analysis of the Mexican Health and Aging Study. Aging Clin Exp Res 2019; 31:1429-1434. [PMID: 30706427 DOI: 10.1007/s40520-019-01127-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/11/2019] [Indexed: 01/07/2023]
Abstract
Frailty has been recognized as a common condition in older adults, however, there is scarce information on the association between frailty and commonly used biomarkers. The aim of this study was to assess the individual and cumulative association of biomarkers with frailty status. This is a cross-sectional analysis of the 2012 wave of the Mexican Health and Aging Study. A sub-sample of 60-year or older adults with anthropometric measurements was analyzed. Frailty was defined with a 31-item frailty index and those considered frail had a score ≥ 0.21. Biomarkers were further categorized as normal/abnormal and tested both one by one and grouped (according to their usual cutoff values). Adjusted logistic models were performed. A total of 1128 older adults were analyzed and their mean age was 69.45 years and 51.24% of them were women. 26.7% (n = 301) were categorized as frail. Individual biomarkers associated with frailty after adjusting for confounding were: hemoglobin [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.13-2.46, p = 0.009], glycated hemoglobin (OR 2.04, 95% CI 1.54-2.7, p < 0.001) and vitamin D (OR 1.53, 95% CI 1.13-2.07, p = 0.005). Those with ≥ 4 abnormal biomarkers had an independent association with frailty when compared to those without any abnormal biomarker (OR 2.64, 95% CI 1.3-5.25, p = 0.005). Aside from the individual associations of specific biomarkers, our findings show that an incremental association of abnormal biomarkers increases the probability of frailty, accounting for the multidimensional nature of frailty and the possible interplay between components of the system that potentiate to give rise to a negative condition such as frailty.
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Affiliation(s)
- Mario Ulises Pérez-Zepeda
- Instituto Nacional de Geriatría, Mexico, México
- Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - María Fernanda Carrillo-Vega
- Instituto Nacional de Geriatría, Periférico Sur 2767, colonia San Jerónimo Lídice, delegación Magdalena Contreras, 10200, Mexico, Mexico.
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Kawada T. Frailty and mortality in patients with hypertension. J Clin Hypertens (Greenwich) 2019; 21:437. [DOI: 10.1111/jch.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public HealthNippon Medical School Tokyo Japan
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Vetrano DL, Palmer KM, Galluzzo L, Giampaoli S, Marengoni A, Bernabei R, Onder G. Hypertension and frailty: a systematic review and meta-analysis. BMJ Open 2018; 8:e024406. [PMID: 30593554 PMCID: PMC6318510 DOI: 10.1136/bmjopen-2018-024406] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To review the association between hypertension and frailty in observational studies. DESIGN A systematic review of the PubMed, Web of Science and Embase databases was performed. A meta-analysis was performed if at least three studies used the same definition of frailty and a dichotomous definition of hypertension. SETTING, PARTICIPANTS AND MEASURES Studies providing information on the association between frailty and hypertension in adult persons, regardless of the study setting, study design or definition of hypertension and frailty were included. RESULTS Among the initial 964 articles identified, 27 were included in the review. Four longitudinal studies examined the incidence of frailty according to baseline hypertension status, providing conflicting results. Twenty-three studies assessed the cross-sectional association between frailty and hypertension: 13 of them reported a significantly higher prevalence of frailty in hypertensive participants and 10 found no significant association. The pooled prevalence of hypertension in frail individuals was 72% (95% CI 66% to 79%) and the pooled prevalence of frailty in individuals with hypertension was 14% (95% CI 12% to 17%). Five studies, including a total of 7656 participants, reported estimates for the association between frailty and hypertension (pooled OR 1.33; 95% CI 0.94 to 1.89). CONCLUSIONS Frailty is common in persons with hypertension. Given the possible influence of frailty on the risk-benefit ratio of treatment for hypertension and its high prevalence, it is important to assess the presence of this condition in persons with hypertension. TRIAL REGISTRATION NUMBER CRD42017058303.
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Affiliation(s)
- Davide L Vetrano
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Geriatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Lucia Galluzzo
- Department of Cardiovascular, Dysmetabolic and Ageing-Associated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Simona Giampaoli
- Department of Cardiovascular, Dysmetabolic and Ageing-Associated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Li CL, Stanaway FF, Lin JD, Chang HY. Frailty and health care use among community-dwelling older adults with diabetes: a population-based study. Clin Interv Aging 2018; 13:2295-2300. [PMID: 30519011 PMCID: PMC6233865 DOI: 10.2147/cia.s183681] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose The aims of this study were to investigate the prevalence of frailty and its relationship with health care use among community-dwelling older adults with diabetes. Methods We analyzed data from a nationally representative sample of people aged 65 years and above (n=3,203) participating in the 2013 National Health Interview Survey in Taiwan. A total of 719 participants had a history of self-reported physician-diagnosed diabetes. The presence of frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale proposed by the International Association of Nutrition and Aging. FRAIL scores range from 0 to 5 and are categorized as frail (3–5), pre-frail (1–2), and robust (0). Participants were asked whether they had been hospitalized or had visited an emergency department in the past year. Results Among community-dwelling older adults with diabetes, 9.4% of participants were frail and 35.3 % were pre-frail. After adjustment for other factors, being frail was significantly associated with hospitalization during the past year (OR =5.31, 95% CI =1.87–15.10), whereas being pre-frail was not associated with hospitalization. Both being pre-frail and frail were significantly associated with emergency department visits during the past year (OR =2.64, 95% CI =1.35–5.17 and OR =4.05, 95% CI =1.31–12.49, respectively) after adjustment for other factors. Conclusion Our results highlight the high prevalence of frailty in community-dwelling older adults with diabetes. Furthermore, being frail is associated with a greater burden of hospitalizations and emergency department visits.
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Affiliation(s)
- Chia-Lin Li
- Department of Health Care Management, College of Management, Chang Gung University, Kwei-Shan, Tao-Yuan 333, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Tao-Yuan 333, Taiwan
| | - Fiona F Stanaway
- Sydney School of Public Health, University of Sydney, Sydney 2006, NSW, Australia
| | - Jen-Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Tao-Yuan 333, Taiwan
| | - Hsing-Yi Chang
- Division of Preventive Medicine and Health Service Research, Institute of Population Health Sciences, National Health Research Institutes, Maoli 350, Taiwan,
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Tamura Y, Ishikawa J, Fujiwara Y, Tanaka M, Kanazawa N, Chiba Y, Iizuka A, Kaito S, Tanaka J, Sugie M, Nishimura T, Kanemaru A, Shimoji K, Hirano H, Furuta K, Kitamura A, Seino S, Shinkai S, Harada K, Kyo S, Ito H, Araki A. Prevalence of frailty, cognitive impairment, and sarcopenia in outpatients with cardiometabolic disease in a frailty clinic. BMC Geriatr 2018; 18:264. [PMID: 30400831 PMCID: PMC6219198 DOI: 10.1186/s12877-018-0955-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 10/18/2018] [Indexed: 12/25/2022] Open
Abstract
Background Although frailty and cognitive impairment are critical risk factors for disability and mortality in the general population of older inhabitants, the prevalence and incidence of these factors in individuals treated in the specialty outpatient clinics are unknown. Methods We recently established a frailty clinic for comprehensive assessments of conditions such as frailty, sarcopenia, and cognition, and planned 3-year prospective observational study to identify the risk factors for progression of these aging-related statuses. To date, we recruited 323 patients who revealed symptoms suggestive of frailty mainly from a specialty outpatient clinic of cardiology and diabetes. Frailty status was diagnosed by the modified Cardiovascular Health Study (mCHS) criteria and some other scales. Cognitive function was assessed by Mini-Mental State Examination (MMSE), Japanese version of the Montreal Cognitive Assessment (MoCA-J), and some other modalities. Sarcopenia was defined by the criteria of the Asian Working Group for Sarcopenia (AWGS). In this report, we outlined our frailty clinic and analyzed the background characteristics of the subjects. Results Most patients reported hypertension (78%), diabetes mellitus (57%), or dyslipidemia (63%), and cardiovascular disease and probable heart failure also had a higher prevalence. The prevalence of frailty diagnosed according to the mCHS criteria, cognitive impairment defined by MMSE (≤27) and MoCA-J (≤25), and of AWGS-defined sarcopenia were 24, 41, and 84, and 31%, respectively. The prevalence of frailty and cognitive impairment increased with aging, whereas the increase in sarcopenia prevalence plateaued after the age of 80 years. No significant differences were observed in the prevalence of frailty, cognitive impairment, and sarcopenia between the groups with and without diabetes mellitus, hypertension, or dyslipidemia with a few exceptions, presumably due to the high-risk subjects who had multiple cardiovascular comorbidities. A majority of the frail and sarcopenic patients revealed cognitive impairment, whereas the frequency of suspected dementia among these patients were both approximately 20%. Conclusions We found a high prevalence of frailty, cognitive impairment, and sarcopenia in patients with cardiometabolic disease in our frailty clinic. Comprehensive assessment of the high-risk patients could be useful to identify the risk factors for progression of frailty and cognitive decline.
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Affiliation(s)
- Yoshiaki Tamura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Masashi Tanaka
- Department of Clinical Laboratory, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Nobuo Kanazawa
- Department of Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Yuko Chiba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Ai Iizuka
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Sho Kaito
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Jun Tanaka
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Masamitsu Sugie
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Akiko Kanemaru
- Department of Rehabilitation, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Keigo Shimoji
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Hirohiko Hirano
- Department of Dentistry and Oral Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Ko Furuta
- Department of Psychiatry, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Akihiko Kitamura
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Satoshi Seino
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shoji Shinkai
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kazumasa Harada
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Shunei Kyo
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Hideki Ito
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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Ma L, Zhang L, Sun F, Li Y, Tang Z. Frailty in Chinese older adults with hypertension: Prevalence, associated factors, and prediction for long-term mortality. J Clin Hypertens (Greenwich) 2018; 20:1595-1602. [PMID: 30318776 DOI: 10.1111/jch.13405] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/20/2018] [Accepted: 09/07/2018] [Indexed: 11/30/2022]
Abstract
Hypertension and frailty are associated and often coexist in older adults. Few studies have examined the association between hypertension and frailty in Chinese population. We explored the prevalence of and the factors associated with frailty as well as whether frailty could identify patients at risk of adverse outcomes among older adults with hypertension. Data were from the Beijing Longitudinal Study of Aging. A total of 1111 hypertensive participants aged ≥60 years old who completed the comprehensive geriatrics assessment were included. All participants were followed up for 8 years. The total number of deaths was 604. Frailty was assessed by the 68-item frailty index. Stepwise forward logistic regression was used to explore the association between the associated factors and frailty in hypertensive participants. The prediction for mortality was assessed using the adjusted Cox proportional hazards model. Two hundred and eighteen older adults were determined as frail (prevalence rate: 19.6%). Frail older adults with hypertension had worse physical performance, worse psychological, and social function, as well as worse lifestyle habits, compared to nonfrail older adults with hypertension. Chair stand test failure, balance test failure, fracture, disability, depression, and physical frailty measured with modified frailty phenotype were independently associated with frailty. Frailty was associated with a higher 8-year mortality, hazard ratio (HR) = 3.40, adjusted for age and sex, HR = 2.61. Frailty is associated with poorer physical function and higher mortality in community-dwelling hypertensive older adults in China. These findings emphasize the importance and need for frailty intervention and prevention in older adults with hypertension.
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Affiliation(s)
- Lina Ma
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Geriatrics, Beijing, China.,Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China.,China National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Li Zhang
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Geriatrics, Beijing, China.,Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China.,China National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Fei Sun
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Geriatrics, Beijing, China.,Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China.,China National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Yun Li
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Geriatrics, Beijing, China.,Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China.,China National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Zhe Tang
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Geriatrics, Beijing, China.,Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China.,China National Clinical Research Center for Geriatric Disorders, Beijing, China
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Bustamante AV, Vilar-Compte M, Ochoa Lagunas A. Social support and chronic disease management among older adults of Mexican heritage: A U.S.-Mexico perspective. Soc Sci Med 2018; 216:107-113. [PMID: 30292581 DOI: 10.1016/j.socscimed.2018.09.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/02/2018] [Accepted: 09/14/2018] [Indexed: 01/16/2023]
Abstract
This study explores the association between social support and chronic disease self-management among older adults of Mexican heritage who live in the U.S. and Mexico. We hypothesize that social support increases the ability to manage hypertension and Type 2 (T2) diabetes, regardless of place of residence. We also investigate if differences in country of residence and health system factors influence the ability to manage chronic conditions. Older adults 65 years or older from Los Angeles (LA) and Mexico City (CDMX), with diagnosed hypertension or T2 diabetes (self-reported), attending government agencies, participated in the study. The statistical analyses investigate differences between older adults in LA and CDMX; identify the association between social support and chronic disease self-management; and examine the role of T2 diabetes treatment, testing and complications on self-management. Our study findings show that social support was a statistically significant predictor of improved T2 diabetes self-management (37%-51%, p < 0.05). The association between social support and hypertension self-management was only significant (90% confidence level) for adherence to weight management and increased alcohol consumption. Our study did not identify statistically significant differences in social support between LA and CDMX. However, almost 40% of sampled older adults were at risk of social isolation, signaling a vulnerable population that needs to be targeted by health and social systems in the U.S. and Mexico. Our study also shows that social support is a strong predictor of improved T2 diabetes management in the U.S. and Mexico. While older adults in the U.S. and Mexico reported similar access to care and health insurance coverage, higher adherence to low salt diets in LA and reduced coverage of glucose testing in CDMX could signal areas of opportunity for policymakers. Health care providers in both countries need to identify ways of improving adherence to physical activity and weight management.
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Affiliation(s)
- Arturo Vargas Bustamante
- Department of Health Policy & Management, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South Room 31-299C, Box 951772, Los Angeles, CA, 90095, USA.
| | - Mireya Vilar-Compte
- Department of Health Studies, Universidad Iberoamricana, Prolongación Paseo de Reforma 880, Lomas de Santa Fe, CP 01219, CDMX, Mexico.
| | - Adriana Ochoa Lagunas
- University of Sussex in Brighton, Guillermo Prieto 25 Bis, Lomas Quebradas Magdalena Contreras, CP 10000, CDMX, Mexico.
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Sims OT, Oh H, Noh H, Melton PA, Sheffield S, Ingram K, Sawyer P. Prevalence and predictors of co-occurring diabetes and hypertension in community-dwelling older adults. Geriatr Gerontol Int 2018; 18:1356-1360. [PMID: 30094913 DOI: 10.1111/ggi.13489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/09/2018] [Accepted: 06/15/2018] [Indexed: 01/02/2023]
Abstract
AIM The objectives of the present study were to estimate the prevalence of co-occurring diabetes and hypertension among older adults, examine predictors of co-occurring diabetes and hypertension, and ascertain whether predictors varied by race. METHODS A retrospective analysis was carried out using a statewide survey of Alabama community-dwelling older adults (n = 1204). Measures of central tendency and frequency distributions were used for univariate analysis. Logistic regression was used to predict co-occurring diabetes and hypertension. RESULTS The prevalence of co-occurring diabetes and hypertension among older adults was 17%. African American race (OR 2.28, 95% CI 1.596-3.255), body mass index ≥30 (OR 2.45, 95% CI 1.732-3.463), heart disease (OR 1.93, 95% CI 1.355-2.756) and eye disease (OR 1.44, 95% CI 1.018-2.024) were associated positively with co-occurring diabetes and hypertension. CONCLUSIONS The prevalence of co-occurring diabetes and hypertension among older adults was alarmingly high. The notable difference in the likelihood of co-occurring diabetes and hypertension is representative of a racial health disparity that largely disfavors African American older adults. Findings from the present study highlight a need for identification of older adults who have and who are at risk of co-occurring diabetes and hypertension in the general population and in clinical settings, and the development and implementation of suitable interventions, particularly targeting older African American adults. Geriatr Gerontol Int 2018; 18: 1356-1360.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Comprehensive Center for Healthy Aging, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hyejung Oh
- Department of Social Work, School of Social Sciences & Education, California State University Bakersfield, Bakersfield, California, USA
| | - Hyunjin Noh
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Pamela A Melton
- Department of Social Work, Psychology and Counseling, College of Education, Humanities, and Behavioral Sciences, Alabama A&M University, Normal, Alabama, USA
| | - Samantha Sheffield
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kacey Ingram
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patricia Sawyer
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Adame Perez SI, Senior PA, Field CJ, Jindal K, Mager DR. Frailty, Health-Related Quality of Life, Cognition, Depression, Vitamin D and Health-Care Utilization in an Ambulatory Adult Population With Type 1 or Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Cross-Sectional Analysis. Can J Diabetes 2018; 43:90-97. [PMID: 30139571 DOI: 10.1016/j.jcjd.2018.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Frailty can cause increased vulnerability to adverse health outcomes, such as falls, fractures, depression and reduced health-related quality of life (HRQoL). This cross-sectional study compared the differences in body composition, HRQoL, mental health and cognitive and vitamin D (vitD) status with health-care utilization by frail and nonfrail adults with diabetes mellitus (type 1 and type 2) and with chronic kidney disease (stages 1 through 5). METHODS We studied adults with type 1 and type 2 diabetes and chronic kidney disease stages 1 through 5 who were participating in a longitudinal follow-up study (41 to 83 years of age; n=41). Body composition (dual-energy x-ray absorptiometry); vitD status (serum 25[OH]D3); frailty (Edmonton Frail Scale); depression (Major Depression Inventory); HRQoL (Short Form Health Survey-36); and cognitive status (Mini Mental State exam) were measured using validated tools. Participants who were on dialysis and had body weights >136 kg, and coinciding comorbidities known to influence vitD metabolism were excluded. RESULTS Frailty occurred in 17% of participants (n=7). Frail participants had lower lean body mass, lower HRQoL scores (individual and composite scores), more depression (p=<0.05) and higher numbers of health visits (total, inpatient and emergency) compared with nonfrail participants (p<0.05). No differences in health-care visit types or vitD status were noted between frail and nonfrail participants (p>0.05). CONCLUSIONS Frailty in an ambulatory population of adults with chronic kidney disease and diabetes is associated with low lean body mass, low HRQoL, greater depression and higher numbers of health-care visits.
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Affiliation(s)
- Stephany I Adame Perez
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Peter A Senior
- Department of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Kailash Jindal
- Northern Alberta Renal Program, Alberta Health Services and Department of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Diana R Mager
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
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Aprahamian I, Sassaki E, Dos Santos MF, Izbicki R, Pulgrossi RC, Biella MM, Borges ACN, Sassaki MM, Torres LM, Fernandez ÍS, Pião OA, Castro PLM, Fontenele PA, Yassuda MS. Hypertension and frailty in older adults. J Clin Hypertens (Greenwich) 2017; 20:186-192. [PMID: 29105991 DOI: 10.1111/jch.13135] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/15/2017] [Accepted: 08/23/2017] [Indexed: 01/16/2023]
Abstract
The association between hypertension and frailty syndrome in older adults remains unclear. There is scarce information about the prevalence of hypertension among frail elderly patients or on its relationship with frailty. Up to one quarter of frail elderly patients present without comorbidity or disability, yet frailty is a leading cause of death. The knowledge and better control of frailty risk factors could influence prognosis. The present study evaluated: (1) the prevalence of hypertension in robust, prefrail, and frail elderly; and (2) factors that might be associated with frailty including hypertension. A cross-sectional study was conducted in 619 older adults at a university-based outpatient center. Study protocol included sociodemographic data, measures of blood pressure and body mass index, frailty screening according to the internationally validated FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, number of comorbidities, drug use assessment, physical activity, cognitive status, and activities of daily living. Ordinal logistic regression was used to evaluate factors associated with frailty. Prevalence of hypertension and frailty was 67.3% and 14.8%, respectively, in the total sample. Hypertension was more prevalent in the prefrail (72.5%) and frail (83%) groups than among controls (51.7%). Hypertension, physical activity, number of prescribed drugs, and cognitive performance were significantly associated with frailty status. Hypertension presented an odds ratio of 1.77 towards frailty (95% confidence interval, 1.21-2.60; P = .002). Hypertension was more prevalent in frail elderly patients and was significantly associated with frailty. Intensive control of hypertension could influence the trajectory of frailty, and this hypothesis should be explored in future prospective clinical trials.
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Affiliation(s)
- Ivan Aprahamian
- Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, São Paulo, Brazil.,Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Eduardo Sassaki
- Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, São Paulo, Brazil
| | - Marília F Dos Santos
- Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, São Paulo, Brazil
| | - Rafael Izbicki
- Department of Statistics, Federal University of São Carlos, São Carlos, Brazil
| | - Rafael C Pulgrossi
- Department of Statistics, Federal University of São Carlos, São Carlos, Brazil
| | - Marina M Biella
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ana Camila N Borges
- Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, São Paulo, Brazil
| | - Marcela M Sassaki
- Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, São Paulo, Brazil
| | - Leonardo M Torres
- Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, São Paulo, Brazil
| | - Ícaro S Fernandez
- Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, São Paulo, Brazil
| | - Olívia A Pião
- Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, São Paulo, Brazil
| | - Paula L M Castro
- Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, São Paulo, Brazil
| | - Pedro A Fontenele
- Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, São Paulo, Brazil
| | - Mônica S Yassuda
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
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Mair ML, Athavale R, Abdelhafiz AH. Practical considerations for managing patients with diabetes and dementia. Expert Rev Endocrinol Metab 2017; 12:429-440. [PMID: 30063433 DOI: 10.1080/17446651.2017.1395692] [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] [Indexed: 10/18/2022]
Abstract
Diabetes and dementia appear to be linked epidemiologically and share a common pathogenetic mechanism. The development of dementia in older people with diabetes will have a significant impact on diabetes self-care and will increase the risk of hypoglycaemia and frailty which ultimately lead to disability and poor outcome. Areas covered: We performed a Medline and Embase search from 1997 to present on relevant dementia and diabetes studies published in English language. Expert commentary: Older people with comorbid diabetes and dementia are functionally heterogeneous and interventions should be proportionate to patients 'functional capacity. Metabolic targets can be tightened in fit persons and relaxed when cognitive abilities continue to decline and overall function deteriorates. A holistic multidisciplinary team approach that involves patients, their carers and integrated primary and secondary care services at one point of care that focuses on improving function and maintaining quality of life is needed.
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Affiliation(s)
- Michelle L Mair
- a Department of Geriatric Medicine , Rotherham General Hospital , Rotherham , UK
| | - Rohin Athavale
- a Department of Geriatric Medicine , Rotherham General Hospital , Rotherham , UK
| | - Ahmed H Abdelhafiz
- a Department of Geriatric Medicine , Rotherham General Hospital , Rotherham , UK
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43
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Hazuda HP, Espinoza SE. Prevention of Falls and Frailty in Older Adults with Diabetes. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Castrejón-Pérez RC, Jiménez-Corona A, Bernabé E, Villa-Romero AR, Arrivé E, Dartigues JF, Gutiérrez-Robledo LM, Borges-Yáñez SA. Oral Disease and 3-Year Incidence of Frailty in Mexican Older Adults. J Gerontol A Biol Sci Med Sci 2017; 72:951-957. [PMID: 28329793 DOI: 10.1093/gerona/glw201] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 09/24/2016] [Indexed: 01/31/2023] Open
Abstract
Background Poor oral health has been associated with some components of frailty. The objective of this study was to identify the association between clinical measures of oral health and the incidence of frailty among community-dwelling older adults aged 70 or older in Mexico City. Methods A 3-year cohort study with a probabilistic representative sample of home-dwelling elders of one district of Mexico City was performed. Baseline and follow-up interview and oral clinical evaluations were carried out by standardized examiners in participants' homes. Dependent variable was incident frailty defined according to the frailty phenotype. Independent variables were the utilization of dental services, the presence of xerostomia, the number of natural teeth, use of removable dental prostheses, presence of severe periodontitis, and presence of root remnants. Sociodemographic, behavioral, and health measures were included as confounders. The association between oral health conditions and incident frailty was modeled using Poisson regression models with robust variance estimators. The models were adjusted for confounders and interactions. Results We identified a 14.8% cumulative incidence of frailty. Each additional tooth was associated with a lower probability of developing frailty by 5.0% (risk ratio = 0.90; 95% CI 1.02-1.10). The 3-year risk ratio of developing frailty was 2.13 times higher (95% CI 1.01-4.50) among participants having severe periodontitis. Conclusions The number of teeth and the presence of severe periodontitis are associated with the development of frailty after controlling for confounders. Further studies are needed on this topic.
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Affiliation(s)
- Roberto Carlos Castrejón-Pérez
- National Institute of Geriatrics, National Institutes of Health, Mexico.,Department of Geriatric Clinical and Epidemiological Research, National Institute of Geriatrics, National institutes of Health, Mexico
| | - Aida Jiménez-Corona
- Department of Ocular Epidemiology, Ophthalmic Institute "Conde de Valenciana,"Mexico
| | - Eduardo Bernabé
- Unit of Dental Public Health, King's College London Dental Institute, UK
| | - Antonio R Villa-Romero
- Department of Research Methodology, School of Medicine, National Autonomous University of Mexico, México
| | - Elise Arrivé
- Department of Epidemiology, Public Health and Development, Inserm U 897, Université de Bordeaux II, France
| | - Jean-François Dartigues
- Department of Epidemiology, Public Health and Development, Inserm U 897, Université de Bordeaux II, France
| | | | - S Aída Borges-Yáñez
- Department of Dental Public Health, Graduate and Research Division, Dental School, National Autonomous University of Mexico, Mexico
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Association between Frailty and Hypertension Prevalence, Treatment, and Control in the Elderly Korean Population. Sci Rep 2017; 7:7542. [PMID: 28790349 PMCID: PMC5548733 DOI: 10.1038/s41598-017-07449-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/26/2017] [Indexed: 11/19/2022] Open
Abstract
Frailty is a common geriatric syndrome characterized by increased risk of disability, hospitalization, and mortality. Hypertension (HTN) is one of the most common chronic medical conditions in the elderly. However, there have been few studies regarding the association between frailty and HTN prevalence, treatment, and control rates. We analyzed data of 4,352 older adults (age ≥ 65 years) from the fifth Korea National Health and Nutrition Examination Survey. We constructed a frailty index based on 42 items and classified participants as robust, pre-frail, or frail. Of the subjects, 2,697 (62.0%) had HTN and 926 (21.3%) had pre-HTN. Regarding frailty status, 721 (16.6%), 1,707 (39.2%), and 1,924 (44.2%) individuals were classified as robust, pre-frail and frail, respectively. HTN prevalence was higher in frail elderly (67.8%) than pre-frail (60.8%) or robust elderly (49.2%) (P < 0.001). Among hypertensive patients, frail elderly were more likely to be treated than pre-frail or robust elderly (P < 0.001), but the proportion of patients whose blood pressure was under control ( < 150/90 mmHg) was lower in frail elderly (P = 0.005). Considering the adverse cardiovascular outcomes associated with frailty, more attention should be paid to the blood pressure control of the frail elderly.
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