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Bos P, Monden R, Benraad C, Groot J, Oude Voshaar R, Hanssen D. Latent profile analysis of biopsychosocial measures in older patients with (un)explained persistent somatic symptoms. Compr Psychiatry 2024; 135:152527. [PMID: 39208557 DOI: 10.1016/j.comppsych.2024.152527] [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: 04/10/2024] [Revised: 08/15/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024] Open
Abstract
Patients with persistent somatic symptoms (PSS) often receive either somatic or psychiatric care, depending on whether symptoms are respectively medically explained (MES) or unexplained (MUS). This separation may not be as clinically relevant as previously assumed; however, research on data-driven subgroups within cohorts of older patients with PSS is not available. Our goal is to identify more clinically relevant homogeneous subgroups beyond the distinction of MUS and MES among older patients with PSS by using a data-driven approach. We performed two Latent Profile Analyses (LPAs), one focused on 6 somatic health measures, the other on 6 psychosocial measures, using data from a case-control study with participants (>60 years) with MUS (N = 118) or MES (N = 154), recruited from the general public, general practices and secondary healthcare. We identified two somatic-health based (strong, vulnerable) and four mental-health based (strong, vulnerable, lonely, non-acceptance) profiles. We found no statistically significant overlap between the somatic - and mental health profiles (κ = 0.019). Health related quality of life negatively associated with the mentally - and somatically vulnerable profiles. We conclude that singular focus on MUS/MES distinction in the care for older PSS patients may lead to undertreatment of the most vulnerable patients. Integrated care is recommended when treating persistent somatic symptoms in later life, regardless of the (un)explained origin of the symptoms.
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Affiliation(s)
- Pauline Bos
- Lentis Psychiatric Institute, Center for Old Age Psychiatry and Somatic Care, E61, 9471 KE Zuidlaren, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Hanzeplein 1, Groningen, 9700 RB, the Netherlands.
| | - Rei Monden
- Hiroshima University, 1 Chome-7-1 Kagamiyama, Higashihiroshima, Hiroshima 739-8521, Japan.
| | - Carolien Benraad
- Radboud University Medical Center Nijmegen, Department of Geriatrics, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
| | - Janneke Groot
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Hanzeplein 1, Groningen, 9700 RB, the Netherlands.
| | - Richard Oude Voshaar
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Hanzeplein 1, Groningen, 9700 RB, the Netherlands.
| | - Denise Hanssen
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Hanzeplein 1, Groningen, 9700 RB, the Netherlands.
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Marcozzi S, Bigossi G, Giuliani ME, Giacconi R, Piacenza F, Cardelli M, Brunetti D, Segala A, Valerio A, Nisoli E, Lattanzio F, Provinciali M, Malavolta M. Cellular senescence and frailty: a comprehensive insight into the causal links. GeroScience 2023; 45:3267-3305. [PMID: 37792158 PMCID: PMC10643740 DOI: 10.1007/s11357-023-00960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/24/2023] [Indexed: 10/05/2023] Open
Abstract
Senescent cells may have a prominent role in driving inflammation and frailty. The impact of cellular senescence on frailty varies depending on the assessment tool used, as it is influenced by the criteria or items predominantly affected by senescent cells and the varying weights assigned to these items across different health domains. To address this challenge, we undertook a thorough review of all available studies involving gain- or loss-of-function experiments as well as interventions targeting senescent cells, focusing our attention on those studies that examined outcomes based on the individual frailty phenotype criteria or specific items used to calculate two humans (35 and 70 items) and one mouse (31 items) frailty indexes. Based on the calculation of a simple "evidence score," we found that the burden of senescent cells related to musculoskeletal and cerebral health has the strongest causal link to frailty. We deem that insight into these mechanisms may not only contribute to clarifying the role of cellular senescence in frailty but could additionally provide multiple therapeutic opportunities to help the future development of a desirable personalized therapy in these extremely heterogeneous patients.
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Affiliation(s)
- Serena Marcozzi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
- Scientific Direction, IRCCS INRCA, 60124, Ancona, Italy
| | - Giorgia Bigossi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Maria Elisa Giuliani
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Robertina Giacconi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Francesco Piacenza
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Maurizio Cardelli
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Dario Brunetti
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20126, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20129, Milan, Italy
| | - Agnese Segala
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa, 11, 25123, Brescia, Italy
| | - Alessandra Valerio
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa, 11, 25123, Brescia, Italy
| | - Enzo Nisoli
- Center for Study and Research On Obesity, Department of Medical Biotechnology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20129, Milan, Italy
| | | | - Mauro Provinciali
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Marco Malavolta
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy.
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Hu Y, Wang Z, Wu L. Multidimensional health heterogeneity of Chinese older adults and its determinants. SSM Popul Health 2023; 24:101547. [PMID: 38021459 PMCID: PMC10661850 DOI: 10.1016/j.ssmph.2023.101547] [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: 06/15/2023] [Revised: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Nowadays, the "Healthy China" and "Actively Addressing Population Aging" are two important national strategies in China. Promoting high-quality development of demand-driven older adults health services is an important way to achieve these strategies. From the perspective of active ageing, assessing the health status of older adults from multiple dimensions becomes crucial as it helps identify their specific health service needs, intervention measures, and health policies tailored to this population. Methods Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) wave 4 (2018). A total of 4190 older adults (aged ≥60 years) were included as the analysis sample. Latent class analysis was performed to categorize older adults based on 6 health indicators, including Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), doctor diagnosed chronic diseases, depressive symptoms, cognitive function, and social participation. Multinomial logistic model was used to explore determinants associated with the various patterns of multidimensional health of older adults. Results The multidimensional health of older people was classified into three latent classes: Relatively Healthy (Class 1, n = 2806, 66.97%), Highly Depressed and Relatively Health Risk (Class 2, n = 1189, 28.38%), and Functional Impairment (Class 3, n = 195, 4.65%). Gender, age, education, marital status, number of children, alcohol consumption, physical activity, savings, residence, air quality satisfaction, and medical service satisfaction had significant effects on the attribution of all multidimensional health latent classes. Conclusion Heterogeneous and multidimensional health classes exist in China's older population, and these classes are influenced by a variety of factors and to varying degrees. Policymakers and healthcare providers can use these evidence to further address the diverse needs of older adults and improve older-care health services, ultimately achieving the goal of Active Ageing and Healthy China.
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Affiliation(s)
- Yi Hu
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, 518028, China
| | - Zhenyu Wang
- School of Government, Sun Yat-sen University, Guangzhou, Guangdong, 510006, China
| | - Liqun Wu
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, 518028, China
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Goggins S. The importance of a comprehensive geriatric assessment for older people admitted onto a virtual ward. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:882-889. [PMID: 37830865 DOI: 10.12968/bjon.2023.32.18.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
A comprehensive geriatric assessment (CGA) provides a holistic assessment for the frail and older person. The CGA considers physical and mental conditions as well as function, environmental and a person's social circumstances. Virtual wards are a new concept within the NHS, and use of virtual wards during the COVID-19 pandemic reduced hospital admissions by 50%. The British Geriatrics Society has set clear guidelines on how virtual wards should be developed within integrated care services via multidisciplinary community rapid response teams to improve patient outcomes. This article considers a logical approach to assessing suitability for admission onto a virtual ward for a patient who required hospital-at-home services. It does this through the use of a theoretical patient case study, in this case involving delirium and urinary tract infection. Frailty and frailty scoring tools are discussed, as are the advantages and disadvantages of a CGA, considering a clear progression through the five domains. It shows how conducting a CGA allows for the development of a problem list to help prioritise the patient's problems and plan accordingly. A critical review of the literature around virtual wards, hospital-at-home services and admission avoidance identified that community rapid response teams were the logical choice to provide a multidisciplinary holistic approach to the older person admitted onto a virtual ward.
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Affiliation(s)
- Suzanne Goggins
- Consultant Practitioner, Northern Care Alliance NHS Foundation Trust/Bury Local Care Organisation, Bury
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Fluit M, Bortolotti T, Broekhuis M, van Teerns M. Segmenting citizens according to their self-sufficiency: A tool for local government. Soc Sci Med 2023; 335:116246. [PMID: 37741189 DOI: 10.1016/j.socscimed.2023.116246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/02/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
Identifying subgroups of citizens with varying levels of self-sufficiency in a large local or regional population provides local government with essential input for providing matching services and well-grounded spending of health and well-being expenditures. This paper identifies self-sufficiency levels of citizens by segmenting a broad adult population. We used data from a citizen survey based on a randomly selected response group containing questions on a wide range of topics, including finances, health and living conditions, and complemented these data with registration data, including information on housing type and household composition. We conducted a latent class cluster analysis using six indicators: perception of making ends meet, perceived health, quality of life, self-efficacy, access to socialsupport and social network. High scores on the indicators translate to high levels of self-sufficiency. We used a biased-adjusted, three-step approach to characterise the segments. Six meaningful segments were identified and labelled as 'highly self-sufficient,' 'self-sufficient - medium access to social support,' 'self-sufficient - medium self-efficacy,' 'moderately self-sufficient - low self-efficacy & high social network,' 'moderately self-sufficient - low access to social support/social network & high perceived health' and 'not self-sufficient.' At a macro level, perception of making ends meet and quality of life have discriminating value in assessing self-sufficiency. For a more detailed differentiation between groups with similar levels of self-sufficiency, perceived health, self-efficacy, access to socialsupport, and social network are valuable indicators. Overall, this study introduces a comprehensive tool to assess self-sufficiency in larger groups of citizens by using a parsimonious number of indicators. Local and regional governments can apply this tool to effectively assess the self-sufficiency levels of their population and signal potentially vulnerable groups. In this way, the tool makes the identification of self-sufficiency levels of larger populations more feasible and more efficient and can be widely adopted in different contexts.
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Affiliation(s)
- Marleen Fluit
- Department of Operations Management, University of Groningen, the Netherlands, P.O. Box 800, 9700, AV, Groningen.
| | - Thomas Bortolotti
- Department of Operations Management, University of Groningen, the Netherlands, P.O. Box 800, 9700, AV, Groningen.
| | - Manda Broekhuis
- Department of Operations Management, University of Groningen, the Netherlands, P.O. Box 800, 9700, AV, Groningen.
| | - Mayan van Teerns
- Onderzoek Informatie en Statistiek, Municipality of Groningen, the Netherlands, P.O. 30026, 9700, RM, Groningen.
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Li G, Pan Y. Can the Frailty of Older Adults in China Change? Evidence from a Random-Intercept Latent Transition Profile Analysis. Behav Sci (Basel) 2023; 13:723. [PMID: 37754001 PMCID: PMC10525735 DOI: 10.3390/bs13090723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/18/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND A major aspect of caring for older adults in the medical field is addressing their health risks. The term "frailty" is generally used to describe the changes in health risks of older adults. Although there is considerable heterogeneity in the Chinese older adult population who are classified as frail, there remain few relevant studies. Furthermore, there is a lack of research on the frailty status transitions of older Chinese adults at different time points. This research intends to determine the frailty status and category of older adults according to their physical, psychological, social, and cognitive function domains, and on this basis, to investigate changes in their frailty states. METHODS This article studied 2791 respondents who were over 60 years old (n = 2791; 53.2% were women) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) follow-up survey on factors affecting the health of older adults in China. In this article, the frailty variables include self-reported health, social function, mental health, cognitive function, functional limitations, and morbidity status. Random-intercept latent transition profile analysis (RI-LTPA) was used to divide older adults into different subgroups, and then an in-depth analysis of the state transitions was conducted. RESULTS The latent profile analysis revealed that the evaluation results of the frailty state of older adults showed obvious group heterogeneity. Each fitting index supported four latent states, which were named according to the degree of the symptoms (i.e., multi-frailty, severe socially frailty, mild socially frailty, and relatively healthy frailty). Based on the categorical probability and the probability of transition, it can be concluded that most of the samples belonged to the healthy population, and the health status had generally improved across the four time points. The relatively healthy frailty group and the severe socially frailty group have relatively strong stabilities. The multi-frailty group and the mild socially frailty group had the highest probability of joining to the relatively healthy frailty group. Strengthening social interactions among older adults and promoting their participation in social activities can significantly improve their frail state. CONCLUSIONS This study supplements related research on frailty. Firstly, it deepens the meaning of frailty, which is defined based on four aspects: physical, psychological, cognitive, and social functioning. Secondly, it divides frailty into different sub-categories. Frailty is discussed from the perspective of longitudinal research, which can provide practical adjustment suggestions for older adult nursing intervention systems and measures in China.
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Affiliation(s)
- Guangming Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou 510631, China
- School of Psychology, Center for Studies of Psychological Application and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Yuxi Pan
- School of Psychology, Center for Studies of Psychological Application and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
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Loh DA, Naqiah Hairi N, Mohd Hairi F, Peramalah D, Kandiben S, Abd Hamid MAI, Bulgiba A, Salam M, Said MA, Rizal H, Danaee M, Choo WY. Effects of a Multicomponent Exercise and Therapeutic Lifestyle (CERgAS) Intervention on Gait Function in Lower-Income Urban-Dwelling Older Adults: A Cluster Randomized Controlled Trial. J Aging Phys Act 2023; 31:531-540. [PMID: 36509091 DOI: 10.1123/japa.2022-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 12/14/2022]
Abstract
This study aims to determine the effectiveness of a multicomponent exercise and therapeutic lifestyle (CERgAS) intervention at improving gait speed among older people in an urban poor setting in Malaysia. A total of 249 participants were divided into the intervention (n = 163) and control (n = 86) groups. The mean (SD) age of participants was 67.83 (6.37) and consisted of 88 (35.3%) males and 161 (64.7%) females. A generalized estimating equation with an intention-to-treat analysis was used to measure gait speed at four time points, baseline (T0), 6 weeks (T1), 3 months postintervention (T2), and 6 months postintervention (T3). The results showed significant changes for time between T0 and T3 (mean difference = 0.0882, p = .001), whereas no significant association were found for group (p = .650) and interaction (p = .348) effects. A 6-week intervention is inadequate to improve gait speed. Future efforts should introduce physical activity monitoring and increase exercise duration, frequency, and intensity.
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Affiliation(s)
- Debbie Ann Loh
- Centre for Epidemiology and Evidence-based Practice (CEBP), Department of Social and Preventive Medicine, Faculty of Medicine,Universiti Malaya, Kuala Lumpur,Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
| | - Noran Naqiah Hairi
- Centre for Epidemiology and Evidence-based Practice (CEBP), Department of Social and Preventive Medicine, Faculty of Medicine,Universiti Malaya, Kuala Lumpur,Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
| | - Farizah Mohd Hairi
- Centre for Epidemiology and Evidence-based Practice (CEBP), Department of Social and Preventive Medicine, Faculty of Medicine,Universiti Malaya, Kuala Lumpur,Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
| | - Devi Peramalah
- Centre for Epidemiology and Evidence-based Practice (CEBP), Department of Social and Preventive Medicine, Faculty of Medicine,Universiti Malaya, Kuala Lumpur,Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
| | - Shathanapriya Kandiben
- Centre for Epidemiology and Evidence-based Practice (CEBP), Department of Social and Preventive Medicine, Faculty of Medicine,Universiti Malaya, Kuala Lumpur,Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
| | - Mohd Alif Idham Abd Hamid
- Centre for Epidemiology and Evidence-based Practice (CEBP), Department of Social and Preventive Medicine, Faculty of Medicine,Universiti Malaya, Kuala Lumpur,Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
| | - Awang Bulgiba
- Centre for Epidemiology and Evidence-based Practice (CEBP), Department of Social and Preventive Medicine, Faculty of Medicine,Universiti Malaya, Kuala Lumpur,Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
| | - Mushtahid Salam
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
| | - Mas Ayu Said
- Centre for Epidemiology and Evidence-based Practice (CEBP), Department of Social and Preventive Medicine, Faculty of Medicine,Universiti Malaya, Kuala Lumpur,Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
| | - Hussein Rizal
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya,Kuala Lumpur,Malaysia
| | - Mahmoud Danaee
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
| | - Wan Yuen Choo
- Centre for Epidemiology and Evidence-based Practice (CEBP), Department of Social and Preventive Medicine, Faculty of Medicine,Universiti Malaya, Kuala Lumpur,Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur,Malaysia
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Fan S, Ye J, Xu Q, Peng R, Hu B, Pei Z, Yang Z, Xu F. Digital health technology combining wearable gait sensors and machine learning improve the accuracy in prediction of frailty. Front Public Health 2023; 11:1169083. [PMID: 37546315 PMCID: PMC10402732 DOI: 10.3389/fpubh.2023.1169083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background Frailty is a dynamic and complex geriatric condition characterized by multi-domain declines in physiological, gait and cognitive function. This study examined whether digital health technology can facilitate frailty identification and improve the efficiency of diagnosis by optimizing analytical and machine learning approaches using select factors from comprehensive geriatric assessment and gait characteristics. Methods As part of an ongoing study on observational study of Aging, we prospectively recruited 214 individuals living independently in the community of Southern China. Clinical information and fragility were assessed using comprehensive geriatric assessment (CGA). Digital tool box consisted of wearable sensor-enabled 6-min walk test (6MWT) and five machine learning algorithms allowing feature selections and frailty classifications. Results It was found that a model combining CGA and gait parameters was successful in predicting frailty. The combination of these features in a machine learning model performed better than using either CGA or gait parameters alone, with an area under the curve of 0.93. The performance of the machine learning models improved by 4.3-11.4% after further feature selection using a smaller subset of 16 variables. SHapley Additive exPlanation (SHAP) dependence plot analysis revealed that the most important features for predicting frailty were large-step walking speed, average step size, age, total step walking distance, and Mini Mental State Examination score. Conclusion This study provides evidence that digital health technology can be used for predicting frailty and identifying the key gait parameters in targeted health assessments.
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Affiliation(s)
- Shaoyi Fan
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jieshun Ye
- School of Civil Engineering and Transportation, South China University of Technology, Guangzhou, China
| | - Qing Xu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Runxin Peng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bin Hu
- Division of Translational Neuroscience, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zhong Pei
- Department of Neurology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhimin Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Fuping Xu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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9
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Hudgins BL, Hevel DJ, Maher JP. Screen-based and non-screen-based sedentary behaviors are differentially associated with affective states in older adults. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 67:102433. [PMID: 37665886 DOI: 10.1016/j.psychsport.2023.102433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 09/06/2023]
Abstract
Excessive sedentary behavior (SB) contributes to poor affective and physical feeling states, which is particularly concerning for older adults who are the most sedentary sector of the population. Specific types of SB have been shown to differentially impact health in cross-sectional and longitudinal studies, with screen-based SB more negatively impacting aspects of mental health. This study used Ecological Momentary Assessment (EMA), a real-time, intensive longitudinal data capture methodology, to examine the differential impact of screen-based behaviors on momentary affective responses during SB in naturalistic settings. A diverse sample of older adults (pooled across 2 studies) completed an EMA protocol for 8-10 days with six randomly delivered, smartphone assessments per day. At each EMA prompt, participants reported their current activity, whether they were sitting while doing that activity, and affective states. Multilevel models assessed whether screen-based (vs. non-screen-based) behavior moderated affective response during SB. At the within-person level, older adults experienced less positive affect during SB when engaged in a screen-based behavior compared to a non-screen-based SB (B = -0.10, p < 0.01). At the between-person level, positive associations between SB and negative affect (B = 0.79, p = 0.03) were stronger if participants reported engaging in screen-based behaviors for a greater proportion of prompts. Among older adults, screen-based SB may lead to poorer affective states compared to non-screen-based SB. Interventions aiming to reduce SB in this population should consider targeting reductions in screen-based SB as means to improve affective states.
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Affiliation(s)
- Brynn L Hudgins
- University of North Carolina Greensboro, 1400 Spring Garden Street, Greensboro, NC, 27412, USA.
| | - Derek J Hevel
- University of North Carolina Greensboro, 1400 Spring Garden Street, Greensboro, NC, 27412, USA.
| | - Jaclyn P Maher
- University of North Carolina Greensboro, 1400 Spring Garden Street, Greensboro, NC, 27412, USA.
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10
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Zhu M, Wang T, Sun J, Zhou Z, Wang D, Teng L. Heterogeneity of vulnerability and taste changes in older cancer patients undergoing chemotherapy: a latent class analysis. Support Care Cancer 2023; 31:392. [PMID: 37310497 DOI: 10.1007/s00520-023-07862-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Taste changes and vulnerability are commonly co-occurring in oncology patients undergoing chemotherapy. However, few studies explored the association and the inter-individual variability of these two conditions. This study aimed to identify heterogeneous subtypes of vulnerability and taste changes in older cancer patients undergoing chemotherapy, and explore individuals' characteristics and risk factors. METHODS In this cross-sectional study, the latent class analysis (LCA) was conducted to identify the heterogeneous subgroups of patients with distinct vulnerability and taste change profiles. Differences in sociodemographic and clinical characteristics among the subpopulation were evaluated using parametric and nonparametric tests. Multinomial logistic regression was performed to investigate predictors of taste change-vulnerability subgroup classification. RESULTS Three subgroups of those older cancer survivors were identified from the LCA: Class 1 (27.5%)-"Moderate taste change and low vulnerability", Class 2 (29.0%)-"Low taste change and moderate vulnerability", Class 3 (43.5%)-"High taste change and high vulnerability". 98.9% of Class 3 reported taste changes and 54.0% reported vulnerability. Results from multinomial logistic regression indicated that patients in Class 3 were more likely to report experiencing mouth dryness and high blood pressure, and have received more than 3 cycles of chemotherapy. CONCLUSION The findings could provide new insights into the association between taste changes and vulnerability in older cancer adults receiving chemotherapy. Identifying different latent classes of taste changes and vulnerability would be helpful for developing interventions tailored to the heterogeneous survivors.
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Affiliation(s)
- Min Zhu
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Teng Wang
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Jun Sun
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Zhou Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Danhui Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Liping Teng
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China.
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11
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Santos PHS, Dos Santos L, Fernandes MH, Brito TA, Munaro HLR, Carneiro JAO. Factors associated with frailty syndrome in older adults with three- and four-criteria clustering. Geriatr Nurs 2023; 51:121-128. [PMID: 36940506 DOI: 10.1016/j.gerinurse.2023.03.005] [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: 12/19/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
This study aimed to identify the main clusters of diagnostic criteria pertaining to frailty syndrome as well as the factors associated with the occurrence of frailty without diagnostic criteria clusters and with clusters of three and four criteria. This is a cross-sectional study, carried out with 216 older adults. In order to determine the dependent variable, a combination of the following criteria for frailty syndrome diagnostic criteria was used: unintentional weight loss, exhaustion, muscle weakness, a low level of physical activity, and a slow gait speed. There were different clusters of Frailty Syndrome diagnostic criteria and were associated with Frailty with clustering of three criteria, age group ≥80 years and negative self-perception of health and Frailty with clustering of four criteria, age group ≥80 years and polypharmacy use. Age, self-perception of health, and polypharmacy can be assessed to target different intervention plans in the frail older adult population.
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Affiliation(s)
- Patrícia Honório Silva Santos
- PhD in Health Sciences, Postgraduate Program in Nursing and Health, State University of Southwest Bahia, José Moreira Sobrinho Street, Jequiezinho., Jequié, Bahia CEP 45206-190, Brazil.
| | - Lucas Dos Santos
- Master in Health Sciences, Postgraduate Program in Nursing and Health, State University of Southwest Bahia, José Moreira Sobrinho Street, Jequiezinho., Jequié, Bahia CEP 45206-190, Brazil
| | - Marcos Henrique Fernandes
- PhD in Health Sciences, Postgraduate Program in Nursing and Health, State University of Southwest Bahia, José Moreira Sobrinho Street, Jequiezinho., Jequié, Bahia CEP 45206-190, Brazil
| | - Thaís Alves Brito
- Master in Health Sciences, State University of Southwest Bahia, José Moreira Sobrinho Street, SN, Jequiezinho., Jequié, Bahia CEP 45206-190, Brazil
| | - Hector Luiz Rodrigues Munaro
- PhD in Physical Education, Postgraduate Program in Physical Education, State University of Southwest Bahia, José Moreira Sobrinho Street, Jequiezinho., Jequié, Bahia CEP 45206-190, Brazil
| | - José Ailton Oliveira Carneiro
- PhD in Health Science, Postgraduate Program in Nursing and Health, State University of Southwest Bahia, José Moreira Sobrinho Street, Jequiezinho., Jequié, Bahia CEP 45206-190, Brazil
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12
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Camacho-Torregrosa S, Albert-Ros X, Aznar-Cardona J, Mollar-Talamantes M, Bordonaba-Mateos MA, Galán-Bernardino JV. [Frail-VIG index: Convergent and discriminatory validity with respect to Short Physical Performance Battery in general population]. Rev Esp Geriatr Gerontol 2023; 58:75-83. [PMID: 36842943 DOI: 10.1016/j.regg.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/21/2023] [Accepted: 01/26/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Studies of frailty in primary health care (PHC) using frailty indexes are scarce. Frail-VIG index assesses the level of frailty through a multidimensional approach. The main objective was to investigate the convergent and discriminative validity of the frail-VIG index with respect to Short Physical Performance Battery (SPPB) in general population ≥ 70 years. POPULATION, MATERIALS AND METHODS Descriptive cross-sectional study. We included 416 non-institutionalized patients aged 70 years or over from two lists of general practitioners in a semi-urban healthcare center. Main variables were: frail-VIG index and SPPB. RESULTS The value of the area under the ROC curve of frail-VIG index respect SPPB < 7 was 0.81 (95% CI: 0.76-0.86). Pearson's correlation coefficient was -0.59 (95% CI: -0.524 to -0.649). The mean of frail-VIG index in those classified as not frail by SPPB < 7 was 0.103 (95% CI: 0.094-0.112) and in the frail was 0.242 (95% CI: 0.215-0.269). We obtained significant differences in the mean and distribution of the SPPB according to the frail-VIG index categories. The frailty prevalence according to the frail-VIG index was 29.3% (95% CI: 25.2-33.9), initial 19%, intermediate 7.5% and advanced 2.9%. There were frailty people by frail-VIG index and not by SPPB < 7 the 10.4%; on the contrary the 9.6%, the mean of affected domains of frail-VIG index was 3.9 and 2.2, respectively. CONCLUSIONS The frail-VIG index presents adequate convergent and discriminative validity with respect to the SPPB that supports the use in PHC. There is a 20% of participants classified as frail in a discordant way, who presents a different profile.
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Affiliation(s)
- Susana Camacho-Torregrosa
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España; Grupo de Atención al Mayor de la Sociedad Valenciana de Medicina Familiar y Comunitaria, Valencia, España.
| | - Xavier Albert-Ros
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España; Grupo de Atención al Mayor de la Sociedad Valenciana de Medicina Familiar y Comunitaria, Valencia, España
| | - Javier Aznar-Cardona
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España
| | - María Mollar-Talamantes
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España
| | - María Alicia Bordonaba-Mateos
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España
| | - José Vicente Galán-Bernardino
- Medicina Familiar y Comunitaria, Centro de Salud de Moncada, Departamento Hospital Arnau de Vilanova-Llíria, Valencia, España
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13
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Akner G. Critical Appraisal of the Concept Frailty: Rating of Frailty in Elderly People has Weak Scientific Basis and should not be Used for Managing Individual Patients. Aging Dis 2023; 14:21-24. [PMID: 36818552 PMCID: PMC9937708 DOI: 10.14336/ad.2022.0506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
The concept frail elderly has been used to highlight the biological, rather than chronological, age. International and national bodies recommend that individuals over age 70 who visit healthcare facilities should be screened for frailty. There are important objections to the concept. Diagnostics: 'Frailty' is used for several completely different types of health problems. There are no useful biomarkers, but more than 60 different published rating methods for frailty, where different methods provide very different prevalence of frailty and also do not identify the same groups of elderly people. There is significant overlap between Clinical Frailty Scale- scores and activity of daily living (ADL)-scores. There is no gold standard method against which published frailty rating scales can be validated. It is unclear when, where and how often screening for frailty should occur in healthcare. Treatment: The evidence for treatment of frailty is very weak. A recent systematic overview found that the 21 included randomised, controlled studies (RCTs) were very heterogeneous as regards inclusion/exclusion criteria, how the condition of frailty was defined, what treatment was given and what health outcomes were assessed. In addition, there are often problems with the quality of the studies. The lack of a clear definition and evidence-based treatment of frailty means that it is inappropriate to introduce assessments of frailty in individual elderly patients in health care.
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Affiliation(s)
- Gunnar Akner
- Correspondence should be addressed to: Dr. Gunnar Akner, Geriatric Medicine at Karolinska Institutet, Stockholm, Sweden. .
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14
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Kapoor D, Cleere EF, Hurley CM, de Blacam C, Theopold CFP, Beausang E. Frailty as a predictor of adverse outcomes in head and neck reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2023; 77:328-338. [PMID: 36610278 DOI: 10.1016/j.bjps.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/20/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Frailty has been shown to adversely impact outcomes in a number of surgical disciplines. In head and neck reconstructive surgery, frailty may represent a significant risk factor in predicting post-operative outcomes due to the common characteristics of the patient population undergoing these procedures. OBJECTIVES To summarize the available evidence about frailty as a predictor of post-operative complications, length of hospital stay and quality of life in patients undergoing head and neck reconstructive surgery. STUDY DESIGN Systematic Review. METHODS The study protocol was registered with PROSPERO, registration CRD42022302899. Methodology was in keeping with the PRISMA Guidelines for Systematic Reviews. MEDLINE, SCOPUS, EMBASE, Web of Science and CENTRAL were the databases searched. Qualitative synthesis of the included studies was carried out, and quality assessment was performed. RESULTS Nine studies that reported data on 10,457 patients undergoing reconstruction of the head and neck were included in the review. A number of different tools were used to assess frailty, with the modified frailty index being the most frequently used. In total, 8 studies reported increased rates of complications in patients with increased levels of frailty, irrespective of the frailty tool used, with varied levels of statistical significance across the studies. CONCLUSION An association is observed between increased rates of perioperative complications and increased levels of frailty in patients undergoing head and neck reconstruction. Frailty tools may represent a useful method to risk stratify patients undergoing reconstructive head and neck surgery.
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Affiliation(s)
- Dhruv Kapoor
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland.
| | - Eoin F Cleere
- Department of Otolaryngology Head and Neck surgery, Galway University Hospital, Galway, Ireland
| | - Ciaran M Hurley
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland
| | - Catherine de Blacam
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland
| | | | - Eamon Beausang
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland
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15
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Are Skeletal Muscle Changes during Prolonged Space Flights Similar to Those Experienced by Frail and Sarcopenic Older Adults? LIFE (BASEL, SWITZERLAND) 2022; 12:life12122139. [PMID: 36556504 PMCID: PMC9781047 DOI: 10.3390/life12122139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Microgravity exposure causes several physiological and psychosocial alterations that challenge astronauts' health during space flight. Notably, many of these changes are mostly related to physical inactivity influencing different functional systems and organ biology, in particular the musculoskeletal system, dramatically resulting in aging-like phenotypes, such as those occurring in older persons on Earth. In this sense, sarcopenia, a syndrome characterized by the loss in muscle mass and strength due to skeletal muscle unloading, is undoubtedly one of the most critical aging-like adverse effects of microgravity and a prevalent problem in the geriatric population, still awaiting effective countermeasures. Therefore, there is an urgent demand to identify clinically relevant biological markers and to underline molecular mechanisms behind these effects that are still poorly understood. From this perspective, a lesson from Geroscience may help tailor interventions to counteract the adverse effects of microgravity. For instance, decades of studies in the field have demonstrated that in the older people, the clinical picture of sarcopenia remarkably overlaps (from a clinical and biological point of view) with that of frailty, primarily when referred to the physical function domain. Based on this premise, here we provide a deeper understanding of the biological mechanisms of sarcopenia and frailty, which in aging are often considered together, and how these converge with those observed in astronauts after space flight.
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16
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Oud FMM, Schut MC, Spies PE, van der Zaag-Loonen HJ, de Rooij SE, Abu-Hanna A, van Munster BC. Interaction between geriatric syndromes in predicting three months mortality risk. Arch Gerontol Geriatr 2022; 103:104774. [PMID: 35849976 DOI: 10.1016/j.archger.2022.104774] [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: 03/23/2022] [Revised: 06/03/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Capturing frailty using a quick tool has proven to be challenging. We hypothesise that this is due to the complex interactions between frailty domains. We aimed to identify these interactions and assess whether adding interactions between domains improves mortality predictability. METHODS In this retrospective cohort study, we selected all patients aged 70 or older who were admitted to one Dutch hospital between April 2015 and April 2016. Patient characteristics, frailty screening (using VMS (Safety Management System), a screening tool used in Dutch hospital care), length of stay, and mortality within three months were retrospectively collected from electronic medical records. To identify predictive interactions between the frailty domains, we constructed a classification tree with mortality as the outcome using five variables: the four VMS-domains (delirium risk, fall risk, malnutrition, physical impairment) and their sum. To determine if any domain interactions were predictive for three-month mortality, we performed a multivariable logistic regression analysis. RESULTS We included 4,478 patients. (median age: 79 years; maximum age: 101 years; 44.8% male) The highest risk for three-month mortality included patients that were physically impaired and malnourished (23% (95%-CI 19.0-27.4%)). Subgroups had comparable three-month mortality risks based on different domains: malnutrition without physical impairment (15.2% (96%-CI 12.4-18.6%)) and physical impairment and delirium risk without malnutrition (16.3% (95%-CI 13.7-19.2%)). DISCUSSION We showed that taking interactions between domains into account improves the predictability of three-month mortality risk. Therefore, when screening for frailty, simply adding up domains with a cut-off score results in loss of valuable information.
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Affiliation(s)
- F M M Oud
- Department of Geriatrics and Centre of Excellence for Old Age Medicine, Gelre Ziekenhuizen Apeldoorn and Zutphen, the Netherlands; Department of Internal Medicine, University Medical Centre Groningen, Groningen, the Netherlands.
| | - M C Schut
- Department of Medical Informatics, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - P E Spies
- Department of Geriatrics and Centre of Excellence for Old Age Medicine, Gelre Ziekenhuizen Apeldoorn and Zutphen, the Netherlands
| | - H J van der Zaag-Loonen
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, the Netherlands
| | - S E de Rooij
- Department of Medical Informatics, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Amstelland Hospital, Amstelveen, the Netherlands
| | - A Abu-Hanna
- Department of Medical Informatics, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - B C van Munster
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, the Netherlands
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17
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de Nooijer K, Van Den Noortgate N, Pype P, Van den Block L, Pivodic L. Palliative care symptoms, concerns and well-being of older people with frailty and complex care needs upon hospital discharge: a cross-sectional study. Palliat Care 2022; 21:173. [PMID: 36203161 PMCID: PMC9540036 DOI: 10.1186/s12904-022-01065-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about the nature and intensity of palliative care needs of hospitalised older people. We aimed to describe the palliative care symptoms, concerns, and well-being of older people with frailty and complex care needs upon discharge from hospital to home, and to examine the relationship between palliative care symptoms and concerns, and well-being. Methods Cross-sectional study using baseline survey data of a pilot randomised controlled trial. Hospital staff identified patients (≥ 70 years) about to be discharged home, with a clinical frailty score of 5 to 7 and complex needs based on physician-assessment. Patients completed structured interviews, using the Integrated Palliative Care Outcome Scale (IPOS), ICEpop CAPability measure for supportive care (ICECAP-SCM) and IPOS Views on Care quality of life item. We calculated descriptive statistics. Results We assessed 37 older people with complex needs (49% women, mean age 84, standard deviation 6.1). Symptoms rated as causing severe problems were weakness (46%) and poor mobility (40%); 75% reported that their family felt anxious at least occasionally. Of the 17 IPOS items, 41% of patients rated five or more symptoms as causing severe problems, while 14% reported that they were not severely affected by any symptom. 87% expressed feeling supported. There was a negative correlation between symptoms (IPOS) and well-being (ICECAP); r = -0.41. Conclusion We identified a large variety of symptoms experienced by older people identified as having frailty and complex needs upon hospital discharge. Many were severely affected by multiple needs. This population should be considered for palliative care follow-up at home.
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Affiliation(s)
- Kim de Nooijer
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, Belgium.
| | - Nele Van Den Noortgate
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Peter Pype
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Lara Pivodic
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
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18
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Gottesman D, McIsaac DI. Frailty and emergency surgery: identification and evidence-based care for vulnerable older adults. Anaesthesia 2022; 77:1430-1438. [PMID: 36089855 DOI: 10.1111/anae.15860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/30/2022]
Abstract
Frailty is a multidimensional state related to accumulation of age- and disease-related deficits across multiple domains. Older people represent the fastest growing segment of the peri-operative population, and 25-50% of older surgical patients live with frailty. When frailty is present before surgery, adjusted rates of morbidity and mortality increase at least two-fold; the odds of delirium and loss of independence are increased more than four- and five-fold, respectively. Care of the older person with frailty presenting for emergency surgery requires individualised and evidence-based care given the high-risk and complex nature of their presentations. Before surgery, frailty should be assessed using a multidimensional frailty instrument (most likely the Clinical Frailty Scale), and all members of the peri-operative team should be aware of each patient's frailty status. When frailty is present, pre-operative care should focus on documenting and communicating individualised risk, considering advanced care directives and engaging shared decision-making when feasible. Shared multidisciplinary care should be initiated. Peri-operatively, analgesia that avoids polypharmacy should be provided, along with delirium prevention strategies and consideration of postoperative care in a monitored environment. After the acute surgical episode, transition out of hospital requires that adequate support be in place, along with clear discharge instructions, and review of new and existing prescription medications. Advanced care directives should be reviewed or initiated in case of readmission. Overall, substantial knowledge gaps about the optimal peri-operative care of older people with frailty must be addressed through robust, patient-oriented research.
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Affiliation(s)
- D Gottesman
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and Ottawa Hospita, Ottawa, ON, Canada
| | - D I McIsaac
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and Ottawa Hospital, School of Epidemiology and Public Health, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Andrew MK, Matthews S, Kim JH, Riley ME, Curran D. An Easy-to-Implement Clinical-Trial Frailty Index Based on Accumulation of Deficits: Validation in Zoster Vaccine Clinical Trials. Clin Interv Aging 2022; 17:1261-1274. [PMID: 36017192 PMCID: PMC9397533 DOI: 10.2147/cia.s364997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Despite being among those most in need of protection, frail older adults are often not well represented in clinical trials. Although frailty likely influences responses to treatments and vaccines, frailty may not be explicitly considered in trials even when frail participants are enrolled due to the perception that frailty is difficult to measure effectively and efficiently without adding to participant or data collection burden. We developed an easy-to-implement frailty index, the Clinical Trial-Frailty Index (CT-FI), based on baseline medical history and standard patient-reported outcomes using data from clinical trials of recombinant Zoster vaccine (the ZOE-50 and ZOE-70 studies). Our objective was to demonstrate that the CT-FI is a robust measure that may be used retrospectively or prospectively in clinical trials where sufficient patient data have been collected. Methods The CT-FI was based on baseline medical history and Quality of Life questionnaires (SF-36 and EQ-5D). Items meeting criteria for inclusion were scored from 0 to 1, then summed for each participant and divided by the total number of deficits considered. Validation analyses included descriptive verification of distribution and age- and sex-associations in relation to usual patterns of the frailty index, regressions in relation to outcomes hypothesized to be related to frailty, and resampling methods within the index. Results The CT-FI distribution was well represented by a gamma distribution with a range of 0–0.70. Deficit accumulation increased with chronological age and was higher for females. Multivariate Cox regression survival analysis showed that the CT-FI, age, and sex were significant predictors of mortality. Jackknife and Bootstrap resampling methods highlighted the robustness of the CT-FI, which was not sensitive to inclusion/exclusion of specific individual or groups of variables. Conclusion We have developed a reliable, robust and easy-to-implement CT-FI with potential retrospective or prospective application in other clinical trials. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/VbOCDZYBxwI
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Affiliation(s)
- Melissa K Andrew
- Department of Medicine (Division of Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada
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20
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Exploring the type of social support available to aged male hypertensive clients in Ghana. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
To explores the social support available to aged hypertensive male clients in a municipality in Ghana.
Methods
The inclusion criteria were as follows: age ≥60 years and are known hypertensive patients. Data were collected from 186 selected aged male hypertensive patients for 3 months. The questionnaire was self-developed and open-ended. The data were processed and analyzed using SPSS version 23. Some of the variables were subjected to statistical tests and ranks in the order of importance to respondents. The enrolled respondents were allowed to participate in the study after their informed consent was obtained. It was evident that respondents do not obtain much support or help in taking care of their condition.
Results
The result revealed that the repondents has no support to help take care of their condition as evident by the responses in the study. The scores on average mean for some variables are (AM = 2.25, SD = 0.381) more than the test value of 2.50. Some of these supports were on feeding support (M = 3.97, SD = 0.278, n = 186), health support (M = 2.87, SD = 0.167, n = 186), and cleaning support (M = 2.59, SD = 0.868, n = 186). Supports such as clothing, socialization, medication, washing, transportation, and financial support were lacking.
Conclusions
Based on the finding that certain forms of support were lacking, the study concludes that steps undertaken by the government, community, religious bodies, and family toward improving these supports can be of immense help for aged male hypertensive patients living in the Ejura-Sekyedumase municipality.
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21
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Asik Z, Özen M. Evaluation of frailty and neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios relationship in elderly people. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:101-110. [PMID: 35392007 PMCID: PMC8971038 DOI: 10.18999/nagjms.84.1.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022]
Abstract
It was aimed to evaluate the relationship between frailty and inflammation in people receiving home health care. It was a cross-sectional study. Edmonton Frail Scale was used to determine the level of frailty and, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were used to determine inflammation. Of 332 people included in the study, 54.82% were females and 45.18% were males. Participants' ages were between 65 and 106. When we examined the frailty of the participants according to the Edmonton Frail Scale, the mean score was 9.403 ± 2.032. The mean neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of the participants were 4,397±5,038 and 169,363±101,461 respectively. Accordingly, neutrophil-to-lymphocyte ratio was high in men, frail elderly, 75-84 age range, hypertension patients, malnutrition patients; and neutrophil-to-lymphocyte ratio was low in diabetes mellitus, dementia, cerebrovascular accident and hemiplegia. Platelet-to-lymphocyte ratio, another inflammatory marker, was high in men, non-frail elderly, 75-84 age range, hypertension patients and cerebrovascular accident patients; it was low in hemiplegia, malnutrition, dementia, diabetes mellitus. In the study, no statistically significant difference was found between Edmonton Frail Scale and inflammatory markers. More studies are needed on this subject. In addition, we think that examining NLR and PLR values will be useful for monitoring inflammation in frail elderly.
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Affiliation(s)
- Zeynep Asik
- The Clinic of Family Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Mehmet Özen
- The Clinic of Family Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
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22
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Young S, Swarts K, Prior SJ, Doherty D, Campbell SJ. Vertical integration in the Australian community care setting: Can it work? A theoretical review of current literature. Int J Health Plann Manage 2022; 37:1299-1310. [PMID: 35001434 DOI: 10.1002/hpm.3412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/06/2022] Open
Abstract
Vertical integration (VI) is considered a strategic management plan whereby an organisation has ownership of its supply chain. It is utilised as a method for managing the economic needs and approaches of an organisation and ensuring that a product is readily available for use. From a healthcare perspective, this pertains to the coordination of services or levels of care and allows for adaptation to changing circumstances. This study reviews existing literature on VI in a healthcare setting to assess feasibility and effectiveness of this proposed solution. A theoretical literature review was performed utilising conceptual categorisation to understand how VI may benefit community care organisations, using the needs of a local organisation as an example. Seventeen articles were included from a range of databases and grey literature with findings categorised according to two research questions. The findings suggest that for VI to be effective and efficient it is important to consider the following themes: market failure, barriers to entry, productive capabilities and specific healthcare issues. In conclusion, from a management and economic perspective, when markets are not functioning efficiently and are in disequilibrium, VI may provide an appropriate avenue to address these problems, in particular for community care organisations.
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Affiliation(s)
- Sarah Young
- Tasmanian School of Medicine, University of Tasmania, College of Health and Medicine, Launceston, Tasmania, Australia
| | - Kevin Swarts
- Tasmanian School of Business and Economics, University of Tasmania Centenary Building, Sandy Bay, Tasmania, Australia
| | - Sarah J Prior
- Tasmanian School of Medicine, University of Tasmania, College of Health and Medicine, Burnie, Tasmania, Australia
| | | | - Steven J Campbell
- School of Nursing, University of Tasmania, College of Health and Medicine, Launceston, Tasmania, Australia
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Picca A, Coelho-Junior HJ, Calvani R, Marzetti E, Vetrano DL. Biomarkers shared by frailty and sarcopenia in older adults: A systematic review and meta-analysis. Ageing Res Rev 2022; 73:101530. [PMID: 34839041 DOI: 10.1016/j.arr.2021.101530] [Citation(s) in RCA: 118] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/04/2021] [Accepted: 11/21/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Physical frailty and sarcopenia show extensive clinical similarities. Whether biomarkers exist that are shared by the two conditions is presently unclear. METHODS We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated the association of frailty and/or sarcopenia with biomarkers as a primary or secondary outcome in adults aged 60 years and older. Only studies published in English that defined frailty using a validated scale and/or questionnaire and diagnosed sarcopenia according to the presence of muscle atrophy plus dynapenia or low physical function were included. Studies were identified from a systematic search of MEDLINE and SCOPUS databases from inception through August 2020. The quality of reporting of each study was assessed by using the Quality Assessment Tool for Observational Cohort, Cross-Sectional and Case-Control studies of the National Institute of Health. A meta-analysis was conducted when at least three studies investigated the same biomarker in both frailty and sarcopenia. Pooled effect size was calculated based on standard mean differences and random-effect models. Sensitivity analysis was performed based on age and the setting where the study was conducted. RESULTS Eighty studies (58 on frailty and 22 on sarcopenia) met the inclusion criteria and were included in the qualitative analysis. Studies on frailty included 33,160 community-dwellers, hospitalized, or institutionalized older adults (60-88 years) from 21 countries. Studies on sarcopenia involved 4904 community-living and institutionalized older adults (68-87.6 years) from 9 countries. Several metabolic, inflammatory, and hematologic markers were found to be shared between the two conditions. Albumin and hemoglobin were negatively associated with both frailty and sarcopenia. Interleukin 6 was associated with frailty and sarcopenia only in people aged < 75. Community-dwelling older adults with frailty and sarcopenia had higher levels of tumor necrosis factor alpha compared with their robust and non-sarcopenic counterparts. CONCLUSIONS A set of metabolic, hematologic, and inflammatory biomarkers was found to be shared by frailty and sarcopenia. These findings fill a knowledge gap in the quest of biomarkers for these conditions and provide a rationale for biomarker selection in studies on frailty and sarcopenia.
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Affiliation(s)
- Anna Picca
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | | | - Riccardo Calvani
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Department of Geriatrics and Orthopedics, Rome, Italy
| | - Davide Liborio Vetrano
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Sarkar S, MacLeod JB, Hassan A, Dutton DJ, Brunt KR, Légaré JF. An age-independent hospital record-based frailty score correlates with adverse outcomes after heart surgery and increased health care costs. JTCVS OPEN 2021; 8:491-502. [PMID: 36004086 PMCID: PMC9390592 DOI: 10.1016/j.xjon.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/19/2021] [Indexed: 10/29/2022]
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Whitlock EL. Frailty: More Than the Sum of Its Parts? Anesth Analg 2021; 133:1090-1093. [PMID: 34673722 DOI: 10.1213/ane.0000000000005672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Elizabeth L Whitlock
- From the Department of Anesthesia & Perioperative Care, University of California, San Francisco, California
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26
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Alvarez JA, Medford A, Strozza C, Thinggaard M, Christensen K. Stratification in health and survival after age 100: evidence from Danish centenarians. BMC Geriatr 2021; 21:406. [PMID: 34210289 PMCID: PMC8252309 DOI: 10.1186/s12877-021-02326-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The existence of a super-select group of centenarians that demonstrates increased survivorship has been hypothesized. However, it is unknown if this super-select group possesses similar characteristics apart from extreme longevity. METHODS In this study, we analyse high-quality health and survival data of Danish centenarians born in 1895, 1905 and 1910. We use Latent Class Analysis to identify unobserved health classes and to test whether these super-select lives share similar health characteristics. RESULTS We find that, even after age 100, a clear and distinct gradient in health exists and that this gradient is remarkably similar across different birth cohorts of centenarians. Based on the level of health, we identify three clusters of centenarians - robust, frail and intermediate - and show that these groups have different survival prospects. The most distinctive characteristic of the robust centenarians is the outperformance in different health dimensions (physical, functional and cognitive). Finally, we show that our health class categorizations are good predictors of the survival prospects of centenarians. CONCLUSIONS There is a clear stratification in health and functioning among those over 100 years of age and these differences are associated with survival beyond age 100.
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Affiliation(s)
- Jesús-Adrián Alvarez
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, 5000, Odense, Denmark.
| | - Anthony Medford
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, 5000, Odense, Denmark
| | - Cosmo Strozza
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, 5000, Odense, Denmark
| | - Mikael Thinggaard
- Danish Aging Research Center, Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Kaare Christensen
- Danish Aging Research Center, Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Department of Clinical Genetics and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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Profiles of Frailty among Older People Users of a Home-Based Primary Care Service in an Urban Area of Barcelona (Spain): An Observational Study and Cluster Analysis. J Clin Med 2021; 10:jcm10102106. [PMID: 34068296 PMCID: PMC8153285 DOI: 10.3390/jcm10102106] [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: 03/29/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The multidimensional assessment of frailty allows stratifying it into degrees; however, there is still heterogeneity in the characteristics of people in each stratum. The aim of this study was to identify frailty profiles of older people users of a home-based primary care service. Methods: We carried out an observational study from January 2018 to January 2021. Participants were all people cared for a home-based primary care service. We performed a cluster analysis by applying a k-means clustering technique. Cluster labeling was determined with the 22 variables of the Frail-VIG index, age, and sex. We computed multiple indexes to assess the optimal number of clusters, and this was selected based on a clinical assessment of the best options. Results: Four hundred and twelve participants were clustered into six profiles. Three of these profiles corresponded to a moderate frailty degree, two to a severe frailty degree and one to a mild frailty degree. In addition, almost 75% of the participants were clustered into three profiles which corresponded to mild and moderate degree of frailty. Conclusions: Different profiles were found within the same degree of frailty. Knowledge of these profiles can be useful in developing strategies tailored to these differentiated care needs.
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Van der Elst M, Schoenmakers B, Dierckx E, De Roeck E, van der Vorst A, Lambotte D, De Lepeleire J, De Donder L. Towards a more effective strategy to detect community-dwelling frail older adults: validation of risk factors. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2021. [DOI: 10.1108/ijhg-11-2020-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeIn the context of early detection of frail older people, prior research found several risk factors of multidimensional frailty. The current study aims to validate these risk factors.Design/methodology/approachTwo data sets, Belgian Ageing Studies and Detection, Support and Care for older people: Prevention and Empowerment (BAS and D-SCOPE), in three Belgian municipalities (Ghent, Knokke-Heist and Thienen) were used and compared. The BAS data set (N = 1496) is a representative sample of community-dwelling older adults (60+), while the recruitment of the D-SCOPE sample (validation sample, N = 869) is based on risk factors (e.g. age, marital status, moved in the past 10 years). Frailty was measured with the comprehensive frailty assessment instrument (CFAI). The validity was examined by means of prevalence rates, distribution and the odds rates within both data sets.FindingsThe validation sample had an increase in the percentage of elderly who were mildly and highly frail for physical frailty (men: +17.0 percent point, women: +20.7 percent point), for psychological frailty (men: +13.4 percent point, women: +13.7 percent point), for social frailty (men: +24.8 percent point, women: +4.8 percent point) and environmental frailty (men: +24.2 percent point, women: +6.8 percent point). The present results indicate that the risk of being mildly or highly frail was higher in the validation sample in comparison with the BAS data.Originality/valueThe present study proved the validity of aforementioned risk factors. Selecting older people based on these risk factors proved to be an effective strategy for detecting frail older people.
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Bohn L, Zheng Y, McFall GP, Dixon RA. Portals to frailty? Data-driven analyses detect early frailty profiles. Alzheimers Res Ther 2021; 13:1. [PMID: 33397495 PMCID: PMC7780374 DOI: 10.1186/s13195-020-00736-w] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/29/2020] [Indexed: 03/21/2023]
Abstract
BACKGROUND Frailty is an aging condition that reflects multisystem decline and an increased risk for adverse outcomes, including differential cognitive decline and impairment. Two prominent approaches for measuring frailty are the frailty phenotype and the frailty index. We explored a complementary data-driven approach for frailty assessment that could detect early frailty profiles (or subtypes) in relatively healthy older adults. Specifically, we tested whether (1) modalities of early frailty profiles could be empirically determined, (2) the extracted profiles were differentially related to longitudinal cognitive decline, and (3) the profile and prediction patterns were robust for males and females. METHODS Participants (n = 649; M age = 70.61, range 53-95) were community-dwelling older adults from the Victoria Longitudinal Study who contributed data for baseline multi-morbidity assessment and longitudinal cognitive trajectory analyses. An exploratory factor analysis on 50 multi-morbidity items produced 7 separable health domains. The proportion of deficits in each domain was calculated and used as continuous indicators in a data-driven latent profile analysis (LPA). We subsequently examined how frailty profiles related to the level and rate of change in a latent neurocognitive speed variable. RESULTS LPA results distinguished three profiles: not-clinically-frail (NCF; characterized by limited impairment across indicators; 84%), mobility-type frailty (MTF; characterized by impaired mobility function; 9%), and respiratory-type frailty (RTF; characterized by impaired respiratory function; 7%). These profiles showed differential neurocognitive slowing, such that MTF was associated with the steepest decline, followed by RTF, and then NCF. The baseline frailty index scores were the highest for MTF and RTF and increased over time. All observations were robust across sex. CONCLUSIONS A data-driven approach to early frailty assessment detected differentiable profiles that may be characterized as morbidity-intensive portals into broader and chronic frailty. Early inventions targeting mobility or respiratory deficits may have positive downstream effects on frailty progression and cognitive decline.
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Affiliation(s)
- Linzy Bohn
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada.
| | - Yao Zheng
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
| | - G Peggy McFall
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Roger A Dixon
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
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Frailty Status Typologies in Spanish Older Population: Associations with Successful Aging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186772. [PMID: 32957492 PMCID: PMC7558178 DOI: 10.3390/ijerph17186772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022]
Abstract
Background: Defining frailty typologies would contribute to guiding specific care interventions. These typologies could additionally be related to different health outcomes. This study aims at identifying subgroups of frail older adults based on the physical frailty phenotype and examining the relationships of these frailty profiles with quality of life and perceived health. Methods: This study relies on data from the SHARE project, namely a representative sample of 1765 Spanish-dwelling older adults identified as frail or pre-frail. Analysis included general descriptive statistics, exploratory latent class analysis (LCA) to determine the number of frailty subgroups, and LCA with covariates to examine differential relationships with markers of successful aging. Results: Statistical criteria and interpretability of the classes suggested that the LCA model with four classes should be retained. Class 1 was identified as the “frail people” group, Class 2 “activity problems” group, Class 3 “fatigued” group, and those belonging to Class 4 “lack of strength” group. Final LCA with covariates showed lower levels of quality of life and perceived health of the “frail” as compared to other frailty subgroups. Conclusion: This study revealed four different patterns of frailty attributes and further offered evidence on individuals’ differential status of health regarding distinct frailty conditions.
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Strozza C, Pasqualetti P, Egidi V, Loreti C, Vannetti F, Macchi C, Padua L. Health profiles and socioeconomic characteristics of nonagenarians residing in Mugello, a rural area in Tuscany (Italy). BMC Geriatr 2020; 20:289. [PMID: 32799807 PMCID: PMC7429096 DOI: 10.1186/s12877-020-01689-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/03/2020] [Indexed: 01/14/2023] Open
Abstract
Background Health, as defined by the WHO, is a multidimensional concept that includes different aspects. Interest in the health conditions of the oldest-old has increased as a consequence of the phenomenon of population aging. This study investigates whether (1) it is possible to identify health profiles among the oldest-old, taking into account physical, emotional and psychological information about health, and (2) there are demographic and socioeconomic differences among the health profiles. Methods Latent Class Analysis with covariates was applied to the Mugello Study data to identify health profiles among the 504 nonagenarians residing in the Mugello district (Tuscany, Italy) and to evaluate the association between socioeconomic characteristics and the health profiles resulting from the analysis. Results This study highlights four groups labeled according to the posterior probability of determining a certain health characteristic: “healthy”, “physically healthy with cognitive impairment”, “unhealthy”, and “severely unhealthy”. Some demographic and socioeconomic characteristics were found to be associated with the final groups: older nonagenarians are more likely to be in worse health conditions; men are in general healthier than women; more educated individuals are less likely to be in extremely poor health conditions, while the lowest-educated are more likely to be cognitively impaired; and office or intellectual workers are less likely to be in poor health conditions than are farmers. Conclusions Considering multiple dimensions of health to determine health profiles among the oldest-old could help to better evaluate their care needs according to their health status.
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Affiliation(s)
- Cosmo Strozza
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, J.B. Winsløws Vej 9B, 2nd floor, 5000, Odense C, Denmark. .,Department of Statistical Sciences, Sapienza University of Rome, Viale Regina Elena 295, 00161, Rome, Italy.
| | - Patrizio Pasqualetti
- Fatebenefratelli Foundation for Health Research and Education, Via della Lungaretta 177, 00153, Rome, Italy
| | - Viviana Egidi
- Department of Statistical Sciences, Sapienza University of Rome, Viale Regina Elena 295, 00161, Rome, Italy
| | - Claudia Loreti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00136, Rome, Italy
| | - Federica Vannetti
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy
| | | | - Luca Padua
- Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.,UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00136, Rome, Italy
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Zhang Y, Xu XJ, Lian TY, Huang LF, Zeng JM, Liang DM, Yin MJ, Huang JX, Xiu LC, Yu ZW, Li YL, Mao C, Ni JD. Development of frailty subtypes and their associated risk factors among the community-dwelling elderly population. Aging (Albany NY) 2020; 12:1128-1140. [PMID: 31951595 PMCID: PMC7053645 DOI: 10.18632/aging.102671] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022]
Abstract
In order to explore frailty subtypes and find their associated risk factors, we conducted cross-sectional surveys of 5,341 seniors aged 60 and over in China using the Frailty Index (FI) scale. We identified four frailty subtypes, namely multi-frail, cognitive and functionally frail, psychologically frail and physiologically frail. Old age and low education level were the common risk factors among the four subtypes. Being widowed, divorced or unmarried was a risk factor for multi-frail, cognitive and functionally frail and psychologically frail, and male sex was a protective factor against cognitive and functionally frail and psychologically frail subtypes. Having a harmonious relationship with family was a protective factor against multi-frail, and fewer visits to the elderly by their children was a risk factor for psychologically frail. Dissatisfaction with their housing was a risk factor for cognitive and functionally frail, psychologically frail and physiologically frail, and a pension being the main source of income was a risk factor for cognitive and functionally frail and psychologically frail. Exercising every day was a protective factor against multi-frail and cognitive and functionally frail, and a lower level of physical activity was a risk factor for all four frailty subtypes. Our findings confirm the heterogeneity of frailty and suggest that different frail elderly individuals need more targeted care interventions.
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Affiliation(s)
- Yan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Xiu-Juan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Ting-Yu Lian
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Ling-Feng Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Jin-Mei Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Dong-Mei Liang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Ming-Juan Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Jing-Xiao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Liang-Chang Xiu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
| | - Zu-Wei Yu
- Public Health Office, Dalang Town Community Health Service Center, Dongguan 523808, China
| | - Yu-Lian Li
- Department of Nursing, Dalang Town Community Health Service Center, Dongguan 523808, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Jin-Dong Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
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Patterns of social participation among older adults with disabilities and the relationship with well-being: A latent class analysis. Arch Gerontol Geriatr 2020; 86:103933. [DOI: 10.1016/j.archger.2019.103933] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 11/20/2022]
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Hui Y, van Walraven C, McIsaac DI. How Do Common Comorbidities Modify the Association of Frailty With Survival After Elective Noncardiac Surgery? A Population-Based Cohort Study. Anesth Analg 2019; 129:1699-1706. [PMID: 31743191 DOI: 10.1213/ane.0000000000004387] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Older people with frailty have decreased postoperative survival. Understanding how comorbidities modify the association between frailty and survival could improve risk stratification and guide development of interventions. Therefore, we evaluated whether the concurrent presence of common and high-risk comorbidities (dementia, chronic obstructive pulmonary disease [COPD], coronary artery disease [CAD], diabetes mellitus, heart failure [HF]) in conjunction with frailty might be associated with a larger decrease in postoperative survival after major elective surgery than would be expected based on the presence of the comorbidity and frailty on their own. METHODS This cohort study used linked administrative data from Ontario, Canada to identify adults >65 years having elective noncardiac surgery from 2010 to 2015. Frailty was identified using a validated index; comorbidities were identified with validated codes. We evaluated the presence of effect modification (also called interaction) between frailty and each comorbidity on (1) the relative (or multiplicative) scale by assessing whether the risk of mortality when both frailty and the comorbidity were present was different than the product of the risks associated with each condition; and (2) the absolute risk difference (or additive) scale by assessing whether the risk of mortality when both frailty and the comorbidity were present was greater than the sum of the risks associated with each condition. RESULTS 11,150 (9.7%) people with frailty died versus 7826 (2.8%) without frailty. After adjustment, frailty was associated with decreased survival (adjusted hazard ratio [HR] = 2.42; 95% confidence interval [CI], 2.31-2.54). On the relative (multiplicative) scale, only diabetes mellitus demonstrated significant effect modification (P value for interaction .03; reduced risk together). On the absolute risk difference (additive) scale, all comorbidities except for coronary disease demonstrated effect modification of the association of frailty with survival. Co-occurrence of dementia with frailty carried the greatest excess risk (Synergy Index [S; the excess risk from exposure to both risk factors compared to the sum of the risks from each factor in isolation] = 2.29; 95% CI, 1.32-10.80, the excess risk from exposure to both risk factors compared to the sum of the risks from each factor in isolation). CONCLUSIONS Common comorbidities modify the association of frailty with postoperative survival; however, this effect was only apparent when analyses accounted for effect modification on the absolute risk difference, as opposed to relative scale. While the relative scale is more commonly used in biomedical research, smaller effects may be easier to detect on the risk difference scale. The concurrent presence of dementia, COPD, and HF with frailty were all associated with excess mortality on the absolute risk difference scale.
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Affiliation(s)
- Yin Hui
- From the Departments of Anesthesiology & Pain Medicine, and †Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Carl van Walraven
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- From the Departments of Anesthesiology & Pain Medicine, and †Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Ke JXC, MacDonald DB, McIsaac DI. Perioperative Acute Care of Older Patients Living with Frailty. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hegendörfer E, Vaes B, Van Pottelbergh G, Matheï C, Verbakel J, Degryse JM. Predictive Accuracy of Frailty Tools for Adverse Outcomes in a Cohort of Adults 80 Years and Older: A Decision Curve Analysis. J Am Med Dir Assoc 2019; 21:440.e1-440.e8. [PMID: 31678074 DOI: 10.1016/j.jamda.2019.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the predictive performance of 3 frailty identification tools for mortality, hospitalization, and functional decline in adults aged ≥80 years using risk reclassification statistics and decision curve analysis. DESIGN Population-based, prospective cohort. SETTING BELFRAIL study, Belgium. PARTICIPANTS 560 community-dwelling adults aged ≥80 years. MEASUREMENTS Frailty by Cardiovascular Health Study (CHS) phenotype, Longitudinal Aging Study Amsterdam (LASA) markers, and Groeningen Frailty Indicator (GFI); mortality until 5.1 ± 0.25 years from baseline and hospitalization until 3.0 ± 0.25 years; and functional status assessed by activities of daily living at baseline and after 1.7 ± 0.21 years. RESULTS Frailty prevalence was 7.3% by CHS phenotype, 21.6% by LASA markers, and 22% by GFI. Participants determined to be frail by each tool had a significantly higher risk for all-cause mortality and first hospitalization. For functional decline, only frail by GFI had a higher adjusted odds ratio. Harrell 's C-statistic for mortality and hospitalization and area under receiver operating characteristic curve for functional decline were similar for all tools and <0.70. Reclassification statistics showed improvement only by LASA markers for hospitalization and mortality. In decision curve analysis, all tools had higher net benefit than the 2 default strategies of "treat all" and "treat none" for mortality risk ≥20%, hospitalization risk ≥35%, and functional decline probability ≥10%, but their curves overlapped across all relevant risk thresholds for these outcomes. CONCLUSIONS AND IMPLICATIONS In a cohort of adults aged ≥80 years, 3 frailty tools based on different conceptualizations and assessment sources had comparable but unsatisfactory discrimination for predicting mortality, hospitalization, and functional decline. All showed clinical utility for predicting these outcomes over relevant risk thresholds, but none was significantly superior. Future research on frailty tools should include a focus on the specific group of adults aged ≥80 years, and the predictive accuracy for adverse outcomes of different tools needs a comprehensive assessment that includes decision curve analysis.
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Affiliation(s)
- Eralda Hegendörfer
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain, Belgium.
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Catharina Matheï
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Jan Verbakel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain, Belgium
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van Boekel LC, Cloin JCM, Luijkx KG. Community-Dwelling and Recently Widowed Older Adults: Effects of Spousal Loss on Psychological Well-Being, Perceived Quality of Life, and Health-Care Costs. Int J Aging Hum Dev 2019; 92:65-82. [PMID: 31478390 PMCID: PMC7711306 DOI: 10.1177/0091415019871204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study is on the effects of spousal loss among older adults who continue to live independently after bereavement. Little longitudinal studies focus on this group, which is of special interest, since in many countries, care policy and system reform are aimed at increasing independent living among older adults. Using longitudinal data from a Dutch public data repository, we investigate the effects of spousal loss on psychological well-being, perceived quality of life, and (indication of) yearly health-care costs. Of the respondents who had a spouse and were living independently (N = 9,400) at baseline, the majority had not lost their spouse after 12 months (T12, n = 9,150), but 2.7% (n = 250) had lost their spouse and still lived independently. We compared both groups using multivariate regression (ordinary least squares) analyses. The results show that spousal loss significantly lowers scores on psychological well-being and perceived quality of life, but we found no effect on health-care costs.
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Affiliation(s)
- L C van Boekel
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
| | - J C M Cloin
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
| | - K G Luijkx
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
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Sadiq F, Kronzer VL, Wildes TS, McKinnon SL, Sharma A, Helsten DL, Scheier LM, Avidan MS, Ben Abdallah A. Frailty Phenotypes and Relations With Surgical Outcomes: A Latent Class Analysis. Anesth Analg 2019; 127:1017-1027. [PMID: 30113393 DOI: 10.1213/ane.0000000000003695] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Frailty is an important concept in the care of older adults although controversy remains regarding its defining features and clinical utility. Both the Fried phenotype and the Rockwood deficit accumulation approaches cast frailty as a "burden" without exploring the relative salience of its cardinal markers and their relevance to the patient. New multifactorial perspectives require a reliable assessment of frailty that can validly predict postoperative health outcomes. METHODS In a retrospective study of 2828 unselected surgical patients, we used item response theory to examine the ability of 32 heterogeneous markers capturing limitations in physical, functional, emotional, and social activity domains to indicate severity of frailty as a latent continuum. Eighteen markers efficiently indicated frailty severity and were then subject to latent class analysis to derive discrete phenotypes. Next, we validated the obtained frailty phenotypes against patient-reported 30-day postoperative outcomes using multivariable logistic regression. Models were adjusted for demographics, comorbidity, type and duration of surgery, and cigarette and alcohol consumption. RESULTS The 18 markers provided psychometric evidence of a single reliable continuum of frailty severity. Latent class analyses produced 3 distinct subtypes, based on patients' endorsement probabilities of the frailty indicators: not frail (49.7%), moderately frail (33.5%), and severely frail (16.7%). Unlike the moderate class, severely frail endorsed emotional health problems in addition to physical burdens and functional limitations. Models adjusting for age, sex, type of anesthesia, and intraoperative factors indicated that severely frail (odds ratio, 1.89; 95% confidence interval, 1.42-2.50) and moderately frail patients (odds ratio, 1.31; 95% confidence interval, 1.03-1.67) both had higher odds of experiencing postoperative complications compared to not frail patients. In a 3-way comparison, a higher proportion of severely frail patients (10.7%) reported poorer quality of life after surgery compared to moderately frail (9.2%) and not frail (8.3%) patients (P < .001). There was no significant difference among these groups in proportions reporting hospital readmission (5.6%, 5.1%, and 3.8%, respectively; P = .067). CONCLUSIONS Self-report frailty items can accurately discern 3 distinct phenotypes differing in composition and their relations with surgical outcomes. Systematically assessing a wider set of domains including limitations in functional, emotional, and social activities can inform clinicians on what precipitates loss of physiological reserve and profoundly influences patients' lives. This information can help guide the current discussion on frailty and add meaningful clinical tools to the surgical practice.
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Affiliation(s)
- Furqaan Sadiq
- From the Department of Anesthesiology, Institute of Quality Improvement, Research & Informatics (INQUIRI), Washington University School of Medicine, St Louis, Missouri
| | | | - Troy S Wildes
- From the Department of Anesthesiology, Institute of Quality Improvement, Research & Informatics (INQUIRI), Washington University School of Medicine, St Louis, Missouri
| | - Sherry L McKinnon
- From the Department of Anesthesiology, Institute of Quality Improvement, Research & Informatics (INQUIRI), Washington University School of Medicine, St Louis, Missouri
| | - Anshuman Sharma
- From the Department of Anesthesiology, Institute of Quality Improvement, Research & Informatics (INQUIRI), Washington University School of Medicine, St Louis, Missouri
| | - Daniel L Helsten
- From the Department of Anesthesiology, Institute of Quality Improvement, Research & Informatics (INQUIRI), Washington University School of Medicine, St Louis, Missouri
| | | | - Michael S Avidan
- From the Department of Anesthesiology, Institute of Quality Improvement, Research & Informatics (INQUIRI), Washington University School of Medicine, St Louis, Missouri
| | - Arbi Ben Abdallah
- From the Department of Anesthesiology, Institute of Quality Improvement, Research & Informatics (INQUIRI), Washington University School of Medicine, St Louis, Missouri
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Picca A, Coelho-Junior HJ, Cesari M, Marini F, Miccheli A, Gervasoni J, Bossola M, Landi F, Bernabei R, Marzetti E, Calvani R. The metabolomics side of frailty: Toward personalized medicine for the aged. Exp Gerontol 2019; 126:110692. [PMID: 31421185 DOI: 10.1016/j.exger.2019.110692] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/24/2019] [Accepted: 08/13/2019] [Indexed: 12/12/2022]
Abstract
Frailty encompasses several domains (i.e., metabolic, physical, cognitive). The multisystem derangements underlying frailty pathophysiology, its phenotypic heterogeneity, and the fluctuations of individuals across severity states have hampered a comprehensive appraisal of the condition. Circulating biomarkers emerged as an alleged tool for capturing this complexity and, as proxies for organismal metabolic changes, may hold the advantages of: 1) supporting diagnosis, 2) tracking the progression, 3) assisting healthcare professionals in clinical and therapeutic decision-making, and 4) verifying the efficacy of an intervention before measurable clinical manifestations occur. Among available analytical tools, metabolomics are able to identify and quantify the (ideally) whole repertoire of small molecules in biological matrices (i.e., cells, tissues, and biological fluids). Results of metabolomics analysis may define the final output of genome-environment interactions at the individual level. This entire collection of metabolites is called "metabolome" and is highly dynamic. Here, we discuss how monitoring the dynamics of metabolic profiles may provide a read-out of the environmental and clinical disturbances affecting cell homeostasis in frailty-associated conditions.
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Affiliation(s)
- Anna Picca
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, 00168 Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
| | - Hélio José Coelho-Junior
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, 00168 Rome, Italy; Applied Kinesiology Laboratory-LCA, School of Physical Education, University of Campinas, 13.083-851 Campinas, SP, Brazil
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, Università di Milano, 20122 Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Federico Marini
- Department of Chemistry, Sapienza Università di Roma, 00168 Rome, Italy
| | - Alfredo Miccheli
- Department of Chemistry, Sapienza Università di Roma, 00168 Rome, Italy
| | - Jacopo Gervasoni
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, 00168 Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
| | - Maurizio Bossola
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, 00168 Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
| | - Francesco Landi
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, 00168 Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
| | - Roberto Bernabei
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, 00168 Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy.
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy.
| | - Riccardo Calvani
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, 00168 Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
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Outcomes of hospital admissions among frail older people: a 2-year cohort study. Br J Gen Pract 2019; 69:e555-e560. [PMID: 31308000 PMCID: PMC6650131 DOI: 10.3399/bjgp19x704621] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background ‘Frailty crises’ are a common cause of hospital admission among older people and there is significant focus on admission avoidance. However, identifying frailty before a crisis occurs is challenging, making it difficult to effectively target community services. Better longer-term outcome data are needed if services are to reflect the needs of the growing population of older people with frailty. Aim To determine long-term outcomes of older people discharged from hospital following short (<72 hours) and longer hospital admissions compared by frailty status. Design and setting Two populations aged ≥70 years discharged from hospital units: those following short ‘ambulatory’ admissions (<72 hours) and those following longer inpatient stays. Method Data for 2-year mortality and hospital use were compared using frailty measures derived from clinical and hospital data. Results Mortality after 2 years was increased for frail compared with non-frail individuals in both cohorts. Patients in the ambulatory cohort classified as frail had increased mortality (Rockwood hazard ratio 2.3 [95% confidence interval {CI} = 1.5 to 3.4]) and hospital use (Rockwood rate ratio 2.1 [95% CI = 1.7 to 2.6]) compared with those patients classified as non-frail. Conclusion Individuals with frailty who are discharged from hospital experience increased mortality and resource use, even after short ‘ambulatory’ admissions. This is an easily identifiable group that is at increased risk of poor outcomes. Health and social care systems might wish to examine their current care response for frail older people discharged from hospital. There may be value in a ‘secondary prevention’ approach to frailty crises targeting individuals who are discharged from hospital.
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Vestjens L, Cramm JM, Birnie E, Nieboer AP. Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:14. [PMID: 31333333 PMCID: PMC6617694 DOI: 10.1186/s12962-019-0181-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 06/21/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The article reports on the cost-effectiveness of the proactive, integrated primary care program Finding and Follow-up of Frail older persons (FFF) compared with usual primary care for community-dwelling frail older persons in the Netherlands. METHODS This study had a matched quasi-experimental design (pretest and posttest). The economic evaluation was performed from a healthcare perspective with a time horizon of 12 months. The target population consisted of community-dwelling frail older persons aged ≥ 75 years in the FFF intervention group (11 general practitioner (GP) practices) and in the control group receiving usual care (4 GP practices). The effectiveness measures for the cost-effectiveness and cost-utility analyses were subjective well-being (Social Production Function Instrument for the Level of well-being short; SPF-ILs) and QALYs (EuroQol; EQ-5D-3L), respectively. Costs were assessed using resource use questionnaires. Differences in mean effectiveness between groups were assessed using univariate, multilevel and propensity score matched analyses, with and without imputation of missing values. Differences in costs were assessed using Mann-Whitney U-tests and independent samples t-tests. Bootstrapping was performed, and predicted incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were depicted on cost-effectiveness planes. RESULTS The various analyses showed slightly different results with respect to differences in estimated costs and effects. Multilevel analyses showed a small but significant difference between the groups for well-being, in favor of the control group. No significant differences between groups in terms of QALYs were found. Imputed data showed that mean total costs were significantly higher in the intervention group at follow-up. CONCLUSION Proactive, integrated care for community-dwelling frail older persons as provided in the FFF program is most likely not a cost-effective initiative, compared with usual primary care in the Netherlands, in terms of well-being and QALYs over a 12-month period.
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Affiliation(s)
- Lotte Vestjens
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jane M. Cramm
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Anna P. Nieboer
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Curran D, Andrew MK, Levin MJ, Turriani E, Matthews S, Fogarty C, Klein NP, Grupping K, Oostvogels L, Schmader KE. Evaluation of two frailty indices, with practical application in a vaccine clinical trial. Hum Vaccin Immunother 2019; 15:2960-2968. [PMID: 31157595 PMCID: PMC6930102 DOI: 10.1080/21645515.2019.1622974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Frail older adults are at increased risk of poor clinical outcomes. Frailty assessment is therefore important in clinical trials to understand the benefits and harms of interventions. However, consensus is lacking on how frailty should be assessed.We developed a prospectively specified index using a battery of formal tests and instruments and a retrospectively generated index using medical comorbidities and patient reported outcomes (PROs) within an adjuvanted recombinant zoster vaccine (RZV) trial (NCT02979639). For both frailty indices (FIs), a total deficit score was calculated as the accumulation of deficits and participants were categorized as non-frail, pre-frail and frail. We assessed (1) the feasibility and validity of both FIs; (2) the impact of RZV vaccine reactogenicity by frailty status on Short Form-36 [SF-36] physical functioning (PF) scores.Of 401 participants, aged ≥50 years, 236 (58.9%) were categorized non-frail, 143 (35.7%), pre-frail, and 22 (5.5%) frail using the prospective FI. Corresponding numbers for the retrospective FI were 192 (47.9%), 169 (42.1%) and 40 (10.0%), respectively. Strong concordance was observed between the frailty status assessments (P < .001). The proportion defined as frail increased from 1.5%, to 10.4% in participants aged 50-59, and ≥70 years, respectively, for the prospective FI. Corresponding numbers for the retrospective FI were 3.7%, and 17.2%, respectively. RZV vaccination was associated with a transient, non-clinically meaningful, decrease on the SF-36 PF score in frail participants.Both frailty indices provided similar results. The retrospectively generated FI offers the advantage of being easier to incorporate into vaccine clinical trials of older adults.
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Affiliation(s)
| | - Melissa K Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Myron J Levin
- Departments of Pediatrics and Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | | | | | - Kenneth E Schmader
- Division of Geriatrics, Duke University Medical Center and GRECC, Durham Veterans Affairs Medical Center, Durham, NC, USA
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Segaux L, Oubaya N, Broussier A, Baude M, Canouï-Poitrine F, Naga H, Laurent M, Leissing-Desprez C, Audureau E, Ferrat E, Chailloleau C, Fromentin I, David JP, Bastuji-Garin S. Identification of five frailty profiles in community-dwelling individuals aged 50-75: A latent class analysis of the SUCCEED survey data. Maturitas 2019; 127:1-11. [PMID: 31351514 DOI: 10.1016/j.maturitas.2019.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/24/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to identify frailty profiles in individuals aged 50-75 by considering frailty as an unobservable latent variable in a latent class analysis (LCA). STUDY DESIGN 589 prospectively enrolled community-dwelling individuals aged 50-75 (median: 61.7 years) had undergone a standardized, multidomain assessment in 2010-2015. Adverse health outcomes (non-accidental falls, fractures, unplanned hospitalizations, and death) that had occurred since the assessment were recorded in 2016-2017. MAIN OUTCOME MEASURES The LCA used nine indicators (unintentional weight loss, relative slowness, weakness, impaired balance, osteoporosis, impaired cognitive functions, executive dysfunction, depression, and hearing impairment) and three covariates (age, gender, and consultation for health complaints). The resulting profiles were characterized by the Fried phenotype and adverse health outcomes. RESULTS We identified five profiles: "fit" (LC1, 29.7% of the participants; median age: 59 years); "weight loss, relative slowness, and osteoporosis" (LC2, 33.2%; 63 years); "weakness and osteopenia" (LC3, 21.9%; 60 years); "impaired physical and executive functions" (LC4, 11%; 67 years); and "impaired balance, cognitive functions, and depression" (LC5, 4.3%; 70 years). Almost all members of LC3 and LC4 were female, and were more likely than members of other profiles to have a frail or pre-frail Fried phenotype. Non-accidental falls were significantly more frequent in LC4. LC5 (almost all males) had the highest number of comorbidities and cardiovascular risk factors but none was frail. CONCLUSIONS Our data-driven approach covered most geriatric assessment domains and identified five frailty profiles. With a view to tailoring interventions and prevention, frailty needs to be detected among young seniors.
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Affiliation(s)
- Lauriane Segaux
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Clinical Research Unit (URC Mondor), Créteil, France.
| | - Nadia Oubaya
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France
| | - Amaury Broussier
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor/Emile Roux, Department of Geriatrics, Créteil, France
| | - Marjolaine Baude
- AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France
| | - Florence Canouï-Poitrine
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France
| | - Henri Naga
- AP-HP, Hôpital Henri-Mondor/Emile Roux, Department of Geriatrics, Créteil, France
| | - Marie Laurent
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor/Albert Chenevier, Department of Geriatrics, Créteil, France
| | - Claire Leissing-Desprez
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor/Emile Roux, Department of Geriatrics, Créteil, France
| | - Etienne Audureau
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France
| | - Emilie Ferrat
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; UPEC, Faculté de médecine de Créteil, Primary Care Department, Créteil, France
| | | | - Isabelle Fromentin
- AP-HP, Hôpital Henri-Mondor/Emile Roux, Department of Geriatrics, Créteil, France
| | - Jean-Philippe David
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor/Emile Roux, Department of Geriatrics, Créteil, France
| | - Sylvie Bastuji-Garin
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Clinical Research Unit (URC Mondor), Créteil, France; AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France
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Khastgir J. Antimuscarinic drug therapy for overactive bladder syndrome in the elderly - are the concerns justified? Expert Opin Pharmacother 2019; 20:813-820. [PMID: 30724647 DOI: 10.1080/14656566.2019.1574749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The use of antimuscarinic drugs is common in the management of the overactive bladder (OAB). Concerns have been raised over their use in the elderly population in whom the use of these drugs is highly prevalent, consequent to the reported link between these drugs and cognitive impairment and dementia. Areas covered: Recent publications have heightened concerns regarding antimuscarinic drug use in the elderly. In this review, the author discusses the available evidence upon which conclusions have been based and has presented the need for cortical review and need for caution in interpreting the data. The available evidence is inconsistent, differences in pharmacokinetics have not been widely recognized in clinical trials, clinical estimation of antimuscarinic activity has not been standardized, and serum antimuscarinic activity has not been found to correlate with cognitive impairment. Furthermore, the significant heterogeneity within cognitive aging processes raises questions regarding the extent to which various factors, including medication, influences this process. Expert opinion: Whilst caution should indeed be exercised in the use of antimuscarinic medication in the elderly, advocacy of discontinuation of their use may deprive patients of the benefits of improved quality of life from treatment where currently alternative management remain limited or invasive.
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Affiliation(s)
- Jay Khastgir
- a Swansea University Medical School , Abertawe Bro Morganwwg University Health Board , Swansea , Wales , UK
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