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Van der Elst MCJ, Schoenmakers B, Schols JMGA, De Witte N, De Lepeleire J. Complex interventions in frail older adults. Arch Gerontol Geriatr 2024; 122:105372. [PMID: 38422606 DOI: 10.1016/j.archger.2024.105372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Michaël C J Van der Elst
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
| | | | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Nico De Witte
- Department of Gerontology, Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel, Belgium; Research Center 360° Care and Well-being & Center for Applied Datascience (CADS), University College Ghent, Ghent, Belgium; Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
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Wang Z, Ruan H, Li L, Song N, He S. Association of changes in frailty status with the risk of all-cause mortality and cardiovascular death in older people: results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). BMC Geriatr 2024; 24:96. [PMID: 38267867 PMCID: PMC10809745 DOI: 10.1186/s12877-024-04682-2] [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: 07/27/2023] [Accepted: 01/06/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Few studies have investigated the association between changes in frailty status and all-cause mortality, inconsistent results were reported. What's more, studies that evaluated the effect of changes of frailty on cardiovascular death in older population are scanty. Therefore, the present study aims to investigate the association of such changes with the risk of all-cause mortality and cardiovascular death in older people, using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). METHODS A total of 2805 older participants from two consecutive waves (i.e. 2011 and 2014) of the CLHLS were included for analysis. Based on the changes in frailty status from wave 2011 to wave 2014, participants were categorized into 4 subgroups, including sustained pre/frailty, robustness to pre/frailty, pre/frailty to robustness and sustained robustness. Study outcomes were all-cause mortality and cardiovascular death, and Cox regression analysis examined the association of changes in frailty status with outcomes. RESULTS From wave 2011 to wave 2014, 33.2% of the participants had frailty transitions. From wave 2014 to wave 2018, there were 952 all-cause mortalities and 170 cardiovascular deaths during a follow-up of 9530.1 person-years, and Kaplan-Meier analysis demonstrated that cumulative incidences of the two outcomes were significantly lower in more robust participants (all log-rank p < 0.001). Compared with the subgroup of sustained pre/frailty, the fully adjusted HRs of all-cause mortality were 0.61 (95% CI: 0.51-0.73, p < 0.001), 0.51 (95% CI: 0.42-0.63, p < 0.001) and 0.41 (0.34-0.49, p < 0.001) in the subgroup of robustness to pre/frailty, the subgroup of pre/frailty to robustness, and the subgroup of sustained robustness, respectively. The fully adjusted HRs of cardiovascular death were 0.79 (95% CI: 0.52-1.19, p = 0.256) in the subgroup of robustness to pre/frailty, 0.45 (95% CI: 0.26-0.76, p = 0.003) in the subgroup of pre/frailty to robustness and 0.51 (0.33-0.78, p = 0.002) in the subgroup of sustained robustness when comparing to the subgroup of sustained pre/frailty, respectively. Stratified analysis and extensive sensitivity analyses revealed similar results. CONCLUSIONS Frailty is a dynamic process, and improved frailty and remaining robust are significantly associated with lower risk of all-cause mortality and cardiovascular death in older people.
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Affiliation(s)
- Ziqiong Wang
- Department of Cardiology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, China
| | - Haiyan Ruan
- Department of Cardiology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, China
- Department of Cardiology, Hospital of Traditional Chinese Medicine, Shuangliu District, Chengdu, China
| | - Liying Li
- Department of Cardiology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, China
| | - Ningying Song
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, China.
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, China.
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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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Dal Bello-Haas V, Kaasalainen S, Maximos M, Virag O, Seng-iad S, Te A, Bui M. Short-Term, Community-Based, Slow-Stream Rehabilitation Program for Older Adults Transitioning from Hospital to Home: A Mixed Methods Program Evaluation. Clin Interv Aging 2023; 18:1789-1811. [PMID: 37905200 PMCID: PMC10613420 DOI: 10.2147/cia.s419476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Shortened hospital stays have shifted the burden of care for older adults to community, informal (ie, family, caregiver) and formal post-acute care and services, highlighting the need for effective post-hospital stay services and programs. As there is a dearth of information related to community-based, slow-stream rehabilitation program models for older adults transitioning from hospital to home in the Canadian context, the paper describes a mixed methods evaluation of such a program. Materials and Methods A mixed methods program evaluation, with process- and outcome-related elements, included 1) review and analysis of program documents; 2) observations to examine fidelity. Observation data were coded and summarized using descriptive statistics. Coded information and data were compared to document review data; 3) quantitative assessment of pre-post changes in physical, social, and psychological outcome measure and instrument scores using descriptive statistics, paired t-tests and confidence intervals (p = 0.05); and 4) exploration of acceptability through interviews and focus groups with 41 of the older adult participants and 17 family caregivers. Thematic analysis was used to examine focus group and interview transcripts. Results Observational data indicated alignment with the program document information overall. Statistically and clinically significant positive trends in improvement for physical outcome measure scores were observed (6-minute Walk Test, Life Space Assessment, Short Physical Performance Battery, Rapid Assessment of Physical Activity). Participants and family caregivers identified several positives and benefits of the program, ie, improvement in physical, social and mental well-being, decreased caregiver burden; and areas for improvement ie, need for more information about the program prior to enrollment and individualization, several of which aligned with the observation and quantitative data. Discussion/Conclusion This mixed methods program evaluation provided a detailed description of a community-based, slow-stream rehabilitation program for older adults who are transitioning to home post-hospital stay and its participants. Evidence of program fidelity, acceptability, and positive trends in improvement in physical outcome measure scores were found. Information about program strengths and areas for improvement can be used by stakeholders to inform program refinement and enhancement.
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Affiliation(s)
| | | | | | - Olivia Virag
- Department of Family Medicine, David Braley Health Sciences Centre, Hamilton, Ontario, Canada
| | - Sirirat Seng-iad
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Alyssa Te
- Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Matthew Bui
- McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Sadler E, Khadjesari Z, Ziemann A, Sheehan KJ, Whitney J, Wilson D, Bakolis I, Sevdalis N, Sandall J, Soukup T, Corbett T, Gonçalves-Bradley DC, Walker DM. Case management for integrated care of older people with frailty in community settings. Cochrane Database Syst Rev 2023; 5:CD013088. [PMID: 37218645 PMCID: PMC10204122 DOI: 10.1002/14651858.cd013088.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Ageing populations globally have contributed to increasing numbers of people living with frailty, which has significant implications for use of health and care services and costs. The British Geriatrics Society defines frailty as "a distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves". This leads to an increased susceptibility to adverse outcomes, such as reduced physical function, poorer quality of life, hospital admissions, and mortality. Case management interventions delivered in community settings are led by a health or social care professional, supported by a multidisciplinary team, and focus on the planning, provision, and co-ordination of care to meet the needs of the individual. Case management is one model of integrated care that has gained traction with policymakers to improve outcomes for populations at high risk of decline in health and well-being. These populations include older people living with frailty, who commonly have complex healthcare and social care needs but can experience poorly co-ordinated care due to fragmented care systems. OBJECTIVES To assess the effects of case management for integrated care of older people living with frailty compared with usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Health Systems Evidence, and PDQ Evidence and databases from inception to 23 September 2022. We also searched clinical registries and relevant grey literature databases, checked references of included trials and relevant systematic reviews, conducted citation searching of included trials, and contacted topic experts. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared case management with standard care in community-dwelling people aged 65 years and older living with frailty. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures recommended by Cochrane and the Effective Practice and Organisation of Care Group. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 20 trials (11,860 participants), all of which took place in high-income countries. Case management interventions in the included trials varied in terms of organisation, delivery, setting, and care providers involved. Most trials included a variety of healthcare and social care professionals, including nurse practitioners, allied healthcare professionals, social workers, geriatricians, physicians, psychologists, and clinical pharmacists. In nine trials, the case management intervention was delivered by nurses only. Follow-up ranged from three to 36 months. We judged most trials at unclear risk of selection and performance bias; this consideration, together with indirectness, justified downgrading the certainty of the evidence to low or moderate. Case management compared to standard care may result in little or no difference in the following outcomes. • Mortality at 12 months' follow-up (7.0% in the intervention group versus 7.5% in the control group; risk ratio (RR) 0.98, 95% confidence interval (CI) 0.84 to 1.15; I2 = 11%; 14 trials, 9924 participants; low-certainty evidence) • Change in place of residence to a nursing home at 12 months' follow-up (9.9% in the intervention group versus 13.4% in the control group; RR 0.73, 95% CI 0.53 to 1.01; I2 = 0%; 4 trials, 1108 participants; low-certainty evidence) • Quality of life at three to 24 months' follow-up (results not pooled; mean differences (MDs) ranged from -6.32 points (95% CI -11.04 to -1.59) to 6.1 points (95% CI -3.92 to 16.12) when reported; 11 trials, 9284 participants; low-certainty evidence) • Serious adverse effects at 12 to 24 months' follow-up (results not pooled; 2 trials, 592 participants; low-certainty evidence) • Change in physical function at three to 24 months' follow-up (results not pooled; MDs ranged from -0.12 points (95% CI -0.93 to 0.68) to 3.4 points (95% CI -2.35 to 9.15) when reported; 16 trials, 10,652 participants; low-certainty evidence) Case management compared to standard care probably results in little or no difference in the following outcomes. • Healthcare utilisation in terms of hospital admission at 12 months' follow-up (32.7% in the intervention group versus 36.0% in the control group; RR 0.91, 95% CI 0.79 to 1.05; I2 = 43%; 6 trials, 2424 participants; moderate-certainty evidence) • Change in costs at six to 36 months' follow-up (results not pooled; 14 trials, 8486 participants; moderate-certainty evidence), which usually included healthcare service costs, intervention costs, and other costs such as informal care. AUTHORS' CONCLUSIONS We found uncertain evidence regarding whether case management for integrated care of older people with frailty in community settings, compared to standard care, improved patient and service outcomes or reduced costs. There is a need for further research to develop a clear taxonomy of intervention components, to determine the active ingredients that work in case management interventions, and identify how such interventions benefit some people and not others.
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Affiliation(s)
- Euan Sadler
- School of Health Sciences, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | | | - Alexandra Ziemann
- Department of Social & Policy Sciences, University of Bath, Bath, UK
| | - Katie J Sheehan
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Julie Whitney
- School of Life Course & Population Sciences, King's College London, London, UK
- Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, London, UK
| | - Dan Wilson
- Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Health Service & Population Research Department, King's College London, London, UK
| | - Nick Sevdalis
- Centre for Behavioural & Implementation Science Interventions (BISI), National University of Singapore, Singapore, Singapore
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, London, UK
| | - Tayana Soukup
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Teresa Corbett
- Faculty of Sport, Health and Social Sciences, Solent University, Southampton, UK
| | | | - Dawn-Marie Walker
- School of Health Sciences, University of Southampton, Southampton, UK
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Reid N, Young A, Shafiee Hanjani L, Hubbard RE, Gordon EH. Sex-specific interventions to prevent and manage frailty. Maturitas 2022; 164:23-30. [PMID: 35780633 DOI: 10.1016/j.maturitas.2022.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/20/2022] [Accepted: 05/28/2022] [Indexed: 12/15/2022]
Abstract
There is growing interest in interventions that delay, slow, and even reverse frailty. In this narrative review, we explore the evidence on exercise, nutrition, medication optimisation and social support interventions for frailty and consider how these relate to underlying frailty pathophysiology. We also consider pathophysiological mechanisms underpinning sex differences in frailty before evaluating the limited evidence for sex-specific frailty interventions that is currently available. Through this review of the literature, we generate a list of potential sex-specific interventions for frailty. While individual-level recommendations are certainly important, future work should turn the focus towards population-level interventions that take into account sex differences in frailty, including changes to healthcare and socioeconomic systems, as well as changes to the built environment to promote healthy behaviours.
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Affiliation(s)
- Natasha Reid
- Faculty of Medicine, The University of Queensland, Queensland, Australia.
| | - Adrienne Young
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Royal Brisbane and Women's Hospital, Metro North Health, Queensland, Australia
| | | | - Ruth E Hubbard
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health, Queensland, Australia
| | - Emily H Gordon
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health, Queensland, Australia
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Van der Elst M, Schoenmakers B, Dierckx E, De Donder L, De Roeck E, Duppen D, Fret B, Schols JMGA, Kempen GIJM, De Lepeleire J. A search for relevant contextual factors in intervention studies: a stepwise approach with online information. BMJ Open 2022; 12:e057048. [PMID: 36691193 PMCID: PMC9472109 DOI: 10.1136/bmjopen-2021-057048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 07/11/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The aim of the present study is to describe a stepwise approach to study which contextual factors might moderate the effect of healthcare interventions and to test feasibility of this approach within the D-SCOPE project. DESIGN Exploratory case study. SETTING In the D-SCOPE project, a complex intervention by means of home visits was set up to improve access to tailored care in three municipalities (Ghent, Knokke-Heist and Tienen). METHODS One designed and tested an approach including five steps: (1) a theoretical/conceptual discussion of relevant contextual factor domains was held; (2) a search was done to find appropriate web-based public datasets which covered these topics with standardised information; (3) a list of all identified contextual factors was made (inventory); (4) to reduce the long list of contextual factors, a concise list of most relevant contextual factors was developed based on the opinion of two independent reviewers and (5) a nominal grouping technique (NGT) was applied. RESULTS Three public web-based datasets were found resulting in an inventory of 157 contextual factors. After the selection by two independent reviewers, 41 contextual factors were left over and presented in a NGT which selected 10 contextual factors. The NGT included seven researchers, all familiar with the D-SCOPE intervention, with various educational backgrounds and expertise and lasted approximately 1 hour. CONCLUSION The present study shows that a five-step approach is feasible to determine relevant contextual factors that might affect the results of an intervention study. Such information may be used to correct for in the statistical analyses and for interpretation of the outcomes of intervention studies.NCT03168204.
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Affiliation(s)
- Michael Van der Elst
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Eva Dierckx
- Department of Clinical & Lifespan Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Liesbeth De Donder
- Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ellen De Roeck
- Department of Clinical & Lifespan Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Laboratory of Neurochemistry and Behavior, University of Antwerp, Antwerpen, Belgium
| | - Daan Duppen
- Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bram Fret
- Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Denfeld QE, Turrise S, MacLaughlin EJ, Chang PS, Clair WK, Lewis EF, Forman DE, Goodlin SJ. Preventing and Managing Falls in Adults With Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2022; 15:e000108. [PMID: 35587567 DOI: 10.1161/hcq.0000000000000108] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Falls and fear of falling are a major health issue and associated with high injury rates, high medical care costs, and significant negative impact on quality of life. Adults with cardiovascular disease are at high risk of falling. However, the prevalence and specific risks for falls among adults with cardiovascular disease are not well understood, and falls are likely underestimated in clinical practice. Data from surveys of patient-reported and medical record-based analyses identify falls or risks for falling in 40% to 60% of adults with cardiovascular disease. Increased fall risk is associated with medications, structural heart disease, orthostatic hypotension, and arrhythmias, as well as with abnormal gait and balance, physical frailty, sensory impairment, and environmental hazards. These risks are particularly important among the growing population of older adults with cardiovascular disease. All clinicians who care for patients with cardiovascular disease have the opportunity to recognize falls and to mitigate risks for falling. This scientific statement provides consensus on the interdisciplinary evaluation, prevention, and management of falls among adults with cardiac disease and the management of cardiovascular care when patients are at risk of falling. We outline research that is needed to clarify prevalence and factors associated with falls and to identify interventions that will prevent falls among adults with cardiovascular disease.
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Care Coordination Models and Tools-Systematic Review and Key Informant Interviews. J Gen Intern Med 2022; 37:1367-1379. [PMID: 34704210 PMCID: PMC9086013 DOI: 10.1007/s11606-021-07158-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Care coordination (CC) interventions involve systematic strategies to address fragmentation and enhance continuity of care. However, it remains unclear whether CC can sufficiently address patient needs and improve outcomes. METHODS We searched MEDLINE, CINAHL, Embase, Cochrane Database of Systematic Reviews, AHRQ Evidence-based Practice Center, and VA Evidence Synthesis Program, from inception to September 2019. Two individuals reviewed eligibility and rated quality using modified AMSTAR 2. Eligible systematic reviews (SR) examined diverse CC interventions for community-dwelling adults with ambulatory care sensitive conditions and/or at higher risk for acute care. From eligible SR and relevant included primary studies, we abstracted the following: study and intervention characteristics; target population(s); effects on hospitalizations, emergency department (ED) visits, and/or patient experience; setting characteristics; and tools and approaches used. We also conducted semi-structured interviews with individuals who implemented CC interventions. RESULTS Of 2324 unique citations, 16 SR were eligible; 14 examined case management or transitional care interventions; and 2 evaluated intensive primary care models. Two SR highlighted selection for specific risk factors as important for effectiveness; one of these also indicated high intensity (e.g., more patient contacts) and/or multidisciplinary plans were key. Most SR found inconsistent effects on reducing hospitalizations or ED visits; few reported on patient experience. Effective interventions were implemented in multiple settings, including rural community hospitals, academic medical centers (in urban settings), and public hospitals serving largely poor, uninsured populations. Primary studies reported variable approaches to improve patient-provider communication, including health coaching and role-playing. SR, primary studies, and key informant interviews did not identify tools for measuring patient trust or care team integration. Sustainability of CC interventions varied and some were adapted over time. DISCUSSION CC interventions have inconsistent effects on reducing hospitalizations and ED visits. Future work should address how they should be adapted to different healthcare settings and which tools or approaches are most helpful for implementation. TRIAL REGISTRATION PROSPERO #CRD42020156359.
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Hoedemakers M, Karimi M, Leijten F, Goossens L, Islam K, Tsiachristas A, Rutten-van Molken M. Value-based person-centred integrated care for frail elderly living at home: a quasi-experimental evaluation using multicriteria decision analysis. BMJ Open 2022; 12:e054672. [PMID: 35437245 PMCID: PMC9016393 DOI: 10.1136/bmjopen-2021-054672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To evaluate the value of the person-centred, integrated care programme Care Chain Frail Elderly (CCFE) compared with usual care, using multicriteria decision analysis (MCDA). DESIGN In a 12-month quasi-experimental study, triple-aim outcomes were measured at 0, 6 and 12 months by trained interviewers during home-visits. SETTING Primary care, community-based elderly care. PARTICIPANTS 384 community-dwelling frail elderly were enrolled. The 12-month completion rate was 70% in both groups. Propensity score matching was used to balance age, gender, marital status, living situation, education, smoking status and 3 month costs prior to baseline between the two groups. INTERVENTION The CCFE is an integrated care programme with unique features like the presence of the elderly and informal caregiver at the multidisciplinary team meetings, and a bundled payment. PRIMARY AND SECONDARY OUTCOMES MEASURES The MCDA results in weighted overall value scores that combines the performance on physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and costs, with importance weights of patients, informal caregivers, professionals, payers and policy-makers. RESULTS At 6 months, the overall value scores of CCFE were higher in all stakeholder groups, driven by enjoyment of life (standardised performance scores 0.729 vs 0.685) and person-centredness (0.749 vs 0.663). At 12 months, the overall value scores in both groups were similar from a patient's perspective, slightly higher for CCFE from an informal caregiver's and professional's perspective, and lower for CCFE from a payer's and policy-maker's perspective. The latter was driven by a worse performance on physical functioning (0.682 vs 0.731) and higher costs (€22 816 vs €20 680). CONCLUSIONS The MCDA indicated that the CCFE is the preferred way of delivering care to frail elderly at 6 months. However, at 12 months, MCDA results showed little difference from the perspective of patients, informal caregivers and professionals, while payers and policy-makers seemed to prefer usual care.
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Affiliation(s)
- Maaike Hoedemakers
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Milad Karimi
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- OPEN Health, Rotterdam, The Netherlands
| | - Fenna Leijten
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- Staff Defence Healthcare Organisation, Ministry of Defence, Utrecht, The Netherlands
| | - Lucas Goossens
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Kamrul Islam
- Department of Economics, University of Bergen, Bergen, Norway
- Social Sciences, NORCE Norwegian Research Centre AS, Bergen, Norway
| | | | - Maureen Rutten-van Molken
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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11
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Explaining the association between frailty and mortality in older adults: The mediating role of lifestyle, social, psychological, cognitive, and physical factors. Prev Med Rep 2021; 24:101589. [PMID: 34976648 PMCID: PMC8683887 DOI: 10.1016/j.pmedr.2021.101589] [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: 05/25/2021] [Revised: 08/18/2021] [Accepted: 10/03/2021] [Indexed: 01/02/2023] Open
Abstract
Frailty in older adults is associated with adverse outcomes such as mortality. Not much is known about underlying pathways of the frailty-mortality association. We assessed the mediating role of a wide range of factors. In both men and women, only polypharmacy was identified as explanatory factor. Targeting polypharmacy in frail older adults could reduce their risk of mortality.
Frailty is associated with a higher risk of mortality, but not much is known about underlying pathways of the frailty-mortality association. In this study, we explore a wide range of possible mediators of the relation between frailty and mortality. Data were used from the Longitudinal Aging Study Amsterdam (LASA). We included 1477 older adults aged 65 years and over who participated in the study in 2008–2009 and linked their data to register data on mortality up to 2015. We examined a range of lifestyle, social, psychological, cognitive, and physical factors as potential mediators. All analyses were stratified by sex. We used causal mediation analyses to estimate the indirect effects in single-mediator analyses. Statistically significant mediators were then included in multiple-mediator analyses to examine their combined effect. The results showed that older men (OR = 2.79, 95% CI = 1.23;6.34) and women (OR = 2.31, 95% CI = 1.24;4.30) with frailty had higher odds of being deceased 6 years later compared to those without frailty. In men, polypharmacy (indirect effect OR = 1.21, 95% CI = 1.03;1.50) was a statistically significant mediator in this association. In women, polypharmacy, self-rated health, and multimorbidity were statistically significant mediators in the single-mediator models, but only the indirect effect of polypharmacy remained in the multiple-mediator model (OR = 1.16, 95% CI = 1.03;1.38). In conclusion, of many factors that were considered, we identified polypharmacy as explanatory factor of the association between frailty and mortality in older men and women. This finding has important clinical implications, as it suggests that targeting polypharmacy in frail older adults could reduce their risk of mortality.
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12
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Frailty and dementia: what can the body tell us about the brain? Int Psychogeriatr 2021; 33:1001-1003. [PMID: 34078500 DOI: 10.1017/s1041610220004160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Hatfield LA, Caudry D, Grabowski DC. Change in condition alerts for home care recipients: A stepped wedge cluster randomized trial. J Am Geriatr Soc 2021; 69:2548-2555. [PMID: 34138464 DOI: 10.1111/jgs.17324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Paid home care providers (caregivers) are in close, regular contact with people for whom they care (clients). This study evaluated whether caregivers, by noting changes in physical and mental health, could prevent hospitalizations. DESIGN Stepped wedge cluster randomized trial with 4 sequences, 244 clusters, an open cohort, and continuous outcome assessment. SETTING Franchises of a national home care company. PARTICIPANTS Eligible clusters were all franchises operating at the study start, excluding those in a previous pilot. The sample included all clients who received private-pay home care services from an eligible franchise, could be linked to Medicare enrollment records, and were enrolled in fee-for-service Medicare. INTERVENTION A telephone- and app-based questionnaire at the end of each caregiving shift asked caregivers whether they noted changes in mental or physical health of their client. This generated a change-in-condition report that staff at the franchise office addressed at their discretion (e.g., by contacting clients or primary care providers). The control condition was no questionnaire. The study was unblinded. Clusters were randomized to four treatment sequences in eight strata of franchise characteristics. MEASUREMENTS The primary outcome was hospitalization during months of home care enrollment. Secondary outcomes were emergency department (ED) visits and mortality. RESULTS Two hundred and forty-four franchises were randomized to the four sequences (n = 40, 66, 68, 70 franchises, respectively) and 40,137 people were observed during 276,938 person-months of home care enrollment. We found no evidence of impact on hospitalization (odds ratio [OR] 1.03, 95% confidence interval [CI]: 0.97, 1.10), ED visits (OR 1.03, 95% CI: 0.98, 1.08), or mortality (OR 1.07, 95% CI: 0.96, 1.19). CONCLUSION A technology-enabled intervention to identify health changes among home care recipients did not show evidence of impact on hospitalizations, ED visits, or mortality. Providing change-in-condition reports to home care staff, without a structured response to manage these changes, was not effective at improving care.
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Affiliation(s)
- Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Daryl Caudry
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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14
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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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15
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Montano AR. A concept analysis of interprofessional collaborative practice for community-dwelling older adults. Nurs Forum 2021; 56:413-420. [PMID: 33533058 DOI: 10.1111/nuf.12553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
Models of interprofessional collaborative practice have demonstrated improved outcomes for community-dwelling older adults. However, the concept of interprofessional collaborative practice for community-dwelling older adults needs clarification and a clear definition. A concept analysis based on the method posited by Walker and Avant was conducted to formulate an operational definition of this concept. Defining attributes, antecedents, consequences and empirical referents were identified from a review of the literature. A model case and contrary case were selected to further clarify the concept of interprofessional collaborative practice for community-dwelling older adults. Nurses are ideal leaders of interprofessional teams caring for older adults and can utilize this concept in practice, education and research.
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Affiliation(s)
- Anna-Rae Montano
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
- The Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
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16
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Li CM, Lin CH, Li CI, Liu CS, Lin WY, Li TC, Lin CC. Frailty status changes are associated with healthcare utilization and subsequent mortality in the elderly population. BMC Public Health 2021; 21:645. [PMID: 33794860 PMCID: PMC8017879 DOI: 10.1186/s12889-021-10688-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 03/23/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study determined (1) whether a change in frailty status after a 1 year follow up is associated with healthcare utilization and evaluated (2) whether a change in frailty status after a 1 year follow up and health care utilization are associated with all-cause mortality in a sample of Taiwan population. METHODS This work is a population-based prospective cohort study involving residents aged ≥65 years in 2009. A total of 548 elderly patients who received follow-ups in the subsequent year were included in the current data analysis. Fried frailty phenotype was measured at baseline and 1 year. Information on the outpatient visits of each specialty doctor, emergency care utilization, and hospital admission during the 2 month period before the second interview was collected through standardized questionnaires administered by an interviewer. Deaths were verified by indexing to the national database of deaths. RESULTS At the subsequent 1 year follow-up, 73 (13.3%), 356 (64.9%), and 119 (21.7%) elderly participants exhibited deterioration, no change in status, and improvement in frailty states, respectively. Multivariate logistic analysis showed the high risk of any type of outpatient use (odds ratios [OR] 1.94, 95% confidence interval [CI] 1.02-3.71) among older adults with worse frailty status compared with those who were robust at baseline and had unchanged frailty status after 1 year. After multivariate adjustment, participants with high outpatient clinic utilization had significantly higher mortality than those with low outpatient clinic visits among unchanged pre-frail or frail (hazard ratios [HR] 2.79, 95% CI: 1.46-5.33) and frail to pre-frail/robust group (HR 9.32, 95% CI: 3.82-22.73) if the unchanged robustness and low outpatient clinic visits group was used as the reference group. CONCLUSIONS The conditions associated with frailty status, either after 1 year or at baseline, significantly affected the outpatient visits and may have increased medical expenditures. Combined change in frailty status and number of outpatient visits is related to increased mortality.
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Affiliation(s)
- Chia-Ming Li
- Department of Family Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC. .,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. .,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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17
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Zhu Y, Ge J, Huang C, Liu H, Jiang H. Application of mesenchymal stem cell therapy for aging frailty: from mechanisms to therapeutics. Theranostics 2021; 11:5675-5685. [PMID: 33897874 PMCID: PMC8058725 DOI: 10.7150/thno.46436] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Aging frailty is a complex geriatric syndrome that becomes more prevalent with advancing age. It constitutes a major health problem due to frequent adverse outcomes. Frailty is characterized by disruption of physiological homeostasis and progressive decline of health status. Multiple factors contribute to development of frailty with advancing age, including genome instability, DNA damage, epigenetic alternations, stem cell exhaustion, among others. These interrelated factors comprehensively result in loss of tissue homeostasis and diminished reserve capacity in frailty. Therefore, the aged organism gradually represents symptoms of frailty with decline in physiological functions of organs. Notably, the brain, cardiovascular system, skeletal muscle, and endocrine system are intrinsically interrelated to frailty. The patients with frailty may display the diminished reserves capacity of organ systems. Due to the complex pathophysiology, no specific treatments have been approved for prevention of this syndrome. At such, effective strategies for intervening in pathogenic process to improve health status of frail patients are highly needed. Recent progress in cell-based therapy has greatly contributed to the amelioration of degenerative diseases related to age. Mesenchymal stem cells (MSCs) can exert regenerative effects and possess anti-inflammatory properties. Transplantation of MSCs represents as a promising therapeutic strategy to address the pathophysiologic problems of frail syndrome. Currently, MSC therapy have undergone the phase I and II trials in human subjects that have endorsed the safety and efficacy of MSCs for aging frailty. However, despite these positive results, caution is still needed with regard to potential to form tumors, and further large-scale studies are warranted to confirm the therapeutic efficacy of MSC therapy.
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18
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Frost R, Rait G, Wheatley A, Wilcock J, Robinson L, Harrison Dening K, Allan L, Banerjee S, Manthorpe J, Walters K. What works in managing complex conditions in older people in primary and community care? A state-of-the-art review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1915-1927. [PMID: 32671922 DOI: 10.1111/hsc.13085] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
The number of older people living with complex health conditions is increasing, with the majority of these managed in primary and community settings. Many models of care have been developed to support them, however, there is mixed evidence on their value and they include multiple overlapping components. We aimed to synthesise the evidence to learn what works for managing complex conditions in older people in primary and community care. We carried out a state-of-the-art review of systematic reviews. We searched three databases (January 2009 to July 2019) for models of primary and community care for long-term conditions, frailty, multimorbidity and complex neurological conditions common to older people such as dementia. We narratively synthesised review findings to summarise the evidence for each model type and identify components which influenced effectiveness. Out of 2,129 unique titles and abstracts, 178 full texts were reviewed and 54 systematic reviews were included. We found that the models of care were more likely to improve depressive symptoms and mental health outcomes than physical health or service use outcomes. Interventions including self-management, patient education, assessment with follow-up care procedures, and structured care processes or pathways had greater evidence of effectiveness. The level of healthcare service integration appeared to be more important than inclusion of specific professional types within a team. However, more experienced and qualified nurses were associated with better outcomes. These conclusions are limited by the overlap between reviews, reliance on vote counting within some included reviews and the quality of study reports. In conclusion, primary and community care interventions for complex conditions in older people should include: (a) clear intervention targets; (b) explicit theoretical underpinnings; and (c) elements of self-management and patient education, structured collaboration between healthcare professionals and professional support. Further work needs to determine the optimal intensity, length, team composition and role of technology in interventions.
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Affiliation(s)
- Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Alison Wheatley
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Louise Allan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jill Manthorpe
- NIHR Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
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19
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Gorroñogoitia Iturbe A, López-Torres Hidalgo J, Martin Lesende I, Herreros Herreros Y, Acosta Benito MÁ, de Hoyos Alonso MDC, Baena Díez JM, Magán Tapia P, García Pliego R. [PAPPS GdT Major 2020 Update]. Aten Primaria 2020; 52 Suppl 2:114-124. [PMID: 33388111 PMCID: PMC7801214 DOI: 10.1016/j.aprim.2020.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/09/2020] [Indexed: 12/28/2022] Open
Abstract
In this update, we have introduced new topics that we believe are of vital importance in the major areas, such as the revision of walking aids, as well as recommendations on nutrition and social isolation. Recommendations on deprescribing, fragility, mild cognitive impairment, and dementia have already been presented in previous updates.
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20
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Khan N, Hewson D, Randhawa G. Effectiveness of integrated chronic care interventions for older people with different frailty levels: a systematic review protocol. BMJ Open 2020; 10:e038437. [PMID: 32912991 PMCID: PMC7485241 DOI: 10.1136/bmjopen-2020-038437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/14/2020] [Accepted: 07/31/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Frailty poses a huge burden to individuals, their families and to healthcare systems. Several interventions have been evaluated for the improvement of outcomes for older people with frailty, including integrated care interventions. Reviews synthesising evidence on the effectiveness of integrated care for older people with frailty have treated them as a single population, without considering the heterogeneity between different frailty levels such as non-frail, mild frailty, moderate frailty and severe frailty. Findings from these studies have shown inconsistent results on the various outcomes assessed. People with different frailty status have different care needs, which should be addressed accordingly. The aim of this study is to synthesise evidence on the effectiveness of integrated care interventions on older people with different frailty status who are community dwelling or living in retirement housing or residential setting but not in care homes or in nursing homes. METHODS AND ANALYSIS This is a protocol for a systematic review assessing the effectiveness of integrated chronic care interventions on older people with different frailty status. A literature search will be conducted on the databases Cochrane Central Register of Controlled Trials, PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and clinical trial registers. Two authors will independently conduct search and screening for eligible studies. Full-text screening will be used to include only studies that fulfil the inclusion criteria. Data extraction will be done on a data extraction form and methodological quality of studies will be assessed using the Effective Practice and Organisation of Care risk of bias tool. The interventions will be described following Wagner's Chronic Care Model. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the Institute for Health Research Ethics Committee of the University of Bedfordshire (IHREC934). The results of the review will be disseminated through a peer-reviewed journal article, conferences and also with local provider and user stakeholders. PROSPERO REGISTRATION NUMBER CRD42020166908.
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Affiliation(s)
- Nimra Khan
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - David Hewson
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
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21
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Vidal PP, Vienne-Jumeau A, Moreau A, Vidal C, Wang D, Audiffren J, Bargiotas I, Barrois R, Buffat S, Dubost C, Ghidaglia JM, Labourdette C, Mantilla J, Oudre L, Quijoux F, Robert M, Yelnik AP, Ricard D, Vayatis N. An opinion paper on the maintenance of robustness: Towards a multimodal and intergenerational approach using digital twins. Aging Med (Milton) 2020; 3:188-194. [PMID: 33103039 PMCID: PMC7574634 DOI: 10.1002/agm2.12115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/29/2022] Open
Abstract
The increasing number of frail elderly people in our aging society is becoming problematic: about 11% of community‐dwelling older persons are frail and another 42% are pre‐frail. Consequently, a major challenge in the coming years will be to test people over the age of 60 years to detect pre‐frailty at the earliest stage and to return them to robustness using the targeted interventions that are becoming increasingly available. This challenge requires individual longitudinal monitoring (ILM) or follow‐up of community‐dwelling older persons using quantitative approaches. This paper briefly describes an effort to tackle this challenge. Extending the detection of the pre‐frail stages to other population groups is also suggested. Appropriate algorithms have been used to begin the tracing of faint physiological signals in order to detect transitions from robustness to pre‐frailty states and from pre‐frailty to frailty states. It is hoped that these studies will allow older adults to receive preventive treatment at the correct institutions and by the appropriate professionals as early as possible, which will prevent loss of autonomy. Altogether, ILM is conceived as an emerging property of databases (“digital twins”) and not the reverse. Furthermore, ILM should facilitate a coordinated set of actions by the caregivers, which is a complex challenge in itself. This approach should be gradually extended to all ages, because frailty has no age, as is testified by overwork, burnout, and post‐traumatic syndrome.
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Affiliation(s)
- Pierre-Paul Vidal
- Institute of Information and Control Hangzhou Dianzi University Zhejiang China.,Centre Borelli CNRS Paris University Paris France
| | | | - Albane Moreau
- Centre Borelli CNRS Paris University Paris France.,Service de Neurologie Hôpital d'Instruction des Armées de Percy Service de Santé des Armées Clamart France
| | - Catherine Vidal
- Centre Borelli CNRS Paris University Paris France.,ENT Department Salpetriere Hospital Paris France
| | - Danping Wang
- Institute of Information and Control Hangzhou Dianzi University Zhejiang China.,Plateforme Sensorimotricité Paris University - CNRS - INSERM Paris France
| | | | | | - Remi Barrois
- Centre Borelli CNRS Paris University Paris France
| | | | - Clément Dubost
- Centre Borelli CNRS Paris University Paris France.,Hôpital d'instruction des armées Bégin Saint-Mandé France
| | | | | | | | - Laurent Oudre
- L2TI Sorbonne Paris Nord University Villetaneuse France
| | | | - Matthieu Robert
- Centre Borelli CNRS Paris University Paris France.,Service d'ophtalmologie AP-HP Hôpital Universitaire Necker-Enfants Malades Paris France
| | - Alain P Yelnik
- Centre Borelli CNRS Paris University Paris France.,PRM Department GH St Louis Lariboisière F. Widal Paris University Paris France
| | - Damien Ricard
- Centre Borelli CNRS Paris University Paris France.,Service de Neurologie Hôpital d'Instruction des Armées de Percy Service de Santé des Armées Clamart France.,École d'application du Val-de-Grâce Service de Santé des Armée Paris France
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Montano AR, Shellman J, Malcolm M, McDonald D, Rees C, Fortinsky R, Reagan L. A mixed methods evaluation of got care! Geriatr Nurs 2020; 41:822-831. [PMID: 32532562 DOI: 10.1016/j.gerinurse.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Abstract
This study aimed to assess the relationship between an Interprofessional Collaborative Practice (IPCP) intervention for community-dwelling older adults, Geriatric Outreach and Training with Care! (GOT Care!), and the observed 26% reduction in Emergency Department (ED) visits for the 51 older adult participants. A convergent parallel mixed-methods design was utilized. Demographic data and ED visit data were collected and analyzed using paired-samples t-tests, poisson regression and generalized poisson regression. Stakeholder perspectives were assessed via emailed open-ended surveys and analyzed using content analysis. The quantitative results were transformed into trends that were compared and contrasted with the qualitative themes. The results were consistent with the current literature that IPCP models may have a greater impact on older adults with certain demographic characteristics such as polypharmacy, diabetes and prior ED use, while nursing was identified as an ideal leader for IPCP teams.
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Affiliation(s)
- Anna-Rae Montano
- University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269, United States.
| | - Juliette Shellman
- University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269, United States.
| | - Millicent Malcolm
- University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269, United States.
| | - Deborah McDonald
- University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269, United States.
| | - Catherine Rees
- Middlesex Health, 28 Crescent Street, Middletown, CT 06457, United States.
| | - Richard Fortinsky
- UConn Center on Aging, UConn Health, 263 Farmington Avenue, Farmington, CT 06030-5215, United States.
| | - Louise Reagan
- University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269, United States.
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Peng LN, Hsiao FY, Lee WJ, Huang ST, Chen LK. Comparisons Between Hypothesis- and Data-Driven Approaches for Multimorbidity Frailty Index: A Machine Learning Approach. J Med Internet Res 2020; 22:e16213. [PMID: 32525481 PMCID: PMC7317629 DOI: 10.2196/16213] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/17/2019] [Accepted: 01/24/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Using big data and the theory of cumulative deficits to develop the multimorbidity frailty index (mFI) has become a widely accepted approach in public health and health care services. However, constructing the mFI using the most critical determinants and stratifying different risk groups with dose-response relationships remain major challenges in clinical practice. OBJECTIVE This study aimed to develop the mFI by using machine learning methods that select variables based on the optimal fitness of the model. In addition, we aimed to further establish 4 entities of risk using a machine learning approach that would achieve the best distinction between groups and demonstrate the dose-response relationship. METHODS In this study, we used Taiwan's National Health Insurance Research Database to develop a machine learning multimorbidity frailty index (ML-mFI) using the theory of cumulative diseases/deficits of an individual older person. Compared to the conventional mFI, in which the selection of diseases/deficits is based on expert opinion, we adopted the random forest method to select the most influential diseases/deficits that predict adverse outcomes for older people. To ensure that the survival curves showed a dose-response relationship with overlap during the follow-up, we developed the distance index and coverage index, which can be used at any time point to classify the ML-mFI of all subjects into the categories of fit, mild frailty, moderate frailty, and severe frailty. Survival analysis was conducted to evaluate the ability of the ML-mFI to predict adverse outcomes, such as unplanned hospitalizations, intensive care unit (ICU) admissions, and mortality. RESULTS The final ML-mFI model contained 38 diseases/deficits. Compared with conventional mFI, both indices had similar distribution patterns by age and sex; however, among people aged 65 to 69 years, the mean mFI and ML-mFI were 0.037 (SD 0.048) and 0.0070 (SD 0.0254), respectively. The difference may result from discrepancies in the diseases/deficits selected in the mFI and the ML-mFI. A total of 86,133 subjects aged 65 to 100 years were included in this study and were categorized into 4 groups according to the ML-mFI. Both the Kaplan-Meier survival curves and Cox models showed that the ML-mFI significantly predicted all outcomes of interest, including all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions at 1, 5, and 8 years of follow-up (P<.01). In particular, a dose-response relationship was revealed between the 4 ML-mFI groups and adverse outcomes. CONCLUSIONS The ML-mFI consists of 38 diseases/deficits that can successfully stratify risk groups associated with all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions in older people, which indicates that precise, patient-centered medical care can be a reality in an aging society.
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Affiliation(s)
- Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan, Taiwan
| | - Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
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Identification and management of frailty in English primary care: a qualitative study of national policy. BJGP Open 2020; 4:bjgpopen20X101019. [PMID: 32184213 PMCID: PMC7330193 DOI: 10.3399/bjgpopen20x101019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/08/2019] [Indexed: 01/03/2023] Open
Abstract
Background Policymakers are directing attention to addressing the needs of an ageing population. Since 2017, general practices in England have been contractually required to identify and code ‘frailty’ as a new clinical concept and, in doing so, support targeted management for this population with the aim of improving outcomes. However, embedding frailty policies into routine practice is not without challenges and little is currently known about the success of the programme. Aim To explore the implementation of a national policy on frailty identification and management in English primary care. Design & setting Qualitative study entailing interviews with primary care professionals in the North of England. Method Semi-structured interviews were conducted with GPs (n = 10), nurses (n = 6), practice managers (n = 3), and health advisors (n = 3). Normalisation process theory (NPT) and ‘system thinking’ provided sensitising frameworks to support data collection and analysis. Results Primary care professionals were starting to use the concept of frailty to structure care within practices and across organisations; however, there was widespread concern about the challenge of providing expanded care for the identified needs with existing resources. Concerns were also expressed around how best to identify the frail subpopulation and the limitations of current tools for this, and there was a professional reticence to use the term ‘frailty’ with patients. Conclusion Findings suggests that additional, focused resources and the development of a stronger evidence base are essential to facilitate professional engagement in policies to improve the targeted coding and management of frailty in primary care.
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Lette M, Boorsma M, Lemmens L, Stoop A, Nijpels G, Baan C, de Bruin S. Unknown makes unloved-A case study on improving integrated health and social care in the Netherlands using a participatory approach. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:670-680. [PMID: 31773803 PMCID: PMC7028071 DOI: 10.1111/hsc.12901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/04/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
Many initiatives integrating health and social care have been implemented in order to provide adequate care and support to older people living at home. Further development of existing initiatives requires iterative processes of developing, implementing and evaluating improvements to current practice. This case study provides insight into the process of improving an existing integrated care initiative in the Netherlands. Using a participatory approach, researchers and local stakeholders collaborated to develop and implement activities to further improve collaboration between health and social care professionals. Improvement activities included interprofessional meetings focussing on reflection and mutual learning and workplace visits. Researchers evaluated the improvement process, using data triangulation of multiple qualitative and quantitative data sources. According to participating professionals, the improvement activities improved their communication and collaboration by establishing mutual understanding and trust. Enabling factors included the safe and informal setting in which the meetings took place and the personal relationships they developed during the project. Different organisational cultures and interests and a lack of ownership and accountability among managers hindered the improvement process, whereas issues such as staff shortages, time constraints and privacy regulations made it difficult to implement improvements on a larger scale. Still, the participatory approach encouraged the development of partnerships and shared goals on the level of both managers and professionals. This case study highlights that improving communication between professionals is an important first step in improving integrated care. In addition, it shows that a participatory approach, in which improvements are co-created and tailored to local priorities and needs, can help in the development of shared goals and trust between stakeholders with different perspectives. However, stakeholders' willingness and ability to participate in such an improvement process is challenged by many factors.
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Affiliation(s)
- Manon Lette
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Marijke Boorsma
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
| | - Lidwien Lemmens
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Annerieke Stoop
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
| | - Caroline Baan
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Simone de Bruin
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
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Wolfe JD, Wolfe NK, Rich MW. Perioperative care of the geriatric patient for noncardiac surgery. Clin Cardiol 2019; 43:127-136. [PMID: 31825127 PMCID: PMC7021644 DOI: 10.1002/clc.23302] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/27/2019] [Accepted: 11/08/2019] [Indexed: 12/21/2022] Open
Abstract
Adults age 65 and over are the fastest growing segment of the population in the United States and around the world. As the size of this population expands, the number of older adults referred for surgical procedures will continue to increase. Due to the physiologic changes of aging and the increased frequency of comorbidities, older adults are at increased risk for adverse outcomes, and perioperative care is inherently more complex than in younger individuals. In this review, we discuss the physiologic changes of aging relevant to the surgical patient, comprehensive preoperative assessment, and postoperative management of common complications in older adults in order to promote optimal clinical outcomes both perioperatively and long‐term.
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Affiliation(s)
- Jonathan D Wolfe
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Natasha K Wolfe
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael W Rich
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
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Vergara I, Mateo-Abad M, Saucedo-Figueredo MC, Machón M, Montiel-Luque A, Vrotsou K, Nava Del Val MA, Díez-Ruiz A, Güell C, Matheu A, Bueno A, Núñez J, Rivas-Ruiz F. Description of frail older people profiles according to four screening tools applied in primary care settings: a cross sectional analysis. BMC Geriatr 2019; 19:342. [PMID: 31795949 PMCID: PMC6892171 DOI: 10.1186/s12877-019-1354-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 11/11/2019] [Indexed: 11/30/2022] Open
Abstract
Background Regarding the health care of older populations, WHO recommends shifting from disease-driven attention models towards a personalized, integrated and continuous care aimed to the maintenance and enhancement of functional capacities. Impairments in the construct of functional intrinsic capacity have been understood as the condition of frailty or vulnerability. No consensus has been yet reached regarding which tools are the most suitable for screening this kind of patients in primary care settings. Tools based on the measurement of functional performance such as Timed up and go test (TUG), Short Physical Performance battery (SPPB), self-completed questionnaires like Tilburg Frailty Indicator (TFI) and clinical judgement, as the Gerontopole Frailty Scale (GFS) may be adequate. The objective of this work is to describe and compare characteristics of community-dwelling individuals identified as vulnerable or frail by four tools applied in primary care settings. Methods Cross sectional analysis developed in primary care services in two regions of Spain. Community-dwelling independent individuals aged 70 or more willing to participate were recruited and data was collected via face-to-face interviews. Frailty was assessed by TUG, SPPB, TFI and GFST. Also socio-demographic characteristics, lifestyle habits and health status data (comorbidities, polypharmacy, self-perceived health), were collected. Multiple correspondence analysis (MCA) and cluster analysis were used to identify groups of individuals with similar characteristics. Results Eight hundred sixty-five individuals were recruited, 53% women, with a mean age of 78 years. Four clusters of participants emerge. Cluster 1 (N = 263) contained patients categorized as robust by most of the studied tools, whereas clusters 2 (N = 199), 3 (N = 183) and 4 (N = 220) grouped patients classified as frail or vulnerable by at least one of the tools. Significant differences were found between clusters. Conclusions The assessed tools identify different profiles of patients according to their theoretical construct of frailty. There is a group of patients that are identified by TUG and SPPB but not by GFS or TFI. These tools may be useful in primary care settings for the implementation of a function- driven clinical care of older patients.
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Affiliation(s)
- Itziar Vergara
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, 20014, Donostia-San Sebastian, Spain. .,Instituto Biodonostia, Donostia-San Sebastian, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Kronikgune, Barakaldo, Spain.
| | - Maider Mateo-Abad
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, 20014, Donostia-San Sebastian, Spain.,Instituto Biodonostia, Donostia-San Sebastian, Spain.,Kronikgune, Barakaldo, Spain
| | | | - Mónica Machón
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, 20014, Donostia-San Sebastian, Spain.,Instituto Biodonostia, Donostia-San Sebastian, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Kronikgune, Barakaldo, Spain
| | - Alonso Montiel-Luque
- Unidad Gestión Clínica San Miguel, Torremolinos. Distrito de Atención Primaria Costa del Sol, Málaga, Spain
| | - Kalliopi Vrotsou
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, 20014, Donostia-San Sebastian, Spain.,Instituto Biodonostia, Donostia-San Sebastian, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Kronikgune, Barakaldo, Spain
| | - María Antonia Nava Del Val
- Unidad Gestión Clínica Las Albarizas, Marbella, Distrito de Atención Primaria Costa del Sol, Málaga, Spain
| | - Ana Díez-Ruiz
- Instituto Biodonostia, Donostia-San Sebastian, Spain.,Centro de Salud Beraun, OSI Donostialdea, Osakidetza, Errenteria, Spain
| | - Carolina Güell
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Instituto de Investigación Sanitaria Biodonostia, 20014, Donostia-San Sebastian, Spain.,Instituto Biodonostia, Donostia-San Sebastian, Spain
| | - Ander Matheu
- Grupo de Oncología Celular, Instituto Biodonostia, San Sebastián, Spain; IKERBASQUE, Fundación Vasca para la Ciencia, Bilbao, Spain; CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Bilbao, Spain
| | - Antonio Bueno
- Centro de Salud Beraun, OSI Donostialdea, Osakidetza, Errenteria, Spain
| | - Jazmina Núñez
- Centro de Salud Beraun, OSI Donostialdea, Osakidetza, Errenteria, Spain
| | - Francisco Rivas-Ruiz
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Unidad de Investigación Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain
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Huang CY, Lee WJ, Lin HP, Chen RC, Lin CH, Peng LN, Chen LK. Epidemiology of frailty and associated factors among older adults living in rural communities in Taiwan. Arch Gerontol Geriatr 2019; 87:103986. [PMID: 31901458 DOI: 10.1016/j.archger.2019.103986] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/17/2019] [Accepted: 11/17/2019] [Indexed: 01/19/2023]
Abstract
Frailty is a well-known geriatric syndrome with strong adverse health impact to older people. The socio-economic status and the accessibility of health services in rural communities may increase the risk of frailty. We conducted a cross-sectional study in rural districts of New Taipei City, Taiwan, to explore the epidemiology and associated factors of frailty. Data of 1014 participants (mean age: 78.7 ± 8.0 years, 66.3 % females) were obtained with the prevalence of frailty and pre-frailty 17.6 % and 23.1 %, respectively. The mean Barthel Index was 98.5 ± 5.8, and their mean Instrumental Activities of Daily Living (IADL) were 7.2 ± 1.5. Frail older people tended perform worse in timed up-and-go tests (24.7 % in frailty and 0.4 % in robust). The mean mini-mental state examination (MMSE) score for all participants was 23.3 ± 5.1, but was lower in frail older for around 5 points. Depressive symptoms were more common in frail older persons than robust ones (31.5 % vs 14.3 %), which was similar in the nutritional status. Results of the logistic regression showed that better education, IADL and MMSE scores were protective factors against frailty. The presence of depressive symptoms, urinary incontinence, abnormal performance of TUG, and the presence of the risk for malnutrition were all independent assciated factors for frailty. In conclusion, the prevalence of frailty was higher among older adults living in rural communities that deserves specific public health attentions. Further intervention study covering special needs in rural communities is needed to promote health of older people.
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Affiliation(s)
- Chung-Yu Huang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Aging and Health Research Center, National Yang Ming University, New Taipei City, Taiwan; Department of Geriatric Medicine, National Yang Ming University School of Medicine, New Taipei City, Taiwan
| | - Wei-Ju Lee
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan, Taiwan; Aging and Health Research Center, National Yang Ming University, New Taipei City, Taiwan; Department of Geriatric Medicine, National Yang Ming University School of Medicine, New Taipei City, Taiwan
| | - Hui-Ping Lin
- Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Ren-Chou Chen
- Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Chi-Hung Lin
- Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Aging and Health Research Center, National Yang Ming University, New Taipei City, Taiwan; Department of Geriatric Medicine, National Yang Ming University School of Medicine, New Taipei City, Taiwan.
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Aging and Health Research Center, National Yang Ming University, New Taipei City, Taiwan; Department of Geriatric Medicine, National Yang Ming University School of Medicine, New Taipei City, Taiwan
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